Wi fɔ no bɔt PTLD (Post-Transplant Lymphoproliferative Disorders) afta wi dɔn transplant ɔgan?

Yu ɔ pɔsin we yu sabi go dɔn du big ɔpreshɔn we go sev yu layf, lɛk fɔ transplant yu ɔgan dɛn. Ɔ wan stem sɛl transplant. Afta dɛn tin ya, prɔblɛm dɛn kin apin we nɔ kin apin so ɔltɛm, we dɛn nɔ kin ɛkspɛkt. Wan pan dɛn prɔblɛm ya na PTLD, ɔ Post-Transplant Lymphoproliferative Disorders. Bikɔs dis kin siriɔs smɔl, lɛ wi tɔk bɔt am simpul wan we yu go ɔndastand.

Wetin rili na PTLD?

Fɔ tɔk am simpul wan, PTLD na kɔmplikeshɔn we kin mek pɔsin in layf de pan denja we kin apin afta dɛn dɔn transplant ɔgan ɔ we dɛn transplant allogeneic stem cell. Wetin kin apin ya na dat wan kayn wayt blɔd sɛl na wi bɔdi we dɛn kɔl limfosayt kin sheb kwik kwik wan ɛn i kin bɔku we wi nɔ kin ebul fɔ kɔntrol.

Dis sik we dɛn kɔl PTLD na rili wan kayn limfoma . Limfoma na wan kayn kansa we de kam na wi limfatik sistɛm. Dis sik kin apin we di wayt blɔd sɛl dɛn kin gɛt kansa ɛn gro kwik kwik wan we dɛn nɔ kin day.

Bɔku tɛm, na di Epstein-Barr Virus (EBV) kin mek pɔsin gɛt PTLD . Dis na vayrɔs we wi ɔl gɛt na wi bɔdi. Difrɛn kayn PTLD de, ɛn di we aw i kin afɛkt pɔsin kin difrɛn. Di gud nyus na dat dɔktɔ dɛn kin trit am. Bɔt, sɔntɛnde, de sik kin kam bak.

Wetin na di men kayn PTLD?

Dɔktɔ dɛn kin sheb PTLD to 4 men kayn dɛn bay aw di limfoma sɛl dɛn de luk ɔnda maykroskɔp:

• Early Lesion: Dɛn pipul ya kin gɛt sɔm kayn sik wae dɛn kin si wit di Epstein-Barr virus (EBV).
• Polymorphic PTLD: Na ya, di limfoma sεl dεm de miks wit כda kayn wayt bכdi sεl dεm, lεk nכmal limfosayt dεm εn plasma sεl dεm.
• Monomorphic PTLD: Dis na di kayn PTLD we kכmכn pas כl . di limfoma sεl dεm we de ya na di sem lεk di wan dεm we de fכnshכn na כda kayn limfoma, lεk ``Nכn-Hכdgkin Limfoma''. fכ egzampl, ``Difכs Big B-sεl Limfoma'' כ ``Burkitt Lymphoma''.
• Klasik Hodgkin Limfoma - PTLD tayp: Dis na di kayn PTLD we nɔ kin bɔku .

Aw kɔmɔn dis sik we dɛn kɔl PTLD?

As wi bin dɔn tɔk, PTLD na wan sik we nɔ kin apin so ɔltɛm . Dat min se i nɔ kin apin to ɔlman. fכ tכk roughly, lεk 2 pan 100 pipul dεm we dεn gεt stεm sεl transplant (`(2%)`) go divεlכp PTLD. Pipul wae dɔn gɛt ɔgan transplant kin gɛt PTLD smɔl. Bɔt dat kin difrɛn bak dipen pan di ɔgan we dɛn transplant.

Tink bɔt am dis we, pan ɔl we lɛk tri pan ɔl 100 pipul dɛm wae dɔn gɛt kidni transplant (`(3%)`) kin gɛt dis sik, masta sabi pipul dɛm se lɛk tɛn pan 100 pipul dɛm wae dɔn gɛt lɔng transplant (`(10%)`) kin gɛt dis sik. So, natin nɔ de fɔ wɔri bɔt, dis nɔto sɔntin we kin apin to bɔku pipul dɛn.

Wetin na di poshubul simptom dɛm fɔ PTLD?

Sɔm pipul dɛn nɔ kin gɛt ɛni sayn fɔs. PTLD simptom kin apia ɛni tɛm, frɔm sɔm mɔnt to sɔm ia afta di transplant. If di sayn dɛm wae de sho se yu gɛt dis sik, dɛn kin bi:

• Fɔ fil taya bad bad wan (`Fatigue`) : Jɔs filin se yu nɔ gɛt layf.
• Fiva fɔ natin .
• Fɔd nɔ kin te .
• We yu nɔ bin de ɛkspɛkt fɔ lɔs yu wet .
• Fɔ swet pasmak na nɛt (`Nayt swet`) .
• Swolen lymph nodes : Dɛn kin fil lɛk lumps na di nɛk ɛn armpit.

Wetin mek dis PTLD kin apin? Wetin na di tin dɛn we kin mek i apin?

Dis na smɔl strɛch fɔ ɔndastand. PTLD kin apin bikɔs wan vayrɔs we rili kɔmɔn kin tek advantej pan wan wikɛd tin we de na wi imyun sistɛm .

Imajin se yu de rɛdi fɔ transplant stem sɛl. Bifo dat, dɛn go gi yu kemotɛrapi fɔ kil di kansa sɛl dɛn we de na yu bon mɛrɔ. Dɛn kɔl dis kɔndishɔn kondishɔn. Dis kin mek yu imyun sistɛm nɔr ebul fɔ protɛkt yu frɔm sik. spεshal wan, kכndishכn de ridyus di aktiviti fכ di T sεl dεm (T-sεl dεm) we dεn infεkt wit EBV εn bi inaktiv bak.

Dɔn, afta dɛn dɔn transplant di stem sɛl ɔ ɔgan, dɛn kin gi yu bɔdi mɛrɛsin we de mek i nɔ ebul fɔ fɛt di sik fɔ mek i nɔ rijek di nyu tin. Pan ɔl we dɛn mɛrɛsin ya de protɛkt di nyu ɔgan ɔ sɛl dɛn, dɛn kin mek wi bɔdi in difɛns wikɛd bak, ɛn dis kin mek i nɔ izi fɔ ɔda pipul dɛn we kin kam insay wi bɔdi lɛk vayrɔs.

insay PTLD, di men vayral ejen na di Epstein-Barr vayrus (EBV) . EBV dεn bin lεnk wit PTLD we de divεlכp insay wan כ tu ia afta dεn transplant stεm sεl כ כgan. Bɔt dɛn stil nɔ no di rayt tin we kin mek pɔsin gɛt PTLD we kin apin sɔm ia afta dɛn dɔn transplant am. di masta sabi pipul dεm de invεstigat bak if vayrus dεm lεk saytomegalovayrus (CMV) כ adenovayrus (Adenovirus) kin ple wan rol.

Akɔdin to masta sabi pipul dɛm, lɛk 90% pan wi pipul dɛm dɔn gɛt EBV sɔm tɛm we dɛn smɔl ɔ we dɛn dɔn yɔŋ. Yu kin gɛt di vayrɔs we nɔ gɛt ɛni sayn, ɛn yu nɔ kin ivin no am. di EBV vayrus de infεkt wi B sεl dεm εn i de stil "slip" insay di bכdi, dat na, insay ``Latent'' stet, we nכ de mek nכ prכblεm. (Yu kin dɔn gɛt di vayrɔs bak frɔm pɔsin we gi yu.)

Bikɔs yu de tek dɛn imyun supreshɔn drɔgs, yu imyun sistɛm nɔ go ebul fɔ kɔntrol da EBV de we de slip. afta dat, di B sεl dεm we dεn infεkt wit EBV de bigin fכ divayd εn mכltiply kwik kwik wan. Na dat kin mek pɔsin gɛt PTLD.

Udat de pan ay risk fɔ gɛt PTLD?

Yu risk fɔ gɛt PTLD kin bɔku fɔ dɛn rizin ya:

• fכ gεt Epstein-Barr vayrus (EBV) na yu bכdi כ na di bכdi fכ di pכsin we gi yu di כgan/sεl dεm (`(Donor)`).
• we yu gεt tritmεnt (`Pre-transplant conditioning') we de ridyus di nכmal fכnshכn fכ yu T sεl dεm bifo di transplant.
• Fɔ tek mɛrɛsin we de mek yu bɔdi nɔ gɛt bɛtɛ wɛlbɔdi fɔ mek yu bɔdi nɔ gri fɔ tek di nyu ɔgan ɔ sɛl dɛn.
• fכ gεt vεryushכn na sכm jin dεm (`(Genes)`) we de inkrεs di risk fכ divεlכp PTLD.

Aw dɔktɔ dɛn kin no dis sik we dɛn kɔl PTLD?

Dɔktɔ dɛn go fɔs du yu bɔdi ɛgzam ɛn tek tɛm luk yu mɛdikal istri. Apat frɔm dat, dɛn go ɔltɛm du dɛn tɛst ya:

• Komplit Blɔd Kɔnt (`Kɔmplit Blɔd Kɔnt - CBC`) .
• Kɔmprɛhɛnsif Mɛtabolik Panɛl .
• Laktat dihaydrojenεz (LDH) lεvεl.
• Urinalysis , inklud di yurik asid lɛvɛl.
• wan tεst fכ no di antibodi dεm we dεn prodyuz na di bכdi agens di EBV vayrus .
• CT skan (`Kɔmpyut Tomografi - CT skan`) .
• MRI skan (Magnɛtik Rɛsɔnans Imej - MRI) .
• PET skan (`Positron Ɛmishin Tomografi - PET skan`) .
• Bɔn mɛrɔ bayɔpsi .

Dɛn tɛst ya na dɛn kin mek dɔktɔ dɛn ebul fɔ no if PTLD de ɔ nɔ de, ɛn if na so, aw i tan.

Wetin na di tritmɛnt dɛm fɔ PTLD?

Bɔku tɛm, dɔktɔ dɛn kin bigin bay we dɛn de ridyus di mɛrɛsin we dɛn kin tek fɔ mek dɛn nɔ gɛt bɛtɛ wɛlbɔdi . Sɔntɛnde, dis kin mek big difrɛns. Apat frɔm dat, ɔda tritmɛnt dɛn de lɛk:

• Kimotɛrapi : Na mɛrɛsin we de kil di kansa sɛl dɛn.
• Radiation therapy : Fɔ pwɛl di kansa sɛl dɛn we yu de yuz ay ɛnaji rayt.
• Immunotherapy wit monoclonal antibodies : Dis involv fכ yuz spεsifi k protin dεm (monoclonal antibodies) fכ atak di kεnsar sεl dεm.
• Ɔpreshɔn : Dɛn nɔ kin du dis ɔltɛm. Dɛn kin jɔs tink bɔt ɔpreshɔn if di PTLD de na di say we dɛn de ɛn dɛn kin pul am sef wan. fכ egzampl, if di tכnsil dεm afekt PTLD, dεn kin pul di tכnsil dεm.

Ɛnitin de we wi kin du fɔ mek PTLD nɔ kam?

Natin nɔr rili de we wi kin du fɔ mek wi nɔ gɛt PTLD dairekt wan. Bɔt dɔktɔ ɛn risach pipul dɛn de luk fɔ sɔm mɛrɛsin dɛn we dɛn kin yuz bifo ɛn/ɔ afta transplant fɔ ridyus di risk fɔ gɛt PTLD. So, op de se bɛtɛ sɔlvishɔn go de fɔ dis tumara bambay.

Wetin kin apin if yu gɛt PTLD? Yu tink se dɛn kin mɛn am?

Aw yu go ansa to PTLD kin difrɛn frɔm wan pɔsin to ɔda pɔsin. I dipen pan bɔku tin dɛn.

Fɔ ɛgzampul, sɔntɛnde PTLD kin bɛtɛ ivin if dɔktɔ dɛn jɔs ridyus di mɛrɛsin dɛn we de mek pɔsin nɔ ebul fɔ fɛt di sik.

Stɔdi dɛm we dɛn jɔs dɔn du dɔn sho se bitwin 60% ɛn 70% pan di pipul dɛm we gɛt limfoma afta dɛn dɔn transplant dɛn ɔgan ɛn we dɛn de trit wit imyunotɛrapi ɛn kemotɛrapi dɔn gɛt ridyus ɔ disappearance of symptoms (remission) .

Yu tink se dɛn kin mɛn PTLD? Yes, PTLD kin mɛn wit `Immunotherapy` nɔmɔ ɔ we dɛn jɔyn am wit `Kemotherapy`. Stɔdi dɔn sho se bitwin 50% ɛn 60% pan di pipul dɛm wae gɛt dis tritmɛnt kin wɛl kpatakpata . So, dis na sɔntin we wi fɔ gɛt op bɔt.

Wetin na di impɔtant kwɛstyɔn dɛn we a fɔ aks mi dɔktɔ?

If yu gɛt PTLD, i fayn fɔ aks yu dɔktɔ kwɛstyɔn dɛn lɛk dɛn wan ya:

• Wetin mek dis bin apin to mi?
• Aw dɛn kin trit PTLD?
• If a ridyus mi immunosuppressant mεdikeshכn, wetin na di chans fכ mi bכdi go rijek di nyu כgan/sεl dεm?
• If mi tritmɛnt dɔn wok fayn, wetin na di chans fɔ mek dis sik kam bak?

Apat frɔm dɛn kwɛstyɔn ya, nɔ fred fɔ aks di dɔktɔ ɛnitin we yu gɛt na yu maynd.

Ustɛm a fɔ go to di dɔktɔ?

If yu gɛt PTLD, yu dɔktɔ go wach yu ɔl wɛlbɔdi biznɛs gud gud wan . Dɛn go luk fɔ sayn dɛm wae de sho se yu sik de wɔs. If dɛn de trit yu fɔ PTLD, yu dɔktɔ go ɛksplen wetin chenj yu de gɛt ɔ if yu sik dɛn de wɔs. I impɔtant fɔ tɛl yu dɔktɔ wantɛm wantɛm if dis apin.

Fɔ dɔn, tin dɛn we wi fɔ mɛmba

כgan transplant εn stεm sεl transplant kin sev layf כ εksεnd layf sכ mtεm . Bɔt bikɔs dɛn tin ya na big big mɛrɛsin, dɛn kin kam wit prɔblɛm dɛn. PTLD na wan pan dɛn kayn prɔblɛm ya we nɔ kin apin so ɔltɛm, bɔt we kin rili siriɔs.

If yu na kandidet fɔ gɛt ɔgan ɔ stem sɛl transplant, yu wɛlbɔdi tim go tɔk to yu bɔt yu risk fɔ gɛt PTLD , ɛn bɔku ɔda tin dɛn we kin mek yu gɛt PTLD. Dɔktɔ ɛn risach pipul dɛn de luk fɔ we fɔ ridyus di risk fɔ gɛt PTLD. Di tin we impɔtant pas ɔl na fɔ no bɔt dis ɛn fɔ aks yu wɛlbɔdi tim ɛni kwɛstyɔn we yu gɛt.

`PTLD, Pɔst-Transplant Limfoproliferativ Disɔda, Ɔgan Transplant, Limfoma, Ɛpstayn-Bar Vayrɔs, Imyunɔlɔji, Kansa