Pono anei mākou e makaʻala i ka PTLD (Post-Transplant Lymphoproliferative Disorders) ma hope o kahi hoʻoili kino?

Ua hana paha ʻoe a i ʻole kekahi āu i ʻike ai i kahi ʻoki kino nui e hoʻōla ai i ke ola, e like me ka hoʻoili ʻana o ke kino. A i ʻole ka hoʻoili ʻana o ke kelepona kumu. Ma hope o kēia mau mea, aia nā pilikia kakaikahi a i ʻole i manaʻo ʻole ʻia. ʻO kekahi o ia mau pilikia ʻo PTLD, a i ʻole Post-Transplant Lymphoproliferative Disorders. No ka mea hiki ke lilo i mea koʻikoʻi iki kēia, e kamaʻilio kākou e pili ana i ia mea ma ke ʻano maʻalahi e hiki ai iā ʻoe ke hoʻomaopopo.

He aha maoli ka PTLD?

I ka ʻōlelo maʻalahi, he pilikia hoʻoweliweli ola ka PTLD e hiki ke hana ma hope o kahi hoʻoili kino a i ʻole kahi hoʻoili cell kumu allogeneic. ʻO ka mea e hana ʻia ma ʻaneʻi, ʻo ia ke ʻano o ke koko keʻokeʻo i loko o ko mākou kino, i kapa ʻia ʻo lymphocytes, e māhele koke a hoʻonui me ka ʻole o ke kāohi.

ʻO kēia kūlana i kapa ʻia ʻo PTLD he ʻano lymphoma maoli nō ia. ʻO Lymphoma kahi ʻano maʻi kanesa e ulu ana i loko o kā mākou ʻōnaehana lymphatic. Hana ʻia kēia kūlana i ka wā e lilo ai nā hunaola koko keʻokeʻo i maʻi kanesa a ulu koke me ka ʻole o ka make.

Hoʻokumu pinepine ʻia ka PTLD e ka Epstein-Barr Virus (EBV) . He maʻi kēia i loaʻa iā kākou āpau i loko o ko kākou kino. Nui nā ʻano PTLD like ʻole, a ʻokoʻa ke ʻano o kona hoʻopilikia ʻana i kekahi. ʻO ka nūhou maikaʻi, hiki i nā kauka ke mālama iā ia. Eia nō naʻe, i kekahi manawa hiki ke hoʻi hou mai ke ʻano.

He aha nā ʻano nui o PTLD?

Hoʻokaʻawale nā ​​kauka i ka PTLD i ʻehā mau ʻano nui e pili ana i ke ʻano o nā pūnaewele lymphoma ma lalo o kahi microscope:

• ʻEha Mua: Loaʻa i kēia poʻe nā hōʻailona like me nā mea i ʻike ʻia me ka maʻi Epstein-Barr (EBV).
• Polymorphic PTLD: Maanei, ua hui pū ʻia nā pūnaewele lymphoma me nā ʻano ʻē aʻe o nā keʻokeʻo koko keʻokeʻo, e like me nā lymphocytes maʻamau a me nā keʻena plasma.
• Monomorphic PTLD: ʻO kēia ke ʻano maʻamau o ka PTLD . Ua like nā pūnaewele lymphoma ma aneʻi me nā mea i loaʻa i nā ʻano lymphoma ʻē aʻe, e like me "Non-Hodgkin Lymphomas". No ka laʻana, "Diffuse Large B-cell Lymphoma" a i ʻole "Burkitt Lymphoma".
• ʻO ka Lymphoma Hodgkin Kuʻuna - ʻAno PTLD: ʻO kēia ke ʻano PTLD i maʻamau ʻole ʻia .

Pehea ka maʻamau o kēia kūlana i kapa ʻia ʻo PTLD?

E like me ka mea i ʻōlelo ʻia ma mua, he maʻi kakaikahi loa ka PTLD. ʻO ia hoʻi, ʻaʻole ia e hiki i nā kānaka a pau. Ma ke ʻano laulā, ma kahi o 2 o 100 mau kānaka i loaʻa i kahi hoʻoili cell kumu (`(2%)`) e loaʻa iā lākou ka PTLD. ʻOi aku ka nui o ka poʻe i loaʻa i kahi hoʻoili kino e loaʻa iā lākou ka PTLD. Akā, ʻokoʻa nō hoʻi kēlā ma muli o ka mea i hoʻoili ʻia ai ke kino.

E noʻonoʻo i kēia ʻano, ʻoiai ma kahi o ʻekolu o 100 mau kānaka i loaʻa i kahi hoʻoili puʻupaʻa (`(3%)`) e loaʻa i kēia maʻi, ʻōlelo nā loea ma kahi o ʻumi o 100 mau kānaka i loaʻa i kahi hoʻoili māmā (`(10%)`) e loaʻa paha i kēia maʻi. No laila, ʻaʻohe mea e hopohopo ai, ʻaʻole kēia he mea e hana ʻia i ka hapa nui o nā kānaka.

He aha nā hōʻailona hiki ke loaʻa o ka PTLD?

ʻAʻole paha e loaʻa i kekahi poʻe kekahi mau hōʻailona i ka wā mua. Hiki ke ʻike ʻia nā hōʻailona PTLD i kēlā me kēia manawa, mai kekahi mau mahina a i kekahi mau makahiki ma hope o ke kāpili ʻana. Inā ʻike ʻia nā hōʻailona, ​​​​hiki iā lākou ke komo pū me:

• Manaʻo luhi loa (`Fatigue`) : He manaʻo ola ʻole wale nō.
• Kuni me ke kumu ʻole .
• ʻAʻohe ʻono o ka meaʻai .
• Ka pohō kaumaha i manaʻo ʻole ʻia .
• Ka hou nui ʻana i ka pō ('Night sweats`) .
• Nā kīʻaha lymph pehu : Manaʻo lākou e like me nā puʻu ma ka ʻāʻī a me nā ʻauwae.

No ke aha i hana ʻia ai kēia PTLD? He aha nā kumu?

He ʻano paʻakikī kēia e hoʻomaopopo ai. Hana ʻia ka PTLD no ka mea ua hoʻohana kahi maʻi maʻamau i ka nāwaliwali o kā mākou ʻōnaehana pale .

E noʻonoʻo ʻoe e hoʻomākaukau ana no kahi hoʻoili ʻana o nā cell stem. Ma mua o kēlā, e hāʻawi ʻia ʻoe i ka chemotherapy e pepehi i nā cell cancer i loko o kou iwi iwi. Ua kapa ʻia kēia he conditioning. Hoʻonāwaliwali kēia i ka hiki o kāu ʻōnaehana pale e pale iā ʻoe mai ka maʻi. ʻO ke kikoʻī, hoʻemi ka conditioning i ka hana o nā cell T (nā cell T) i loaʻa i ka maʻi EBV a lilo hou i mea hana ʻole.

A laila, ma hope o ka hoʻoili ʻia ʻana o nā hunaola kumu a i ʻole ke kino, hāʻawi ʻia kou kino i ka lāʻau immunosuppressant e pale aku iā ia mai ka hōʻole ʻana i ka mea hou. ʻOiai ke pale nei kēia mau lāʻau i ke kino a i ʻole nā ​​hunaola hou, hoʻonāwaliwali pū lākou i nā pale o ko mākou kino, e hoʻolilo ana iā ia i mea maʻalahi i nā mea komo hewa mai nā ʻāina ʻē e like me nā maʻi.

Ma ka PTLD, ʻo ka mea hoʻolaha nui o ka maʻi viral ʻo ia ka maʻi Epstein-Barr (EBV) . Ua pili ʻia ʻo EBV me ka PTLD e ulu ana i loko o hoʻokahi a ʻelua paha makahiki o kahi hoʻoili ʻana o ke kino a i ʻole ke kumu o ka hoʻoili ʻana. Eia nō naʻe, ʻaʻole ʻike ʻia ke kumu kikoʻī o ka PTLD e ulu ana i nā makahiki ma hope o ke hoʻoili ʻana. Ke noiʻi nei hoʻi nā loea inā paha he kuleana ko nā maʻi e like me ka cytomegalovirus (CMV) a i ʻole adenovirus (Adenovirus).

Wahi a nā loea, ua loaʻa i kahi 90% o ko kākou heluna kanaka ka maʻi EBV i kekahi manawa i ko lākou wā kamaliʻi a ʻōpio paha. Loaʻa paha iā ʻoe ka maʻi me ka ʻole o nā hōʻailona, ​​a ʻaʻole paha ʻoe e ʻike. Hoʻopilikia ka maʻi EBV i kā mākou mau cell B a noho "hiamoe" i loko o ke kino, ʻo ia hoʻi, ma ke ʻano "Latent", me ka ʻole o ka pilikia. (Ua loaʻa paha iā ʻoe ka maʻi mai kahi mea hāʻawi.)

Ma muli o kou lawe ʻana i kēlā mau lāʻau immunosuppressive, ʻaʻole hiki i kāu ʻōnaehana pale ke mālama i kēlā EBV hiamoe ma lalo o ka mana. A laila, hoʻomaka nā pūnaewele B i loaʻa i ka maʻi EBV e māhele a hoʻonui koke. ʻO ia ka mea e alakaʻi ai i ka PTLD.

ʻO wai ka mea i ʻoi aku ka nui o ka pilikia o ka hoʻomohala ʻana i ka PTLD?

Hiki ke hoʻonui ʻia kou pilikia o ka hoʻomohala ʻana i ka PTLD no nā kumu aʻe:

• Loaʻa ka maʻi Epstein-Barr (EBV) i loko o kou kino a i ʻole i loko o ke kino o ka mea nāna i hāʻawi iā ʻoe i ke kino/nā cell (`(Donor)`).
• Ua loaʻa iā ʻoe ka lāʻau lapaʻau ('Pre-transplant conditioning') e hōʻemi ana i ka hana maʻamau o kāu mau cell T ma mua o ke kāpili ʻana.
• Ke lawe nei i ka lāʻau immunosuppressant e pale ai i kou kino mai ka hōʻole ʻana i ke kino a i ʻole nā ​​​​​​pūnaewele hou.
• Loaʻa nā ʻokoʻa i kekahi mau genes (`(Genes)`) e hoʻonui ai i ka pilikia o ka hoʻomohala ʻana i ka PTLD.

Pehea e ʻike ai nā kauka i kēia maʻi i kapa ʻia ʻo PTLD?

E hana mua nā kauka i kahi hoʻokolokolo kino a nānā pono i kāu mōʻaukala olakino. Eia kekahi, e hana pinepine lākou i kēia mau hoʻokolohua:

• Helu Koko Piha (`Helu Koko Piha - CBC`) .
• Papa Hana Metabolic Piha .
• Ka pae o ka lactate dehydrogenase (LDH) .
• ʻO ka urinalysis , me nā pae waikawa uric.
• He hoʻāʻo e ʻike ai i nā antibodies i hana ʻia i loko o ke kino e kūʻē i ka maʻi EBV .
• ʻO ke kiʻi CT ('Computed Tomography - CT scan') .
• ʻO ke kiʻi MRI (Magnetic Resonance Imaging - MRI) .
• ʻO ke kiʻi PET (ʻO ke kiʻi ʻana o ka Positron Emission Tomography - PET scan`) .
• ʻO ka biopsy iwi .

ʻO kēia mau hoʻokolohua ka mea e hiki ai i nā kauka ke hoʻoholo pono inā loaʻa ka PTLD a i ʻole, a inā pēlā, pehea kona ʻano.

He aha nā lāʻau lapaʻau no PTLD?

Hoʻomaka pinepine nā kauka ma ka hōʻemi ʻana i ka nui o nā lāʻau lapaʻau immunosuppressant a lākou e lawe ai . I kekahi manawa hiki i kēia ke hana i kahi ʻokoʻa nui. Eia kekahi, aia kekahi mau lāʻau lapaʻau ʻē aʻe e like me:

• Chemotherapy : Lāʻau lapaʻau e pepehi i nā hunaola kanesa.
• Lapaʻau radiation : Ke luku ʻana i nā hunaola kanesa me ka hoʻohana ʻana i nā kukuna ikehu kiʻekiʻe.
• ʻO ka Immunotherapy me nā antibodies monoclonal : Pili kēia i ka hoʻohana ʻana i nā protein kikoʻī (monoclonal antibodies) e hoʻouka i nā cell cancer.
• ʻOki kino : ʻAʻole hana pinepine ʻia kēia. Manaʻo ʻia ke ʻoki kino inā pili ka PTLD a hiki ke wehe palekana ʻia. No ka laʻana, inā pili ka PTLD i nā tonsils, hiki ke wehe ʻia nā tonsils.

Aia kekahi mea e hiki ai iā mākou ke hana e pale aku i ka ulu ʻana o PTLD?

ʻAʻohe mea hiki iā mākou ke hana e pale pololei i ka PTLD. Eia nō naʻe, ke nānā nei nā kauka a me nā mea noiʻi i kekahi mau lāʻau lapaʻau e hiki ke hoʻohana ʻia ma mua a/a ma hope paha o ke kāpili ʻana e hōʻemi i ka pilikia o ka PTLD. No laila, aia ka manaʻolana e loaʻa nā hopena maikaʻi aʻe no kēia i ka wā e hiki mai ana.

He aha ka mea e hana ʻia inā loaʻa iā ʻoe ka PTLD? Hiki ke ho'ōla ʻia?

Hiki ke ʻokoʻa ke ʻano o kāu pane ʻana i ka PTLD mai kēlā kanaka a kēia kanaka. Aia ia i nā mea he nui.

Eia kekahi laʻana, i kekahi manawa hoʻomaikaʻi ka PTLD ʻoiai inā hōʻemi wale nā ​​​​kauka i nā immunosuppressants.

Ua hōʻike ʻia nā haʻawina hou nei ma waena o 60% a me 70% o ka poʻe i loaʻa i ka lymphoma ma hope o kahi hoʻoili kino a ua mālama ʻia me ka immunotherapy a me ka chemotherapy ua ʻike i ka emi ʻana a i ʻole ka nalo ʻana o nā hōʻailona (remission) .

Hiki ke ho'ōla ʻia ka PTLD? ʻAe, hiki ke ho'ōla ʻia ka PTLD me ka `Immunotherapy` wale nō a i ʻole me ka hui pū ʻana me ka `Chemotherapy`. Ua hōʻike ʻia nā noiʻi ma waena o 50% a me 60% o ka poʻe i loaʻa i kēia lāʻau lapaʻau e ho'ōla piha ana . No laila, he mea kēia e manaʻolana ai.

He aha nā nīnau koʻikoʻi e pono iaʻu e nīnau aku i kaʻu kauka?

Inā loaʻa iā ʻoe ka PTLD, he mea maikaʻi e nīnau i kāu kauka i nā nīnau e like me kēia:

• No ke aha i hiki mai ai kēia iaʻu?
• Pehea e mālama ʻia ai ka PTLD?
• Inā wau e hōʻemi i kaʻu lāʻau lapaʻau immunosuppressant, he aha ka manawa kūpono e hōʻole ai koʻu kino i nā ʻōkana/nā pūnaewele hou?
• Inā holomua kaʻu lāʻau lapaʻau, he aha ka manawa kūpono e hoʻi hou mai ai kēia maʻi?

Ma waho aʻe o kēia mau nīnau, mai makaʻu e nīnau i ke kauka i kekahi mea āu e noʻonoʻo nei.

Āhea wau e ʻike ai i ke kauka?

Inā loaʻa iā ʻoe ka PTLD, e nānā pono kāu kauka i kou olakino holoʻokoʻa . E nānā lākou i nā hōʻailona e hōʻike ana e ʻoi aku ka ʻino o kou kūlana. Inā e mālama ʻia ana ʻoe no ka PTLD, e wehewehe kāu kauka i nā loli āu e ʻike nei a i ʻole inā e ʻoi aku ka ʻino o kāu mau hōʻailona. He mea nui e haʻi koke i kāu kauka inā hana ʻia kēia.

ʻO ka mea hope loa, nā mea e hoʻomanaʻo ai

Hiki i nā hoʻoili kino a me nā hoʻoili cell kumu ke hoʻōla i nā ola a hoʻolōʻihi paha i ke ola . Eia nō naʻe, no ka mea he mau kaʻina hana lapaʻau nui kēia, hiki iā lākou ke hele mai me nā pilikia. ʻO ka PTLD kekahi o nā pilikia kakaikahi, akā he koʻikoʻi paha.

Inā he moho ʻoe no kahi hoʻoili kino a i ʻole ke kelepona kumu, e kamaʻilio kāu hui mālama ola me ʻoe e pili ana i kou pilikia o ka PTLD , a me nā kumu pilikia ʻē aʻe he nui. Ke ʻimi nei nā kauka a me nā mea noiʻi i nā ala e hōʻemi ai i ka pilikia o ka PTLD. ʻO ka mea nui loa, ʻo ia ka makaʻala i kēia a e nīnau i kāu hui mālama ola i nā nīnau āu e loaʻa ai.

`PTLD, Nā Maʻi Lymphoproliferative Ma hope o ke Kānana ʻana, Hoʻololi ʻŌkana, Lymphoma, Virus Epstein-Barr, Immunology, Kanesa