Peb puas yuav tsum paub txog PTLD (Post-Transplant Lymphoproliferative Disorders) tom qab hloov lub cev?

Koj lossis ib tug neeg uas koj paub tej zaum tau phais loj uas cawm txoj sia, xws li kev hloov pauv lub cev. Los yog kev hloov pauv noob hlwb. Tom qab tej yam no, muaj tej yam tsis tshua muaj thiab tsis tau xav txog. Ib qho teeb meem zoo li no yog PTLD, lossis Post-Transplant Lymphoproliferative Disorders. Vim tias qhov no tuaj yeem loj me ntsis, cia peb tham txog nws hauv txoj kev yooj yim uas koj tuaj yeem nkag siab.

PTLD yog dab tsi tiag?

Hais yooj yim xwb, PTLD yog ib qho teeb meem uas ua rau tuag taus uas tuaj yeem tshwm sim tom qab hloov pauv lub cev lossis hloov pauv hlwb allogeneic. Qhov tshwm sim ntawm no yog tias ib hom hlwb dawb hauv peb lub cev, hu ua lymphocytes, faib sai sai thiab nce ntxiv yam tsis tuaj yeem tswj tau.

Qhov mob no hu ua PTLD yog ib hom mob lymphoma . Lymphoma yog ib hom mob qog nqaij hlav uas tshwm sim hauv peb lub cev lymphatic. Qhov mob no tshwm sim thaum cov qe ntshav dawb ua mob qog nqaij hlav thiab loj hlob sai yam tsis tuag.

PTLD feem ntau yog tshwm sim los ntawm Epstein-Barr Virus (EBV) . Qhov no yog ib hom kab mob uas peb txhua tus muaj nyob hauv peb lub cev. Muaj ntau hom PTLD sib txawv, thiab txoj kev uas nws cuam tshuam rau ib tus neeg tuaj yeem sib txawv. Qhov xov xwm zoo yog tias cov kws kho mob tuaj yeem kho nws. Txawm li cas los xij, qee zaum qhov mob tuaj yeem rov qab los.

Cov hom PTLD tseem ceeb yog dab tsi?

Cov kws kho mob faib PTLD ua plaub hom tseem ceeb raws li cov hlwb lymphoma zoo li cas hauv qab lub tshuab microscope:

• Mob Thaum Ntxov: Cov neeg no muaj cov tsos mob zoo ib yam li cov uas pom nrog tus kab mob Epstein-Barr (EBV).
• Polymorphic PTLD: Ntawm no, cov hlwb lymphoma sib xyaw nrog lwm hom hlwb ntshav dawb, xws li cov lymphocytes ib txwm muaj thiab cov hlwb plasma.
• Monomorphic PTLD: Qhov no yog hom PTLD uas feem ntau pom . Cov hlwb lymphoma ntawm no zoo ib yam li cov uas pom muaj nyob rau hauv lwm hom lymphoma, xws li "Non-Hodgkin Lymphomas". Piv txwv li, "Diffuse Large B-cell Lymphoma" lossis "Burkitt Lymphoma".
• Classic Hodgkin Lymphoma - hom PTLD: Qhov no yog hom PTLD uas tsis tshua muaj .

Tus mob no hu ua PTLD ntau npaum li cas?

Raws li tau hais ua ntej lawm, PTLD yog ib qho mob tsis tshua muaj . Qhov ntawd txhais tau tias nws tsis tshwm sim rau txhua tus. Kwv yees li ntawm 2 ntawm 100 tus neeg uas tau hloov pauv stem cell (`(2%)`) yuav muaj PTLD. Cov neeg uas tau hloov pauv lub cev muaj feem yuav muaj PTLD ntau dua me ntsis. Tab sis qhov ntawd kuj txawv nyob ntawm lub cev uas tau hloov.

Xav txog nws li no, thaum kwv yees li peb ntawm 100 tus neeg uas tau hloov raum (`(3%)`) muaj tus mob no, cov kws tshaj lij hais tias kwv yees li kaum ntawm 100 tus neeg uas tau hloov ntsws (`(10%)`) yuav muaj tus mob no. Yog li, tsis muaj dab tsi yuav txhawj txog, qhov no tsis yog ib yam dab tsi uas tshwm sim rau feem ntau ntawm cov neeg.

Cov tsos mob ntawm PTLD yog dab tsi?

Tej zaum ib txhia neeg yuav tsis muaj tsos mob thaum xub thawj. Cov tsos mob ntawm PTLD tuaj yeem tshwm sim txhua lub sijhawm, txij li ob peb lub hlis mus txog ob peb xyoos tom qab hloov pauv. Yog tias cov tsos mob tshwm sim, lawv yuav suav nrog:

• Xav tias nkees heev ('Qaug zog') : Tsuas yog xav tias tsis muaj sia nyob.
• Kub taub hau tsis muaj laj thawj .
• Khoom noj tsis qab .
• Poob phaus tsis tau xav txog .
• Hws ntau dhau thaum hmo ntuj ('Hws hmo ntuj') .
• Cov qog ntshav o : Lawv zoo li cov pob hauv caj dab thiab caj dab.

Vim li cas qhov PTLD no thiaj tshwm sim? Dab tsi yog cov ua rau muaj qhov teeb meem no?

Qhov no nyuaj me ntsis rau kev nkag siab. PTLD tshwm sim vim tias muaj tus kab mob uas feem ntau siv qhov tsis muaj zog hauv peb lub cev tiv thaiv kab mob .

Xav txog tias koj tab tom npaj rau kev hloov pauv stem cell. Ua ntej ntawd, koj yuav tau txais chemotherapy los tua cov cell mob qog noj ntshav hauv koj cov pob txha. Qhov no hu ua conditioning. Qhov no ua rau koj lub cev tiv thaiv kab mob tsis muaj zog los tiv thaiv koj ntawm kab mob. Tshwj xeeb, conditioning txo cov haujlwm ntawm T cell (T-cells) uas tau kis tus kab mob EBV thiab rov qab tsis ua haujlwm dua.

Tom qab ntawd, tom qab cov noob hlwb lossis lub cev raug hloov pauv, koj lub cev tau txais tshuaj tiv thaiv kab mob kom tiv thaiv nws kom tsis txhob tsis lees txais yam tshiab. Txawm hais tias cov tshuaj no tiv thaiv lub cev lossis cov hlwb tshiab, lawv kuj ua rau peb lub cev tiv thaiv tsis muaj zog, ua rau nws yooj yim rau cov neeg txawv teb chaws nkag los xws li cov kab mob.

Hauv PTLD, tus kab mob tseem ceeb yog tus kab mob Epstein-Barr (EBV) . EBV tau txuas nrog PTLD uas tshwm sim hauv ib xyoos lossis ob xyoos tom qab hloov hlwb lossis hloov cev. Txawm li cas los xij, qhov ua rau PTLD tshwm sim ntau xyoo tom qab hloov hlwb tseem tsis tau paub meej. Cov kws tshaj lij kuj tseem tab tom tshawb nrhiav seb cov kab mob xws li cytomegalovirus (CMV) lossis adenovirus (Adenovirus) puas yuav ua lub luag haujlwm.

Raws li cov kws tshaj lij, kwv yees li 90% ntawm peb cov pej xeem tau kis tus kab mob EBV thaum lawv tseem yog menyuam yaus lossis thaum lawv tseem hluas. Tej zaum koj yuav muaj tus kab mob no yam tsis muaj tsos mob dab tsi, thiab tej zaum koj yuav tsis paub txog nws. Tus kab mob EBV kis rau peb cov qe ntshav B thiab tseem "tsaug zog" hauv lub cev, uas yog, nyob rau hauv lub xeev "Latent", yam tsis ua rau muaj teeb meem dab tsi. (Koj kuj tseem yuav tau txais tus kab mob no los ntawm tus neeg pub dawb.)

Vim koj noj cov tshuaj tiv thaiv kab mob no, koj lub cev tiv thaiv kab mob tsis tuaj yeem tswj tau tus kab mob EBV uas tsis muaj zog. Tom qab ntawd, cov qe ntshav B uas muaj tus kab mob EBV pib faib thiab loj hlob sai. Qhov ntawd yog qhov ua rau muaj tus kab mob PTLD.

Leej twg muaj feem yuav mob PTLD ntau dua?

Koj txoj kev pheej hmoo ntawm kev mob PTLD yuav nce ntxiv rau cov laj thawj hauv qab no:

• Muaj tus kab mob Epstein-Barr (EBV) nyob hauv koj lub cev lossis hauv lub cev ntawm tus neeg uas tau muab lub cev/cov qe ntshav rau koj (`(Tus Pub)`).
• Tau txais kev kho mob ('Kev kho mob ua ntej hloov pauv') uas txo qhov ua haujlwm ib txwm ntawm koj cov qe ntshav T ua ntej hloov pauv.
• Noj tshuaj tiv thaiv kab mob kom tiv thaiv koj lub cev tsis pub cov kab mob tshiab lossis cov cell tshiab.
• Muaj kev hloov pauv ntawm qee cov noob caj noob ces (`(Genes)`) uas ua rau muaj kev pheej hmoo ntawm kev mob PTLD.

Cov kws kho mob kuaj mob no hu ua PTLD li cas?

Cov kws kho mob yuav xub kuaj koj lub cev thiab saib seb koj muaj mob dab tsi. Tsis tas li ntawd xwb, feem ntau lawv yuav ua cov kev kuaj hauv qab no:

• Kev suav ntshav tag nrho (`Kev suav ntshav tag nrho - CBC`) .
• Vaj Huam Sib Luag Metabolic .
• Qib ntawm lactate dehydrogenase (LDH) .
• Kev kuaj zis , suav nrog cov theem ntawm uric acid.
• Ib qho kev kuaj mob los nrhiav cov tshuaj tiv thaiv kab mob uas tsim tawm hauv lub cev tawm tsam tus kab mob EBV .
• Kev thaij duab CT ('Computed Tomography - CT scan') .
• Kev thaij duab MRI (Magnetic Resonance Imaging - MRI) .
• Kev luam theej duab PET (`Positron Emission Tomography - PET scan`) .
• Kev kuaj mob pob txha .

Cov kev kuaj no yog qhov uas tso cai rau cov kws kho mob txiav txim siab seb PTLD puas muaj lossis tsis muaj, thiab yog tias muaj, nws zoo li cas.

Cov kev kho mob rau PTLD yog dab tsi?

Feem ntau cov kws kho mob pib los ntawm kev txo cov tshuaj tiv thaiv kab mob uas lawv noj . Qee zaum qhov no tuaj yeem ua qhov sib txawv loj. Tsis tas li ntawd, muaj lwm yam kev kho mob xws li:

• Kev Kho Mob Qog Noj Ntshav : Tshuaj uas tua cov hlwb qog noj ntshav.
• Kev Kho Mob Hluav Taws Xob : Tua cov hlwb qog noj ntshav siv cov hluav taws xob muaj zog heev.
• Kev kho mob nrog cov tshuaj monoclonal antibodies : Qhov no cuam tshuam nrog kev siv cov protein tshwj xeeb (monoclonal antibodies) los tawm tsam cov hlwb qog noj ntshav.
• Kev Phais Mob : Qhov no tsis tshua muaj neeg ua. Kev phais mob tsuas yog xav txog yog tias PTLD nyob hauv ib cheeb tsam thiab tuaj yeem tshem tawm tau yam tsis muaj kev phom sij. Piv txwv li, yog tias cov tonsils raug cuam tshuam los ntawm PTLD, cov tonsils yuav raug tshem tawm.

Puas muaj dab tsi uas peb ua tau los tiv thaiv PTLD kom tsis txhob loj hlob?

Yeej tsis muaj dab tsi uas peb ua tau los tiv thaiv tus kab mob PTLD ncaj qha. Txawm li cas los xij, cov kws kho mob thiab cov kws tshawb fawb tab tom nrhiav qee cov tshuaj uas siv tau ua ntej thiab/lossis tom qab hloov pauv lub cev kom txo qhov kev pheej hmoo ntawm tus kab mob PTLD. Yog li, muaj kev cia siab tias yuav muaj cov kev daws teeb meem zoo dua rau qhov no yav tom ntej.

Yog koj muaj tus mob PTLD no, yuav ua li cas? Puas kho tau?

Koj yuav teb li cas rau PTLD yuav txawv ntawm ib tus neeg mus rau ib tus neeg. Nws nyob ntawm ntau yam.

Piv txwv li, qee zaum PTLD zoo dua txawm tias cov kws kho mob tsuas yog txo cov tshuaj tiv thaiv kab mob.

Cov kev tshawb fawb tsis ntev los no tau qhia tias ntawm 60% thiab 70% ntawm cov neeg uas muaj mob lymphoma tom qab hloov pauv lub cev thiab tau kho nrog kev kho mob immunotherapy thiab chemotherapy tau muaj kev txo qis lossis ploj mus ntawm cov tsos mob (kev zam txim) .

Puas kho tau PTLD? Yog, PTLD kho tau nrog 'Immunotherapy' ib leeg lossis ua ke nrog 'Chemotherapy'. Cov kev tshawb fawb tau qhia tias ntawm 50% thiab 60% ntawm cov neeg uas tau txais kev kho mob no rov zoo tag nrho . Yog li, qhov no yog ib yam dab tsi uas yuav tsum muaj kev cia siab txog.

Cov lus nug tseem ceeb tshaj plaws uas kuv yuav tsum nug kuv tus kws kho mob yog dab tsi?

Yog tias koj muaj PTLD, nws yog ib lub tswv yim zoo los nug koj tus kws kho mob cov lus nug zoo li no:

• Vim li cas qhov no thiaj tshwm sim rau kuv?
• Yuav kho tus mob PTLD li cas?
• Yog tias kuv txo kuv cov tshuaj tiv thaiv kab mob, muaj feem ntau npaum li cas uas kuv lub cev yuav tsis lees txais cov kab mob/cell tshiab?
• Yog tias kuv txoj kev kho mob ua tiav, muaj feem yuav rov qab muaj mob no dua li cas?

Ntxiv rau cov lus nug no, tsis txhob ntshai nug tus kws kho mob txhua yam uas koj muaj hauv koj lub siab.

Kuv yuav tsum mus ntsib kws kho mob thaum twg?

Yog koj muaj PTLD, koj tus kws kho mob yuav saib xyuas koj txoj kev noj qab haus huv zoo . Lawv yuav nrhiav cov cim qhia tias koj tus mob hnyav zuj zus. Yog tias koj tab tom kho PTLD, koj tus kws kho mob yuav piav qhia txog yam kev hloov pauv uas koj tab tom ntsib lossis yog tias koj cov tsos mob hnyav zuj zus. Nws yog ib qho tseem ceeb uas yuav tsum qhia rau koj tus kws kho mob tam sim ntawd yog tias qhov no tshwm sim.

Thaum kawg, tej yam uas yuav tsum nco ntsoov

Kev hloov cov noob caj noob ces thiab kev hloov cov noob hlwb qee zaum tuaj yeem cawm tau txoj sia lossis ntev txoj sia . Txawm li cas los xij, vim tias cov no yog cov txheej txheem kho mob loj, lawv tuaj yeem muaj kev pheej hmoo. PTLD yog ib qho teeb meem tsis tshua muaj, tab sis tej zaum yuav loj heev.

Yog tias koj yog tus neeg sib tw rau kev hloov pauv lub cev lossis cov noob hlwb, koj pab neeg saib xyuas kev noj qab haus huv yuav nrog koj tham txog koj qhov kev pheej hmoo ntawm PTLD , nrog rau ntau lwm yam kev pheej hmoo. Cov kws kho mob thiab cov kws tshawb fawb tab tom nrhiav txoj hauv kev los txo qhov kev pheej hmoo ntawm PTLD. Qhov tseem ceeb tshaj plaws yog kom paub txog qhov no thiab nug koj pab neeg saib xyuas kev noj qab haus huv txhua lo lus nug uas koj muaj.

`PTLD, Kev Mob Lymphoproliferative Tom Qab Hloov Paug, Kev Hloov Paug Lub Cev, Lymphoma, Epstein-Barr Virus, Kev Tiv Thaiv Kab Mob, Mob Cancer