Ua lohe anei ʻoe i kēia maʻi ʻaʻai koko koʻikoʻi? (Acute Promyelocytic Leukemia - APL) E kamaʻilio kākou me nā kikoʻī!

Ua manaʻo paha ʻoe i ka luhi loa i ka manawa koke, loaʻa iā ʻoe kekahi mau palapū, a i ʻole he mau ʻāʻī kahe pinepine? ʻOiai ʻaʻole mākou e nānā nui i kēia mau mea, i nā hihia kakaikahi, hiki iā lākou ke lilo i mau hōʻailona o kahi maʻi koʻikoʻi, e like me ka Acute Promyelocytic Leukemia (APL) . No laila, mai hopohopo, i kēia lā e kamaʻilio mākou e pili ana i kēia maʻi koko i kapa ʻia ʻo APL ma ke ʻano maopopo a maʻalahi.

He aha ka maʻi leukemia promyelocytic acute (APL)?

I ka ʻōlelo maʻalahi, he ʻano maʻi koko kakaʻikahi loa ka APL . No kahi hui nui o nā leukemias i kapa ʻia ʻo Acute Myeloid Leukemia . ʻO kahi nui e hana ʻia ai ke koko i loko o ko mākou kino, ʻo ia ka iwi iwi . Maanei i loko o kēia iwi iwi, ma muli o kahi loli genetic, ʻo ia hoʻi, kahi mutation genetic , hoʻomaka nā hunaola koko keʻokeʻo ʻē aʻe e hana. Māhelehele a hoʻonui koke kēia mau hunaola ʻē me ka ʻole o ke kaohi a laha ma loko o ka iwi iwi. I kekahi manawa kapa nā kauka i kēia he APL leukemia, a i ʻole M3-leukemia .

He maʻi koʻikoʻi ka APL. Hiki ke hōʻike koke ʻia kona mau hōʻailona a lilo i mea ʻino koke. ʻO ke kahe koko nui kahi kumu pilikia nui. Akā aia ka nūhou maikaʻi! Me nā lāʻau lapaʻau hou, me ka chemotherapy a me nā lāʻau lapaʻau hou ʻaʻole chemotherapy, hiki i nā kauka ke kāohi i ka APL a hoʻōla pinepine iā ia.

Pehea ka maʻamau o kēia maʻi?

He maʻi laha ʻole ka APL. No ka laʻana, ma kahi ʻāina e like me ʻAmelika Hui Pū ʻIa, aia wale nō ma kahi o 30,000 mau kānaka i ʻike ʻia me kēia maʻi i kēlā me kēia makahiki. ʻO ka hapa pinepine, ʻike ʻia ka APL i nā poʻe ma ko lākou mau makahiki 30 .

He aha nā hōʻailona o ka APL?

Loaʻa nā hōʻailona APL i ka wā ʻaʻole hiki i kou iwi iwi ke hana i nā hunaola koko ʻulaʻula olakino, nā hunaola koko keʻokeʻo, a me nā platelets e like me ka maʻamau. ʻO kēia emi ʻana o kēia mau ʻano hunaola koko āpau i kapa ʻia ʻo pancytopenia . Ke hana ʻia kēia, hiki iā ʻoe ke loaʻa nā hōʻailona koʻikoʻi e like me ka anemia , nā pilikia kahe koko ma muli o ke kāpili ʻana o ke koko, a me nā maʻi pinepine.

ʻO nā hōʻailona APL maʻamau ʻē aʻe:

• Manaʻo nui i ka luhi a me ka luhi ʻole ma muli o ka emi ʻana o nā hunaola koko ʻulaʻula (ʻo ia hoʻi ka anemia).
• Nā maʻi pinepine ma muli o ka haʻahaʻa o nā hunaola koko keʻokeʻo e hakakā nei i nā maʻi. Hiki ke loaʻa pinepine nā mea e like me ke kuni a me ke anu.
• No ka mea, ua wikiwiki ka metabolism o kou kino a ua puhi koke ʻia ka ikehu mai ka meaʻai,Ka pohō kaumaha i manaʻo ʻole ʻia.

Nā hōʻailona koko

ʻO ke kanaka me APL he haʻahaʻa ka nui o nā platelets a me nā mea hoʻopaʻa koko e kōkua ana i ke kāpili koko . ʻIke ʻoe, ʻo nā platelets ka mea e kōkua ai i ka hoʻōki a i ʻole ka hōʻemi ʻana i ke kahe ʻana o ke koko. No laila, ke haʻahaʻa kēia mau mea, hoʻomaka ka pilikia.

Eia kekahi mau hōʻailona o ke kahe koko i hoʻokumu ʻia e APL:

• Hiki ke kahe ke koko ma nā wahi a pau o ke kino. Eia kekahi laʻana, ke kahe ʻana o nā ʻāʻī , ke kahe pinepine ʻana o ka ihu , a, i nā wahine, ke kahe nui ʻana o ke koko i ka wā o ka menstruation .
• Hōʻiliʻili ke koko ma lalo o ka ʻili a hoʻoulu i ka palapū ma nā wahi like ʻole o ke kino . ʻOiai kahi ʻoki liʻiliʻi hiki ke hana i kahi palapū nui.
• I kekahi manawa hiki ke kahe ke koko i loko o ka lolo (intracranial hemorrhage) . Inā hana ʻia kēia, hiki iā ʻoe ke paʻakikī i ka hoʻoneʻe ʻana i kou mau lālā, loaʻa iā ʻoe nā poʻo ʻeha nui, a loaʻa paha iā ʻoe nā loli i kou ʻike. He pilikia kēia!
• Inā ʻeleʻele kou noho a he mau kaha koko paha, ma muli paha ia o ke kahe ʻana o ke koko i loko o ka ʻōnaehana hoʻoheheʻe (ke kahe ʻana o ka ʻōpū) .

He aha ke kumu o ka APL?

Hoʻokumu ʻia kēia maʻi e nā genes ʻelua e kāohi ana i ka hana ʻana o kā mākou mau hunaola koko e hui pū ana e hana i kahi gene ʻano ʻē i kapa ʻia ʻo PML-RARa . ʻO ka mea nui, ʻaʻole kēia hoʻololi genetic kahi mea āu e hoʻoilina ai mai kou mau mākua mai . Hana wale ʻia ia, ʻo ia hoʻi me ke kumu ʻole, i kou wā e ola ana. ʻAʻole maopopo i nā loea ke kumu o kēia loli genetic.

ʻO kēia hoʻololi ʻana ke kumu o ka ulu ʻana o nā hunaola koko keʻokeʻo ma waho o ke kaohi, ma kahi o ka ulu pono ʻana, a ma kahi o ia mea, hana i nā hunaola koko keʻokeʻo ʻōpiopio (promyelocytes) . Hoʻopiha kēia mau hunaola ʻōpiopio i ka iwi ʻiʻo, e hoʻopiha ana i ka hakahaka no nā hunaola koko olakino a me nā platelets.

He aha nā pilikia o ka APL?

He maʻi hoʻoweliweli ola ka APL. ʻO kēia no ka mea hiki i ke kahe nui ʻana ke lilo koke i mea weliweli. Inā ʻaʻole hiki iā ʻoe ke hoʻōki i ke kahe ʻana mai kahi ʻoki liʻiliʻi, inā he nui ke koko i loko o kou ʻōpala a i ʻole ka mimi ke hele ʻoe i ka lua, a inā ʻaʻole hiki iā ʻoe ke hoʻōki i ke kahe ʻana mai kou ʻāʻī, pono ʻoe e ʻike koke i ke kauka a i ʻole e hele i ka lumi pilikia o ka haukapila .

E hoʻomanaʻo: Inā he kahe koko kou hiki ʻole ke kāohi ʻia, mai hoʻowahāwahā iā ia. He mea nui ka mālama koke ʻana.

Pehea e ʻike ʻia ai ka APL?

Hana pinepine nā kauka i kekahi mau hoʻokolohua e ʻike ai i kēia maʻi.

• Helu Koko Piha (CBC): Hoʻokumu ʻo APL i nā hunaola koko keʻokeʻo ʻē. Hiki i kahi hoʻāʻo CBC ke nānā i nā ʻano hunaola koko like ʻole a me ka helu o nā platelets i loko o kahi hāpana o kou koko.
• ʻO ka Smear Koko Peripheral:Ma kēia, lawe ʻia kahi hāpana koko a nānā ʻia ma lalo o kahi microscope. A laila, nānā lākou inā he nui nā granules liʻiliʻi i loko o kēlā mau hunaola koko keʻokeʻo ʻōpiopio (promyelocytes), a i ʻole inā he mau mea kūikawā i kapa ʻia ʻo Auer rods . He ʻano kēia o APL.
• Biopsy o ka iwi iwi: Ma kēia hoʻokolohua, lawe ʻia kahi ʻāpana liʻiliʻi o kou iwi iwi a nānā ʻia kona mau ʻāpana.
• Flow Cytometry: Ma kēia hoʻāʻo, ʻimi nā pathologists i nā ʻano o nā protein kikoʻī ma ka ʻili o nā cell ʻē. Hiki i kēia mau ʻano ke hōʻoia i ka APL.
• Hoʻāʻo Polymerase Chain Reaction (PCR): Hiki i kēia hoʻāʻo ke ʻike pololei i ke alo o ka gene ʻano ʻē (PML-RARa) e hoʻoulu ai i ka APL.
• Cytogenetics: Hoʻāʻo kēia no nā loli kikoʻī i nā chromosomes o nā cell ʻano ʻē. ʻO ka loaʻa ʻana o kēia mau loli ke ala nui e hōʻoia ai i ka hōʻoia o APL.

Hoʻokaʻawale nā ​​kauka i ka APL ma ke ʻano he haʻahaʻa a kiʻekiʻe paha ma muli o kāu helu o nā keʻena koko keʻokeʻo. ʻOi aku ka nui o ka poʻe me ka APL kiʻekiʻe i ka loaʻa hou ʻana o ke kanesa a i ʻole ka hoʻi hou ʻana .

Pehea e mālama ʻia ai ka APL?

Hoʻōla ʻia ʻo APL me ka hui pū ʻana o nā mea hoʻokaʻawale cell , chemotherapy, a me ka lāʻau lapaʻau i kuhikuhi ʻia . ʻOiaʻiʻo, mai ka wā i ʻike ʻia ai kēia mau lāʻau lapaʻau i nā makahiki 1980, ua lilo kēia maʻi, ka mea i manaʻo mua ʻia he make, i kēia manawa i maʻi hiki ke ho'ōla ʻia. He hoʻokō nui kēia!

ʻO nā lāʻau hoʻokaʻawale cell he mau lāʻau non-chemotherapy e kōkua ana i nā hunaola keʻokeʻo ʻōpiopio ʻole e hoʻokaʻawale i nā hunaola keʻokeʻo maʻamau a makua. ʻO kēia mau lāʻau non-chemotherapy, i helu ʻia ma lalo nei, ua hopena i ka ʻoi aku ma mua o 95% o nā helu kala a me nā helu ho'ōla.

• ʻO ka waikawa All-trans-retinoic (ATRA) , a i ʻole tretinoin (Vesanoid ®) – He ʻano kēia o ka wikamina A.
• ʻO ka arsenic trioxide (ATO) - He ʻano kēia o ka arsenic.

Inā kānalua kāu kauka he APL kou, e hoʻomaka paha lākou iā ʻoe ma ATRA ma mua o ka hōʻoia ʻana o nā hoʻokolohua ʻē aʻe i ka maʻi. ʻO kēia no ka mea hiki i ka hoʻomaka mua ʻana o ka mālama ʻana ke hōʻemi i ka pilikia o ke kahe koko e hoʻoweliweli i ke ola.

Nā pae o ka mālama ʻana iā APL

Hana ʻia ka lāʻau lapaʻau ma ʻekolu mau pae: Induction, Consolidation, a me Maintenance. Hiki ke ʻokoʻa ka lāʻau lapaʻau ma muli o ka pae o ka pilikia.

• Kahua mua (Induction):ʻO ka pahuhopu nui o kēia pae, ʻo ia ka pepehi ʻana i nā cell leukemia lawa e hoʻihoʻi i kou APL i ke kala ʻana . ʻO ke kala ʻana, ʻaʻohe ou hōʻailona a ʻaʻohe hōʻailona o ka leukemia e ʻike ʻia ma nā hoʻokolohua. Hana ʻia kēia ma ka hoʻohana ʻana i nā lāʻau lapaʻau ʻaʻole chemotherapy, chemotherapy, a me nā lāʻau lapaʻau i kuhikuhi ʻia. I loko o kēia manawa, pono ʻoe e noho ma ka haukapila, maʻamau no ʻehā a ʻeono pule.
• Kaʻina Hoʻohui: Hiki i kāu kauka maʻi ʻōpū ke kapa i kēia ʻo 'post-remission therapy'. Mālama kēia lāʻau i ka APL i ka hoʻomaha ʻana a hoʻomau i ka pepehi ʻana i nā cell leukemia i koe. ʻO kēia ka lāʻau lapaʻau like i hoʻohana ʻia i ka wā mua. Hiki i kēia lāʻau lapaʻau ke mau no kahi o ʻewalu mahina, me nā lāʻau lapaʻau i kēlā me kēia ʻelua mahina. Loaʻa paha iā ʻoe ʻehā pule o ka lāʻau lapaʻau i ukali ʻia e ʻehā pule hoʻomaha. Hiki ke hāʻawi ʻia kēia lāʻau lapaʻau ma ke ʻano he pila a i ʻole he lāʻau intravenous (IV) .
• Kaʻina mālama: He lāʻau lapaʻau hoʻomau kēia, akā hāʻawi ʻia ka lāʻau lapaʻau ma kahi liʻiliʻi ma mua o nā pae mua a me nā pae hoʻopaʻa. Hāʻawi pinepine ʻia kēia lāʻau mālama no kahi o hoʻokahi makahiki.

Hiki i kāu kauka maʻi kanesa ke lawelawe i ka lāʻau lapaʻau kākoʻo , e like me ke kahe koko, me kēia lāʻau lapaʻau.

Nā pilikia o ka mālama ʻana

ʻO ka pilikia maʻamau, a koʻikoʻi iki hoʻi, ua kapa ʻia ʻo ka differentiation syndrome . He hui kēia o nā hopena koʻikoʻi i nā lāʻau APL. ʻIke pinepine ʻia kēia mau hopena i loko o nā pule ʻekolu mua o ka hoʻomaka ʻana o ka lāʻau. Hiki i nā hōʻailona ke akahai a koʻikoʻi paha. ʻO kekahi o lākou:

• Kuke.
• Ka wai keu a puni kou puʻuwai a me kou māmā (pleural effusion) .
• Ka hāʻule ʻana o ka puʻupaʻa .
• Ke koko haʻahaʻa (hypotension) .
• Ua emi ka nui o ka oxygen i loko o ke koko (hypoxemia) .
• Ka paʻakikī o ka hanu ʻana (dyspnea) .
• Ka pehu ʻana/ ka mumū o kou mau lima, nā wāwae, a me ka ʻāʻī.
• Ke kuni e hiki mai ana me ke kumu ʻole.
• Piʻi kaumaha me ke kumu ʻole.

Inā loaʻa iā ʻoe kēia maʻi hoʻokaʻawale, hiki i kāu kauka ke hoʻōki i kāu lāʻau lapaʻau no kekahi manawa. Hiki iā lākou ke hoʻohana i nā lāʻau lapaʻau ʻē aʻe, e like me ka hydroxyurea, e hoʻohaʻahaʻa i kāu helu koko keʻokeʻo.

He aha ka mea hiki i kekahi me APL ke manaʻo?

Ma keʻano laulā, maikaʻi ka wānana o ka maʻi.ʻOiai he ʻokoʻa ke kūlana o kēlā me kēia kanaka, ua hōʻike nā haʻawina ma waena o 90% a me 95% o ka poʻe me APL e hoʻomaha. Eia nō naʻe, hiki i ka APL ke hoʻi hou ma hope o ka mālama ʻana. Ma waena o 5% a me 10% o ka poʻe e loaʻa hou ka maʻi, ʻo ia hoʻi i loko o nā makahiki ʻekolu mua ma hope o ka mālama ʻana. A laila pono lākou i kahi lāʻau hou a ʻokoʻa paha.

Nā helu ola

Ma muli o ka maʻi laha ʻole o ka APL, ʻo ka mea a mākou i ʻike ai e pili ana i nā helu ola e loaʻa mai ana mai nā hoʻokolohua lapaʻau e pili ana i nā poʻe maʻi APL haʻahaʻa a kiʻekiʻe.

Ua hōʻike ʻia kekahi loiloi he 99% o nā poʻe maʻi APL haʻahaʻa e ola ana i ʻehā mau makahiki ma hope o ka mālama ʻana. Ua hōʻike ʻia kekahi loiloi o nā poʻe maʻi APL kiʻekiʻe he 86% e ola ana i ʻelima mau makahiki ma hope o ka mālama ʻana. He mau hopena maikaʻi loa kēia!

Pehea wau e mālama ai iaʻu iho?

Ma muli o ka hiki ke hoʻi hou mai o ka APL, he mea nui loa ia e ʻike ʻoe i kāu kauka i ka manawa kūpono (nā manawa hoʻopaʻa) .

E loaʻa iā ʻoe kahi nānā olakino i kēlā me kēia mahina a ʻelua paha no ka makahiki mua ma hope o ka mālama ʻana. Ma hope o ka makahiki mua, pono ʻoe e ʻike i kāu kauka ma kahi o kēlā me kēia ʻekolu a ʻehā mahina no nā makahiki ʻelua e hiki mai ana. Hiki ke hana ʻia nā hoʻokolohua e like me ka CBC, PCR, a me ka biopsy iwi ma kēia mau kipa.

Āhea wau e hele ai i ka lumi pilikia?

Hiki ke hoʻi hou mai ka APL ma hope o ka mālama ʻana, a hiki ke ʻoi aku ka ʻino o nā hōʻailona. Inā ʻoe e hoʻomaha ana mai ka APL, e hele koke i ka lumi pilikia inā loaʻa iā ʻoe kekahi o kēia mau mea:

• Inā ʻoe e kahe koko ana me ka hiki ʻole ke kāohi .
• Inā hoʻomaka koke ʻoe e pehu me ka ʻeha ma kou mau wāwae a i ʻole ka ʻōpū lalo .

ʻO ka mea hope loa, he leka koʻikoʻi

ʻO ka leukemia promyelocytic acute (APL) kahi maʻi koko laha ʻole i manaʻo ʻia he maʻi make, akā ua lilo ia i maʻi hiki ke ho'ōla ʻia mahalo i nā lāʻau lapaʻau holomua.

Eia nō naʻe, he maʻi koʻikoʻi nō kēia. Inā ʻaʻole i ʻike koke ʻia a mālama ʻia, hiki ke hoʻoweliweli i ke ola . No laila, inā loaʻa iā ʻoe nā hōʻailona e like me ke kahe koko hiki ʻole ke kāohi ʻia, mai hoʻowahāwahā iā ia. ʻO ka mea nui loa, ʻo ia ke ʻimi i ke aʻo lapaʻau a loaʻa kahi hōʻailona i ka wā hikiwawe. Mai makaʻu, e wiwo ʻole, no ka mea, i kēia manawa aia nā lāʻau lapaʻau maikaʻi no kēia!

Leukemia , APL, Kanesa Koko, Kanesa Koko, Iwi ʻŌpū, Anemia, ATRA, Chemotherapy, Leukemia Promyelocytic ʻĀkiu, M3-Leukemia, PML-RARa, Ke kahe koko