Pehea kou manaʻo inā loaʻa iā ʻoe kahi lāʻau lapaʻau nui e like me ke kāpili ʻana o ka iwi iwi no ke kanesa koko a manaʻo ʻoe, "Ua maikaʻi nā mea a pau i kēia manawa," a laila lohe ʻoe ua hoʻi mai ke kanesa? He mea kaumaha maoli nō ia a he mea kaumaha loa. Akā, mai hoʻokuʻu i ka manaʻolana. I kēia lā, ke kamaʻilio nei mākou e pili ana i kahi lāʻau lapaʻau kūikawā e hiki ke kōkua i nā kūlana e like me kēia. Ua kapa ʻia ʻo DLI, ʻo ia hoʻi ke kū nei no Donor Lymphocyte Infusion.
I ka ʻōlelo maʻalahi, he aha ka DLI?
ʻAe, e wehewehe maʻalahi kākou i kēia. ʻO nā lymphocytes kekahi ʻano o nā hunaola koko keʻokeʻo i loko o kou koko. Ua like lākou me nā koa i loko o ko kākou kino. He ʻāpana nui lākou o kā kākou ʻōnaehana pale kino, e hakakā ana i nā huakini haole, nā maʻi, a me nā hunaola kanesa.
I kēia manawa, ʻo DLI (Donor Lymphocyte Infusion) kahi hana kahi e lawe ʻia ai kekahi o kēia mau lymphocytes mai ka mea hāʻawi olakino like i hāʻawi mua i kou iwi iwi (nā cell stem) a hoʻokomo ʻia i loko o kou kino. ʻImi kēia mau 'koa' hou, olakino a ikaika a luku i nā cell kanesa i koe e peʻe ana i loko o kou kino. ʻO ia ka pahuhopu nui o kēia lāʻau lapaʻau.
I nā hihia hea e ʻōlelo ʻia ai ka mālama ʻana iā DLI?
ʻOi aku ka nui o kāu kauka e haʻi aku iā ʻoe e pili ana i kēia lāʻau lapaʻau inā hoʻi mai kou maʻi ʻaʻai koko (relapses) ma hope o ka hoʻoili ʻana o ka iwi iwi.
Eia kekahi o nā kūlana i hoʻohana pinepine ʻia ai ka lāʻau DLI:
- ʻO ka maʻi leukemia myeloid koʻikoʻi (AML)
- ʻO ka maʻi leukemia lymphocytic mau loa (CLL)
- ʻO ka maʻi leukemia myeloid mau loa (CML)
- ʻO ka Myeloma lehulehu
- ʻO ka Myelodysplasia (MDS)
- ʻO ka Lymphoma Non-Hodgkin
ʻO kekahi mea ʻē aʻe, i kekahi manawa ma hope o ka hoʻoili ʻana o ka iwi iwi, loaʻa paha i kou kino kahi hui o nā pūnaewele hāʻawi a me kāu mau pūnaewele kahiko ponoʻī. Kāhea mākou i kēia (mixed chimerism) . Hoʻonui pū kēia i ka pilikia o ka hoʻi hou ʻana mai o ke kanesa. No laila, hiki ke hana ʻia ʻo DLI e hoʻohuli i nā pūnaewele āpau i loko o kou kino i mau pūnaewele mai ka mea hāʻawi.
Pehea ʻoe e hoʻomākaukau ai no kēia lāʻau lapaʻau?
Ma mua o ka hoʻomaka ʻana i ka mālama ʻana iā DLI, e nānā pono kāu kauka iā ʻoe, e kūkākūkā i kāu mau hōʻailona, a kauoha i kekahi mau hoʻokolohua.
- Biopsy iwi ʻiwi: Lawe ʻia kahi hāpana liʻiliʻi o ka iwi ʻiwi e nānā i nā hunaola kanesa i koe.
- Helu Koko Piha (CBC):Ke nānā ʻia nei ka helu o nā hunaola i loko o ke koko.
- Nā hoʻokolohua hana puʻupaʻa a me ke akepaʻa.
Inā hōʻike ka biopsy ua kiʻekiʻe loa ka pae o nā hunaola kanesa, hiki i kāu kauka ke hoʻoholo e hāʻawi iā ʻoe i ka chemotherapy ma mua o DLI. ʻO kēia ke hōʻemi i ka helu o nā hunaola kanesa a hoʻonui i ka holomua o ka mālama ʻana iā DLI.
Pehea e loaʻa ai nā pūnaewele lymphocyte mai kahi mea hāʻawi?
He mea kūikawā loa kēia e hana ʻia ana. ʻO ka mea hāʻawi i hāʻawi iā ʻoe i ke ola, ʻo ia hoʻi, ka mea hāʻawi i hāʻawi iā ʻoe i ka iwi iwi, kōkua pū kekahi me kēia. Hoʻokomo ʻia kahi ʻōmole liʻiliʻi (catheter) i loko o kahi aʻa koko ma kona lima a lawe ʻia kekahi koko. Hele kēia koko ma o kahi mīkini kūikawā. ʻO ka hana a kēlā mīkini, ʻo ia ka hoʻokaʻawale ʻana i nā pūnaewele lymphocyte a mākou e pono ai, a hoʻouna i ke koena o ke koko i ke kino ma o kahi aʻa koko ma kekahi lima o ka mea hāʻawi. Ua kapa ʻia kēia kaʻina hana he apheresis . I kekahi manawa, ke hāʻawi mua ʻoe i ka iwi iwi, hiki ke lawe ʻia kekahi o kēia mau pūnaewele lymphocyte a hoʻopaʻahau ʻia no ka hoʻohana ʻana ma hope.
Pehea ʻoe e loaʻa ai i ka lāʻau DLI?
Ua like kēia me kahi mea maʻalahi e like me ka hāʻawi ʻana iā ʻoe i kahi hopena saline.
1. E hoʻokomo ke kauka a kahu maʻi paha i kahi ʻōmole liʻiliʻi (catheter) i loko o kahi aa koko ma kou lima a i ʻole kou umauma.
2. A laila, ua hoʻopili ʻia ka ʻeke e loaʻa ana nā pūnaewele lymphocyte i hoʻokaʻawale ʻia mai ka mea hāʻawi i kēlā ʻōmole a hoʻokomo ʻia i loko o kou koko.
3. Ma kahi o 30 mau minuke ka lōʻihi o kēia hana.
4. Ke pau ka hana, wehe ʻia ka ʻōmole.
I kekahi manawa hiki iā ʻoe ke hāʻawi i kekahi mau lāʻau e like me kēia ma luna o kekahi mau pule a i ʻole mau mahina.
Ke hoʻokomo ʻia nā ʻāpana hou i loko o ke kino ma kēia ʻano, ʻo kekahi o nā mea nui loa i kapa ʻia ʻo ka hopena graft vs. tumor (GvT) . ʻO ke ʻano kēia, ʻimi kēia mau ʻāpana olakino (graft) mai ka mea hāʻawi i nā ʻāpana kanesa i koe (tumor) i loko o kou kino, hoʻouka iā lākou, a luku iā lākou. Penei ka nalo loa ʻana o ke kanesa.
He aha nā pono a me nā pilikia o ka mālama ʻana iā DLI?
ʻO nā pono nui o kēia
I ka wā ma mua, inā hoʻi mai ke kanesa ma hope o ka hoʻoili iwi iwi, ʻo ke koho wale nō ka loaʻa ʻana o kahi hoʻoili iwi iwi ʻē aʻe. Akā, ʻoi aku ka nui o ka pilikia o nā pilikia me ka lua o ka hoʻoili ʻana. He ala maikaʻi a haʻahaʻa ka DLI e hoʻihoʻi i ke kanesa i ka hoʻomaha ʻana me ka ʻole o nā immunosuppressants.
Nā pilikia a me nā pilikia hiki ke loaʻa
E like me nā lāʻau lapaʻau āpau, aia kekahi mau pilikia. E nānā pono kāu hui lapaʻau iā ʻoe no kēia mau mea.
| Ka pilikia | Ka wehewehe a me nā hōʻailona |
|---|---|
| ʻO ka maʻi Graft vs. Host (GvHD) | ʻO kēia ka manawa e ʻike ai nā pūnaewele mai ka mea hāʻawi (graft) i kou mau pūnaewele kino olakino (host) ma ke ʻano he ʻenemi a hoʻouka iā lākou. Nā hōʻailona: ka maʻi pākī, ka melemele o ka ʻili (jaundice), ka nausea a me ka luaʻi ʻana, nā ʻeha ʻili a i ʻole ka ʻulaʻula. |
| Ka hoʻopau ʻana o ka myelo | He emi iki kēia o ka hana o ka iwi iwi no kekahi manawa, hiki ke alakaʻi i ka emi ʻana o ka helu o nā hunaola koko. - Nā hunaola koko ʻulaʻula haʻahaʻa (Anemia): luhi, pōkole o ka hanu. - Ua emi nā hunaola koko keʻokeʻo (Leukopenia): Hoʻonui ʻia ka pilikia o nā maʻi. - Nā platelet haʻahaʻa: Hoʻonui ʻia ka pilikia o ke kahe ʻana o ke koko. |
He aha e hana ai inā loaʻa nā pilikia?
Mai hopohopo. Aia nā lāʻau lapaʻau no kēia mau mea a pau.
- Inā loaʻa ʻo GvHD: E kuhikuhi kāu kauka i nā immunosuppressants .
- Inā haʻahaʻa kou mau hunaola koko: Nalowale pinepine nā hunaola koko keʻokeʻo haʻahaʻa iā lākou iho. Inā ʻaʻole, aia nā lāʻau lapaʻau e mālama ai iā lākou. Hiki ke hāʻawi ʻia nā hoʻoili koko inā pono e mālama i nā hunaola koko ʻulaʻula a me nā platelets haʻahaʻa.
Ma hope o ka mālama ʻana a e pili ana i ka holomua
E kamaʻilio me kāu kauka e pili ana i ka lōʻihi o ka manawa e hoʻi ai i ka maʻamau ma hope o ka lāʻau lapaʻau. Pono ʻoe i ka nānā mau ʻana a me nā hoʻāʻo koko.
Hiki ke ʻokoʻa ka holomua o kēia lāʻau lapaʻau mai kēlā kanaka a kēia kanaka. Aia kekahi mau kumu e hoʻopilikia ai:
- Ke kahua o ke kanesa.
- Ke olakino o kou ʻōnaehana pale maʻi.
- Ke ʻano o ka hoʻoili ʻana i hana ʻia ma mua.
- Inā paha ua hana ʻia ka chemotherapy ma mua o DLI.
ʻO ka mea nui loa: Inā loaʻa iā ʻoe kekahi mau hōʻailona o GvHD e like me ke kuni, ke kahe koko ʻē, ka paʻakikī o ka hanu ʻana, ka maʻi kahe, ka ʻulaʻula o ka ʻili, a i ʻole kekahi mau hōʻailona ʻē aʻe , e hoʻomaopopo koke i kāu kauka a i ʻole ka haukapila e mālama nei.
He immunotherapy anei ʻo DLI?
ʻAe, ʻo DLI ka immunotherapy.He ʻano lāʻau lapaʻau ia. No ka mea, ʻo ka mea āu e hana nei, ʻo ia ka hāʻawi ʻana i kāu ʻōnaehana pale ponoʻī i nā T-cell olakino mai waho e kōkua iā ia e hakakā i ka maʻi kanesa. He mea hoʻohiki maoli kēlā.
Leka Lawe-Home
- He lāʻau lapaʻau kūikawā ʻo DLI no nā maʻi ʻaʻai koko e hoʻi hou mai ma hope o ka hoʻoili ʻana o ka iwi iwi.
- Hoʻohana kēia i nā pūnaewele i kapa ʻia he lymphocytes mai ka mea hāʻawi olakino like i hāʻawi i kou iwi iwi ma kahi mua.
- ʻO ka pahuhopu o kēia, ʻo ia ka ʻimi ʻana o kēia mau pūnaewele hou a luku aku i nā pūnaewele kanesa i koe i loko o ke kino (hopena GvT).
- ʻO nā pilikia nui ka GvHD (Graft vs. Host Disease) a me ka helu haʻahaʻa o nā cell koko, akā hiki ke mālama ʻia kēia mau mea.
- He ʻano immunotherapy kēia e hāʻawi ana i ka manaʻolana me ka ʻole o nā pilikia kiʻekiʻe o ka hoʻoili ʻana i ka iwi ʻelua.
- E kamaʻilio koke me kāu kauka e pili ana i nā hōʻailona hou a i ʻole nā pilikia.
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