Puas yog mob leukemia yog ib yam mob txawv txawv uas tshwm sim los ntawm tshuaj? Cia peb tham txog Differentiation Syndrome!

Thaum koj lossis ib tus neeg koj paub tab tom kho mob rau ib yam kab mob xws li leukemia, koj yuav ntsib cov kev mob tshwm sim tsis tau xav txog. Hnub no, peb yuav tham txog kev sib xyaw ua ke ntawm cov tshuaj tiv thaiv loj heev uas tuaj yeem tshwm sim nrog cov tshuaj, tshwj xeeb tshaj yog cov uas tau muab rau ob hom mob qog ntshav. Cov kws kho mob hu qhov no ua Differentiation Syndrome . Vim tias nws tuaj yeem loj heev, cov kws kho mob feem ntau pib kho cov tsos mob ua ntej lawv tuaj yeem paub tseeb, uas tuaj yeem txo qhov kev pheej hmoo ntawm cov teeb meem uas yuav ua rau tuag taus.

Kev Sib Txawv ntawm Syndrome yog dab tsi?

Hais yooj yim xwb, Differentiation Syndrome yog ib pawg ntawm cov kev tsis haum tshuaj loj heev uas lub cev muaj rau qee cov tshuaj uas siv los kho ob hom mob qog ntshav, uas yog Acute Promyelocytic Leukemia (APL) thiab Acute Myeloid Leukemia (AML) . Zoo li qee cov cell hauv peb lub cev "ua vwm" nrog cov tshuaj no thiab pib tso ntau yam khoom ib zaug. Qhov no yog qhov ua rau txhua yam tsos mob.

Xav txog koj ib tug phooj ywg raug kuaj pom tias muaj tus kab mob APL thiab pib kho. Ob peb hnub tom qab ntawd, nws tsuas kub taub hau, ua pa nyuaj, thiab o me ntsis. Thaum ntawd, cov kws kho mob xav tias qhov no yog Differentiation Syndrome.

Cov Neeg Sawv Cev Sib Txawv no yog dab tsi?

Cov tshuaj sib txawv yog ib hom tshuaj uas cov kws kho mob siv los kho APL. APL rhiab heev dua li lwm hom AML rau cov tshuaj uas ua rau cov hlwb loj hlob, lossis sib txawv . Cov tshuaj no pab cov hlwb qog noj ntshav (blast cell stage) loj hlob mus ua cov hlwb dawb zoo li qub. Yog vim li ntawd cov kws kho mob thiaj siv cov tshuaj sib txawv no es tsis txhob muab cov tshuaj chemotherapy rau lawv ncaj qha.

Ib yam li lwm cov tshuaj kho mob qog noj ntshav, cov tshuaj no pab nres lossis qeeb txoj kev loj hlob ntawm cov hlwb qog noj ntshav. Cov kws kho mob siv tau cov tshuaj sib txawv no ib leeg xwb, ua ke nrog ib leeg, lossis ua ke nrog kev kho mob qog noj ntshav. Lawv tuaj yeem kho APL tau zoo. Txawm li cas los xij, qee tus neeg uas muaj APL tuaj yeem muaj cov kev mob tshwm sim loj heev los ntawm cov tshuaj no.

Cov tshuaj twg ua rau muaj tus mob Differentiation Syndrome?

Qhov mob no tuaj yeem tshwm sim los ntawm cov neeg sawv cev sib txawv uas tau muab rau APL. Piv txwv li suav nrog:

• All-trans-retinoic acid (ATRA) yog ib hom vitamin A.
• Arsenic Trioxide (ATO) yog ib hom arsenic.

Tsis tas li ntawd xwb, rau qee tus neeg uas muaj AML, cov kws kho mobCov tshuaj Isocitrate Dehydrogenase (IDH) inhibitors yog ib pawg tshuaj chemotherapy uas siv. Cov tshuaj IDH inhibitors (ivosidenib) thiab (enasidenib) no kuj tuaj yeem ua rau muaj Differentiation Syndrome. Tsis yog li ntawd xwb, tab sis cov tshuaj FLT3 inhibitors (piv txwv li (midostaurin) , (gilteritinib) ) kuj tuaj yeem ua rau muaj qhov mob no.

Leej twg yuav xav tau cov tshuaj IDH inhibitors?

• Cov neeg uas mob qog noj ntshav rov qab los dua.
• Cov neeg uas muaj mob qog noj ntshav uas nyuaj kho.
• Cov neeg uas muaj kev hloov pauv ntawm cov noob caj noob ces (IDH1 lossis IDH2 mutation).
• Cov neeg uas tsis tuaj yeem zam kev kho mob chemotherapy ib txwm muaj.

Leej twg yuav muaj feem ntau dua rau qhov muaj tus kab mob Differentiation Syndrome?

Muaj coob tus neeg uas muaj APL muaj cov qe ntshav dawb tsawg (WBC) . Txawm li cas los xij, cov neeg uas muaj cov qe ntshav dawb ntau muaj feem yuav mob Differentiation Syndrome ntau dua. Hauv cov xwm txheej no, cov kws kho mob feem ntau sau tshuaj hu ua Prednisone lossis Dexamethasone kom txo qhov kev pheej hmoo ntawm tus kab mob no.

Kab mob Differentiation Syndrome no feem ntau tshwm sim li cas?

Qhov no yog ib qho mob tsis tshua muaj . AML yog hom mob leukemia feem ntau tshwm sim rau cov neeg laus, txawm hais tias nws suav txog li 1% ntawm tag nrho cov mob qog noj ntshav. Hauv Tebchaws Meskas, APL tshwm sim rau li ib tus neeg ntawm 250,000 tus neeg.

Los ntawm cov neeg uas muaj AML thiab APL:

• Kwv yees li ntawm 25% ntawm cov neeg mob APL uas tau txais tshuaj ATRA thiab ATO tau tsim muaj Differentiation Syndrome.
• Tus mob no tau raug tshaj tawm tias muaj li ntawm 14% thiab 19% ntawm cov neeg mob AML uas noj cov tshuaj IDH inhibitors.

Dab tsi ua rau muaj tus kab mob sib txawv no?

Cov kws tshawb nrhiav tseem tsis tau paub meej tias vim li cas qee tus neeg thiaj li teb rau kev kho mob APL li no. Cov kev tshawb fawb thaum ntxov qhia tias cov tshuaj kho mob qog noj ntshav ua rau cov hlwb leukemia tso tawm ntau cov tshuaj lom neeg ntawm lub cev tiv thaiv kab mob. Qhov no hu ua cytokine release syndrome . Qhov kev o tsis tswj hwm no ua rau muaj ntau yam tsos mob, txij li me me mus rau hnyav.

Cov tsos mob ntawm Differentiation Syndrome yog dab tsi?

Feem ntau ib tug neeg uas muaj APL yuav pib muaj cov tsos mob ntawm Differentiation Syndrome hauv ib lossis ob lub lis piam tom qab pib siv ATRA thiab/lossis Arsenic Trioxide. Txawm li cas los xij, yog tias koj tab tom noj tshuaj IDH inhibitor rau AML, nws yuav siv sijhawm ntev me ntsis kom cov tsos mob tshwm sim.Nws yuav ploj mus (cov tsos mob no yuav tshwm sim txhua qhov chaw txij li ib hnub mus txog tsib txog rau lub hlis tom qab pib siv cov tshuaj).

Cov no yog cov tsos mob uas pom ntau tshaj plaws:

• Hnoos .
• Muaj kua dej ntau dhau nyob ib puag ncig koj lub plawv thiab lub ntsws (Pleural Effusion) .
• Kev Ua Tsis Tau Zoo ntawm Lub Raum .
• Ntshav siab qis (Hypotension) .
• Cov pa oxygen tsawg hauv cov ntshav (Hypoxemia) .
• Ua pa nyuaj (Dyspnea) .
• O (o) ntawm tes, taw, thiab caj dab.
• Kub taub hau tsis muaj laj thawj.
• Qhov hnyav nce tsis muaj laj thawj.

Tseem Ceeb: Yog tias koj muaj ib lossis ntau yam ntawm cov tsos mob no, nws tsis tau txhais hais tias koj muaj tus kab mob sib txawv. Txawm li cas los xij, nws yog ib qho tseem ceeb uas yuav tsum qhia rau koj tus kws kho mob tam sim ntawd yog tias koj pom ib qho ntawm cov tsos mob no.

Cov teeb meem uas yuav tshwm sim ntawm Differentiation Syndrome yog dab tsi?

Qhov mob no qee zaum tuaj yeem ua rau muaj teeb meem loj heev. Piv txwv li:

• Kev Ua Tsis Taus Lub Plawv .
• Kev Ua Tsis Tau Zoo ntawm Lub Raum .
• Kev Ua Tsis Taus Mob Ntsws .
• Kev los ntshav ntawm lub ntsws (Pulmonary Hemorrhage) .
• Mob ntsws o .
• Sepsis ( kev kis kab mob hnyav uas kis thoob plaws lub cev).

Yog tias koj muaj cov tsos mob no, hu rau koj tus kws kho mob tam sim ntawd . Yog tias koj ua pa nyuaj lossis mob hauv siab, hu rau 911 (lossis koj tus xov tooj xwm txheej ceev hauv zos) tam sim ntawd . Cov neeg uas muaj APL feem ntau raug kho hauv tsev kho mob kom txog thaum qhov kev pheej hmoo ntawm kev sib txawv ntawm tus kab mob dhau mus.

Yuav kuaj mob Differentiation Syndrome li cas?

Nws yuav nyuaj rau kuaj mob no rau ib tus neeg uas muaj APL, vim muaj ntau lwm yam mob uas tuaj yeem ua rau muaj cov tsos mob zoo sib xws. Hauv cov xwm txheej hnyav, cov kws kho mob yuav pib kho cov tsos mob sai li sai tau thaum lawv xav tias muaj Differentiation Syndrome, txawm tias ua ntej lawv tuaj yeem paub tseeb tias nws yog qhov yog.

Koj tus kws kho mob yuav pom zoo kom kuaj ntau yam kom paub meej tias muaj mob dab tsi thiab tsis muaj lwm yam mob uas yuav tsum tau kuaj. Tej zaum yuav muaj xws li:

• Kev suav cov ntshav tag nrho (CBC) .
• X-ray hauv siab .
• Echocardiogram (kev kuaj uas xyuas seb lub plawv ua haujlwm li cas).
• Kev luam theej duab CT hauv siab .
• Bronchoscopy (kev kuaj uas siv lub koob yees duab los saib sab hauv lub ntsws).
• Lwm yam kev kuaj ntshav (Bloodwork).

Puas muaj kev kho rau Differentiation Syndrome?

Feem ntau, cov neeg uas muaj mob qog ntshav siab promyelocytic leukemia (APL) tuaj yeem rov zoo los ntawm tus kab mob sib txawv yog tias lawv tau txais kev kho mob sai thiab raug . APL tam sim no yog ib yam kab mob uas feem ntau kho tau. Yog li ntawd tsis muaj dab tsi yuav tsum ntshai.

Yuav kho tus mob Differentiation Syndrome li cas?

Feem ntau cov kws kho mob kho cov tsos mob ntawm tus kab mob sib txawv nrog cov tshuaj corticosteroid lossis glucocorticoid , xws li dexamethasone . Hauv cov xwm txheej hnyav, koj tus kws kho mob kuj tseem yuav pom zoo kom tsum tsis txhob kho koj tus mob qog noj ntshav ib ntus kom txog thaum koj cov tsos mob ploj mus.

Feem ntau cov neeg uas muaj APL raug kho mob hauv tsev kho mob kom txog thaum qhov kev pheej hmoo ntawm kev sib txawv ntawm tus kab mob tau dhau mus. Yog tias koj yog tus neeg mob sab nraud thiab xav tias muaj tus kab mob sib txawv ntawm tus kab mob, koj cov kws kho mob yuav txiav txim siab kom koj nyob hauv tsev kho mob ib hmos rau kev tswj hwm lossis kev soj ntsuam. Koj pab neeg kho mob yuav pab paub meej tias koj tau kuaj mob thiab kho txhua yam mob uas ua rau koj cov tsos mob.

Kuv ua tau dab tsi los txo kuv txoj kev pheej hmoo ntawm kev muaj tus kab mob Differentiation Syndrome?

Yeej tsis muaj dab tsi koj ua tau los txo koj txoj kev pheej hmoo ntawm tus mob no. Yog tias koj tab tom noj tshuaj chemotherapy lossis lwm yam tshuaj kho mob qog noj ntshav, qhia rau koj tus kws kho mob tam sim ntawd txog txhua yam tsos mob uas koj muaj . Tsis tas li ntawd, nco ntsoov txog cov tsos mob uas yuav tsum tau saib xyuas (raws li peb tau tham saum toj no) thiab tham nrog koj tus kws kho mob yog tias koj muaj kev txhawj xeeb. Qhov no yog qhov tseem ceeb tshaj plaws.

Yuav ua li cas thiaj paub tias muaj tus kab mob Differentiation Syndrome?

Feem ntau cov neeg feem coob pom tias tus kab mob sib txawv no zoo . Feem ntau, koj tuaj yeem txuas ntxiv kho koj txoj kev kho mob qog noj ntshav, thaum lub sijhawm lossis tom qab kho nrog cov tshuaj steroids. Koj pab neeg kho mob yuav nrog koj tham txog koj cov kev xaiv kho mob.

Thaum twg koj yuav tsum nrhiav kev pab kho mob rau qhov mob Differentiation Syndrome?

Yog tias koj muaj cov cim qhia txog kev sib txawv ntawm tus kab mob thaum koj tab tom kho mob qog noj ntshav, hu rau koj tus kws kho mob tam sim ntawd . Nws yuav nyuaj rau koj lossis koj tus kws kho mob qhia seb koj cov tsos mob puas yog los ntawm kev kho mob qog noj ntshav lossis los ntawm lwm yam mob. Kev kho mob thaum ntxov tuaj yeem pab txo cov tsos mob thiab txo qhov kev pheej hmoo ntawm cov teeb meem.

Kev kho mob qog noj ntshav yuav nyuaj heev. Txawm li cas los xij, nws yuav ua rau koj poob siab thaum paub tias kev kho mob nws tus kheej muaj cov kev mob tshwm sim. Differentiation Syndrome yog ib pawg ntawm cov tshuaj tiv thaiv uas yuav ua rau tuag taus rau kev kho mob qog noj ntshav. Txawm li cas los xij, nws tuaj yeem kho tau yog tias kuaj pom thiab kho thaum ntxov . Vim tias cov tsos mob tuaj yeem hnyav zuj zus sai, cov kws kho mob yuav pib kho koj ua ntej koj cov txiaj ntsig kuaj pom tseeb tias koj muaj Differentiation Syndrome. Kev kho mob thaum ntxov tuaj yeem pab txo koj cov tsos mob thiab coj koj rov qab mus rau txoj kev zoo.

Cov Lus Qhia Txog Kev Coj Mus Tsev

• Kab Mob Sib Txawv yog ib qho kev tsis haum tshuaj loj heev uas tuaj yeem tshwm sim los ntawm qee cov tshuaj uas tau muab rau cov hom kab mob leukemia hu ua APL thiab AML.
• Tej zaum yuav muaj cov tsos mob xws li kub taub hau, ua pa nyuaj, thiab o ntawm lub cev.
• Yog koj pom cov tsos mob no, nws yog ib qho tseem ceeb uas yuav tsum qhia rau koj tus kws kho mob tam sim ntawd .
• Yog tias kuaj pom thaum ntxov thiab kho nrog cov tshuaj xws li Dexamethasone, nws feem ntau tuaj yeem kho tau.
• Tsis txhob ntshai thaum koj hnov ​​qhov no. Koj pab neeg kho mob yuav pab koj. Qhov tseem ceeb tshaj plaws yog qhia rau lawv paub txog txhua yam kev hloov pauv, txhua yam tsos mob.

Kev sib txawv ntawm cov kab mob ntshav dawb, mob ntshav dawb dawb, kev kho mob qog noj ntshav, cov kev mob tshwm sim, APL, AML, ATRA, cov tsos mob