Olina obubonero buno? Ka twogere ku bulwadde bwa Non-Hodgkin Lymphoma (NHL)

Wali olabyeko ekizimba oba okuzimba mu bulago, mu nnyindo oba mu kisambi? Ate era oyinza okuba nga wawulira ng’okooye oba ng’okuluma. Ebintu bino bisobola okuba ebya bulijjo, naye oluusi biyinza okuba obubonero bw’ekika kya kookolo w’omusaayi ayitibwa Non-Hodgkin Lymphoma (NHL) . Tofaayo, kino tukikuume nga kyangu.

Obulwadde bwa Non-Hodgkin Lymphoma (NHL) kye ki? Ka tukitegeere mu ngeri ennyangu!

Mu ngeri ennyangu, Non-Hodgkin Lymphoma (NHL) kibinja kya kookolo w’omusaayi akula mu nkola y’amazzi mu mubiri gwaffe. Oyinza okuba nga wali owulidde ku kika kya kookolo ekiyitibwa lymphoma. NHL kye kimu ku bika ebikulu ebibiri eby’obulwadde bwa lymphoma. Kookolo ono atandikira mu butoffaali obuyitibwa lymphocytes , ekika ky’obutoffaali obweru mu mubiri gwaffe. Ensigo zino eziyitibwa lymphocytes ziringa abaserikale ba poliisi mu mubiri gwaffe. Bano be batukuuma nga balwanyisa endwadde ne yinfekisoni.

Kati teebereza, kiki ekibaawo singa wabaawo enkyukakyuka, enkyukakyuka, mu buzaale obuli munda mu butoffaali buno obw’obutoffaali obuyitibwa lymphocyte? Wano obutoffaali buno obutali bwa bulijjo obwa lymphoma we butandikira okutondebwa. Bino bitera okukula mu nnywanto zaffe. Awo obutoffaali buno we bukuŋŋaanira ne bukola ebizimba. Kyokka kino tekibeera mu nnywanto zokka, naye era kiyinza okukula ne mu bitundu ebirala eby’enkola yaffe ey’ennywanto, gamba ng’endwadde z’omusaayi, enseke, oba mu bitundu by’amazzi mu bifo ebirala. Ekisinga obukulu nti singa NHL zino tezijjanjabwa bulungi, zisobola okusaasaana mu mubiri gwonna.

Naye tekyetaagisa kweraliikirira. Olw’obujjanjabi obupya, abantu bangi abalina NHL batereera era bawangaala. Oluusi, obujjanjabi busobola ``okuwonya`` ddala obulwadde. Oluusi, ekigendererwa ky'obujjanjabi kwe kufuga obulwadde, okubuteeka mu ``remission``, n'okubukuuma bwe butyo okumala ebbanga nga bwe kisoboka.

Bika ki ebikulu ebya NHL?

Oyinza okwewuunya okukimanya nti waliwo ebika bya NHL ebisukka mu 70! Abasawo bazigabanya okusinziira ku kika kya lymphocyte ekikoseddwa:

• B-cell lymphoma: Kookolo ono ava mu butoffaali bwa B. B-cells kika kya butoffaali obukola antibodies okulwanyisa obuwuka mu mibiri gyaffe. B-cell lymphoma ekola ebitundu 85% ku bulwadde bwa NHL.
• T-cell lymphoma: Kookolo ono ava mu butoffaali bwa T. Obutoffaali bwa T kika kya butoffaali obugenderera n’okulumba obuwuka n’ebirumba ebiva ebweru era buyamba obutoffaali bwa B okukola obuziyiza.

Abasawo era bagabanya obulwadde bwa lymphomas obw’obutoffaali bwa B ne T-cell nga “obukambwe” ne “obutakola .” NHL ezikola obusungu zasaasaana mangu okusinga NHL ezitakola. N’olwekyo, NHL ezikambwe zitera okwetaaga obujjanjabi obw’amaanyi ennyo.

Obulwadde buno obuyitibwa NHL butera kwenkana wa?

Mu butuufu kika kya kookolo ekimanyiddwa ennyo. Okugeza mu Amerika, kisuubirwa nti mu 2024 mujja kubaawo abantu abapya nga 80,620 abakwatibwa obulwadde bwa NHL.Era ye kookolo ow’omulundi ogwa 11 mu nsi yonna. Obulwadde bwa non-Hodgkin lymphoma butera nnyo okusinga Hodgkin lymphoma , ekika ekirala eky’obulwadde bwa lymphoma.

Bubonero ki obulaga obulwadde bwa Non-Hodgkin Lymphoma?

Akabonero akasinga okulabika kwe kuzimba oba ekizimba mu bulago, mu nnyindo oba mu kisambi nga tewali bulumi. Kano kabonero akalaga nti ennywanto mu bitundu ebyo zizimba. Obubonero obulala businziira ku kifo obutoffaali bwa lymphoma we buli. Obubonero obulala obwa NHL buyinza okuli:

• Okukoowa buli kiseera
• Obulumi mu kifuba
• Okukolola
• Obuzibu mu kussa (okusannyalala) .
• Okulumwa olubuto oba okuzimba
• Okuwulira ng’ojjudde ne bw’omala okulya katono
• Omusujja ogutategeerekese (naddala omusujja ogusukka ku diguli 39.5 (103 Fahrenheit) ogutakka oluvannyuma lw’essaawa bbiri oba okusingawo ng’ojjanjabiddwa awaka, oba singa omusujja gubaddewo okumala ennaku ezisukka mu bbiri) .
• Okutuuyana ekiro nnyo ne kiba nti ebitambaala bifuumuuka
• Okugejja mu ngeri etategeerekeka nga 10% ku buzito bw’omubiri (mu myezi 6) .

Ekikulu okujjukira nti obubonero buno bungi buyinza okuva ku mbeera endala. Okubeera n’obubonero buno bumu oba obusingawo tekitegeeza nti olina NHL. Wabula bw’olaba enkyukakyuka yonna mu mubiri gwo naddala ekipya ekimaze wiiki eziwera nga kigenda mu maaso, kiba kya magezi okugenda ew’omusawo amangu ago.

Obubonero bwa "B" bwe buliwa?

Abasawo bwe bazuula obulwadde bwa lymphoma, era banoonya obubonero bwa "B" . Obubonero buno obwa "B" bwe buno:

• Omusujja awatali nsonga
• Okutuuyana ekisusse ekiro
• Okugejja awatali nsonga

Oba olina obubonero buno oba nedda kijja kuyamba omusawo wo okuzuula ekika kya NHL ky’olina n’obujjanjabi obusinga obulungi.

Lwaki obulwadde bwa Non-Hodgkin Lymphoma bubaawo?

Non-Hodgkin Lymphoma eva ku mubiri gwo okukola obutoffaali obuyitibwa lymphocytes bungi (B-cells, T-cells, oba si bulijjo, natural killer (NK) cells). Kino kiva ku nkyukakyuka z’obuzaale ezifunibwa mu buzaale ezikosa enkula y’obutoffaali obukola omusaayi. "Ekifunibwa" kitegeeza nti si kintu ky'ozaalibwa nakyo, wabula ekintu ekibaawo mu bulamu bwo.

Lymphocytes bwe zifuuka ezitali za bulijjo, zaawukana ne zeeyongera mangu, okukkakkana nga zikola ebizimba. Ebizimba bino bitera okutandikira mu nnywanto. Olw’okuba enkola yaffe ey’amazzi ekwatagana kumpi ku buli kitundu ky’omubiri gwaffe, Non-Hodgkin Lymphoma etera okusaasaana mu bitundu ebirala mu nkola y’amazzi.

Biki ebiyinza okuvaako okulwala NHL?

Waliwo ebintu ebiwerako ebyongera obulabe bw’okulwala obulwadde bwa Non-Hodgkin Lymphoma. "Ensonga y'akabi" ye mpisa, emirimu oba embeera eyongera ku mikisa gy'okufuna obulwadde. Okugeza, bino wammanga bye bisinga okukulaakulanya NHL:

• Abantu abasukka mu myaka 60 (obulabe bwa NHL bweyongera n’emyaka) .
• Ku basajja
• Ku bazungu (kino kintu ekyogerwa mu misomo gy’ebweru) .

Ebintu ebirala ebiyinza okuvaako akabi bye bino:

• Abaserikale b’omubiri okunafuwa: Abaserikale b’omubiri abanafuye olw’embeera nga siriimu kiyinza okwongera ku bulabe bw’okulwala NHL. Ate era, okumira eddagala eriweweeza ku busimu bw’omubiri oluvannyuma lw’okusimbuliza ebitundu by’omubiri kiyinza okuvaako akabi.
• Endwadde z’abaserikale b’omubiri: Abantu abalina endwadde nga inflammatory bowel disease (IBD), rheumatoid arthritis, ne psoriasis bali mu bulabe obw’okufuna NHL.
• Yinfekisoni: Yinfekisoni za bakitiriya n’akawuka nga H. pylori, human T-lymphotropic virus Type I, hepatitis C, ne Epstein-Barr virus zizuuliddwa nga zikwatagana ne NHL.
• Okukwatibwa eddagala ly’ebiwuka: Okunoonyereza okumu kulaga nti abantu abakwatibwa ennyo eddagala ly’omuddo n’eddagala ly’ebiwuka bayinza okuba n’obulabe obutono obw’okukwatibwa NHL.
• Ebyafaayo by’amaka: Singa omu ku bazadde bo, baganda bo, bannyina, oba abaana bo alina obulwadde bwa lymphoma oba kookolo omulala ow’omusaayi, naawe oyinza okuba mu bulabe obw’amaanyi.

Obulwadde bwa Non-Hodgkin Lymphoma buzuulibwa butya?

Okuzuula obulwadde bwa Non-Hodgkin Lymphoma nkola ya mitendera mingi. Okusooka, okukeberebwa kujja kukolebwa okuggyawo embeera endala eza bulijjo eziyinza okuba nga ze zikuleetera obubonero. Okugeza, ennywanto ezizimba zitera okuva ku yinfekisoni okusinga obulwadde bwa lymphoma. Omusawo wo bw’amala okukizuula nti olina obulwadde bwa Non-Hodgkin Lymphoma, bajja kukola okukebera okulala okuzuula ekika n’obuwanvu bwe busaasaanye (`omutendera`).

Ebigezo ebirala oba enkola z’oyinza okuba nazo okuzuula obulwadde bwa Non-Hodgkin Lymphoma mulimu:

• Okukebera omubiri: Omusawo ajja kukubuuza ku bubonero bwo era akebere obubonero bw’obulwadde bwa Non-Hodgkin Lymphoma, gamba ng’ennywanto ezizimba.
• Okukebera omusaayi: Okukebera omusaayi, gamba ng’okubala omusaayi mu bujjuvu (CBC), kuyinza okukuwa ekirowoozo ku bulamu bwo okutwalira awamu. Era basobola okunoonya akawuka akakwatagana ne Non-Hodgkin Lymphoma oba ebintu ebiri mu musaayi gwo ebiraga nti ebitundu by’omubiri byonoonese olw’obulwadde buno.
• Okukebera ebifaananyi: Okukebera kuno kulaga obutoffaali bwa kookolo we buli munda mu mubiri gwo. Okusinziira ku butoffaali bwa lymphoma we buli, oyinza okwetaaga okukeberebwa CT scan, MRI, ultrasound scan oba PET scan.
• Okukebera omubiri (biopsy test):Engeri yokka ey’okumanyamu obukakafu oba obutoffaali obutali bwa bulijjo buba NHL kwe kukebera ebitundu by’omubiri (biopsy). Mu kino, omusawo aggya akatundu akatono okuva mu nnywanto oba ekitundu ekikosebwa n’akasindika mu laboratory. Eyo, omukugu mu by’endwadde akebera ebitundu by’omubiri ebyo ng’akozesa microscope okulaba oba waliwo obutoffaali obuyitibwa lymphoma cells.
• Immunophenotyping: Okukebera kuno kuyamba okuzuula ebika bya NHL ebitongole. Egabanya obutoffaali bwa kookolo okusinziira ku bubonero (antigens) obuli ku ngulu kwabwo.

Mitendera ki egy’obulwadde bwa Non-Hodgkin Lymphoma?

Ebyava mu kukeberebwa biyamba abasawo okuzuula omutendera gwa kookolo (cancer staging). Omutendera gwa kookolo gukozesebwa okuteekateeka obujjanjabi n’okuwa ekirowoozo ku bisuubirwa okuvaamu (okuteebereza). Emitendera gy’obulwadde bwa Non-Hodgkin Lymphoma giri bwe giti:

• Omutendera I: Obutoffaali bwa kookolo buli mu kitundu kimu eky’ennywanto oba ekitundu ekimu mu nkola y’ennywanto. Oba, lymphoma ebeera mu kitundu kimu eky’ekitundu ekimu ebweru w’enkola y’amazzi.
• Omutendera II: Waliwo obulwadde bwa lymphoma mu bibinja by’ennywanto bibiri oba okusingawo ku ludda lwe lumu (oba okumpi n’ennywanto).
• Omutendera III: Waliwo obutoffaali bwa kookolo mu nnywanto waggulu ne wansi w’ennywanto, oba mu nnywanto waggulu w’ennywanto ne mu nnywanto.
• Omutendera IV: Obulwadde bwa lymphoma busaasaanidde waakiri ekitundu kimu ekiri ebweru w’enkola y’amazzi, gamba ng’ekibumba oba amawuggwe.

Bujjanjabi ki obw’obulwadde bwa Non-Hodgkin Lymphoma?

Waliwo obujjanjabi obuwerako obw’obulwadde bwa Non-Hodgkin Lymphoma. Obujjanjabi bwe weetaaga businziira ku bintu nga ekika kya NHL, omutendera gwa kookolo, n’obulamu bwo okutwalira awamu. Obujjanjabi bw’oyinza okukozesa mulimu:

• Okulondoola ennyo: Bw’oba ​​olina obulwadde bwa indolent non-Hodgkin lymphoma era nga tolaga bubonero bwonna, omusawo ayinza okulwawo okutandika obujjanjabi. Kino kiyitibwa okulondoola okukola oba "okulinda okutunula." Abasawo bajja kulondoola obulamu bwo buli kiseera, basobole okutandika obujjanjabi amangu ddala ng’obubonero bulabika.
• Chemotherapy: Chemotherapy bujjanjabi obukozesa eddagala okutta obutoffaali bwa kookolo mu mubiri gwonna. Buno bwe bujjanjabi obusinga okukozesebwa mu NHL. Oyinza okufuna obujjanjabi bw’eddagala bwokka oba nga bugatta wamu n’obujjanjabi obulala.
• Obujjanjabi obugendereddwamu: Obujjanjabi buno butunuulira obunafu obw’enjawulo mu butoffaali bwa kookolo ne bubusaanyawo. Obujjanjabi bwa monoclonal antibody bujjanjabi obutera okukozesebwa obugendereddwamu ku NHL.
• Obujjanjabi bw’abaserikale b’omubiri:Obujjanjabi buno busitula abaserikale b’omubiri gwo, ne buba bwa maanyi okusaanyaawo obutoffaali bwa kookolo. Obujjanjabi bw’obutoffaali bwa CAR-T kika kya bujjanjabi bw’abaserikale b’omubiri obutera okukozesebwa ku NHL. Ebirungo ebiziyiza endwadde (bispecific antibodies) kiraasi empya ey’eddagala. Zino zitunuulira obutoffaali bwo obwa T ne zitta obutoffaali bwa kookolo obwa lymphoma.
• Obujjanjabi bw’amasannyalaze: Obujjanjabi buno bukozesa emisinde egy’amaanyi amangi okuva mu kyuma okutta obutoffaali bwa kookolo. Kino kiyinza okumala ku NHL eyasooka. Abasawo era bakozesa enkola eno okutta obutoffaali bwa lymphoma obuyinza okusigalawo oluvannyuma lw’okuweebwa eddagala.
• Obujjanjabi bw’eddagala n’okusimbuliza obutoffaali obusibuka: Mu bujjanjabi buno, dose nnyingi ez’eddagala ziweebwa okujjanjaba kookolo. Oluvannyuma, obutoffaali bw’omusaayi obutakuze obwonooneddwa eddagala eriweweeza ku bulwadde bukyusibwa ne bufuulibwa obutoffaali obusibuka obulungi okuva mu mubiri gwo oba okuva mu muntu agaba. Oyinza okwetaaga okusimbuliza kuno singa obujjanjabi obulala obwa NHL tebuyambye.

Biki ebiva mu bujjanjabi buno?

Enzijanjaba za kookolo eza bulijjo ez’obulwadde bwa Non-Hodgkin Lymphoma, gamba ng’obujjanjabi bw’eddagala, obujjanjabi obw’amasannyalaze, n’obujjanjabi bw’abaserikale b’omubiri, busobola okuvaako ebizibu. Ebisinga bino biba bya bbanga ttono era nga biweddewo ng’obujjanjabi buwedde. Kyokka, ebizibu ebimu bisobola okumala ebbanga eddene.

Nga tonnatandika bujjanjabi, kakasa nti obuuza omusawo wo ku biyinza okuvaamu. Asobola okunnyonnyola emigaso gy’obujjanjabi n’obulabe obuli mu buzibu obuva mu bujjanjabi.

Obulamu bunaaba butya ne NHL? (Endowooza/Okulagula)

Mu mbeera ezimu, obujjanjabi busobola `okuwonya` ddala Non-Hodgkin Lymphoma. Kino kitegeeza nti obutoffaali bwa kookolo bwonna busaanawo enkalakkalira nga bujjanjabwa. Kino kitera okulabibwa oluvannyuma lw’okujjanjabwa obulwadde bwa aggressive B-cell lymphomas. Singa Non-Hodgkin Lymphoma ekomawo, etera okubaawo mu myaka ebiri egisooka oluvannyuma lw’okujjanjabwa. Bwe kitaba ekyo, kiyinza obutaddayo. Wabula ojja kwetaaga okwekebejjebwa buli kiseera okukebera oba ozzeemu okulwala.

Ebika ebirala ebya Non-Hodgkin Lymphoma naddala ebyo ebisaasaana mpola (indolent), bisobola okumala ebbanga eddene. Kino kitegeeza nti oyinza okwetaaga okufuna obujjanjabi obutasalako oba oluusi n’oluusi mu bulamu bwo bwonna.

Naye, ekisinga obukulu kiri nti wadde nga Non-Hodgkin Lymphoma tesobola kuwona, obujjanjabi obuliwo kati busobozesa abantu okuwangaala obulamu obuwanvu, obw’essanyu n’obulwadde buno . Abantu bangi abalina obulwadde bwa lymphoma obukula mpola bafa olw’ensonga endala, ne bwe kiba nti lymphoma tesobola kuwona.

Omuwendo gw’abawona okuva mu NHL guli gutya?

Okusinziira ku kitongole kya US National Cancer Institute, abantu 74% abalina obulwadde bwa Non-Hodgkin Lymphoma baba balamu oluvannyuma lw’emyaka etaano bukya bazuuliddwa.

Okutwaliza awamu, abantu abazuulibwa nga obulwadde buno tebunnasaasaana bawangaala nnyo okusinga abo abazuulibwa nga kookolo amaze okusaasaana. Omuwendo gw’okuwangaala kw’emyaka etaano eri abantu abalina obulwadde bwa Non-Hodgkin Lymphoma obw’omutendera ogusooka (emitendera I ne II) guli wakati wa 79% ne 87%. Ku bantu abalina obulwadde obw’omutendera ogw’oku ntikko (emitendera III ne IV), omuwendo guli wakati wa 64% ne 73%.

Oyinza otya okwerabirira ng’omuntu alina NHL?

Waliwo ebintu ebiwerako by’osobola okukola okuddukanya okubeera n’obulwadde bwa Non-Hodgkin Lymphoma. Ebintu bino tebijja kuleetera bulwadde bwo kuggwaawo, naye bisobola okukuyamba okuwulira nga weesiga mu bulamu nabwo:

• Lya emmere ennungi: Emmere maanyi. Okulya obulungi y’emu ku ngeri y’okukuuma amaanyi. Buuza omukugu mu by’emmere okumanya ebisingawo oba ebirowoozo ku mmere n’emmere ey’akawoowo.
• Wummula nnyo nga bwe kisoboka: Obujjanjabi ng’eddagala eriweweeza ku bulwadde buyinza okukuleetera okuwulira ng’okooye nnyo. Okuwummula kiyamba omubiri gwo okudda engulu n’okuddamu amaanyi.
• Dukanya situleesi: Okubeera n’obulwadde bwa Non-Hodgkin Lymphoma si kyangu. Oyinza okweraliikirira engeri obulwadde n’obujjanjabi gye binaakwata ku bulamu bwo obwa bulijjo. Bw’oba ​​weeraliikirira engeri gy’ogenda okuteeberezaamu, yogerako n’omusawo wo. Asobola okuddamu ebibuuzo byo n‟okukubuulira ku pulogulaamu eziyinza okuyamba, gamba ng‟ebibiina ebiwagira.
• Dduyiro: Dduyiro buli kiseera y’emu ku ngeri ezisinga okukuuma ebirowoozo n’omubiri nga biramu bulungi. Yogerako n’omusawo wo ku bika bya dduyiro n’amaanyi ebikusaanira.
• Funa obuyambi obw’enjawulo: Bw’oba ​​obeera n’obulwadde bwa Non-Hodgkin Lymphoma, tunuulira obujjanjabi obukkakkanya obulumi. Obulabirizi obukkakkanya obulumi buwa obuweerero ku bubonero n‟obuwagizi eri abantu abalina kookolo, awatali kulowooza ku mutendera gw‟obulwadde oba okuteebereza.

Ddi lwe nnina okulaba omusawo?

Bw’oba ​​ojjanjabwa obulwadde bwa Non-Hodgkin Lymphoma, laba omusawo amangu ago singa obubonero bwo buddamu oba bweyongera. Oluvannyuma lw’obujjanjabi bwo okuggwa, kakasa nti ogenda mu kulambula kwonna okugoberera nga bwe kyali kitegekeddwa.

Ddi lw’osaanidde okugenda mu kisenge eky’abalwadde ab’amangu?

Bw’oba ​​olina obubonero obw’amaanyi, oba singa obubonero bwo bweyongera nga tofunye buweerero bwonna ku bintu by’okola okukendeeza ku buzibu bwo, genda mu kisenge eky’amangu.

Ebibuuzo ebikulu by’olina okubuuza omusawo wo

Bino bye bimu ku bibuuzo by’oyinza okubuuza omusawo wo:

• Nnina kika ki ekya Non-Hodgkin Lymphoma?
• Obulwadde bwange buli ku mutendera ki?
• Bujjanjabi ki bw’oteesa?
• Biki ebiva mu bujjanjabi obwo?
• Obulwadde bwange obwa Non-Hodgkin Lymphoma busobola okuwona?
• Omukisa gwa kookolo okuddamu guli gutya?

Okuzuula nti olina obulwadde bwa Non-Hodgkin Lymphoma (NHL) kiyinza okukuzitoowerera olw’ensonga eziwerako. Waliwo ebika by’obulwadde eby’enjawulo, nga buli kimu kivaamu eby’enjawulo. Ebika ebimu ebisaasaana amangu biyinza okwetaaga obujjanjabi obusingawo era biyinza okuba n’ebizibu ebitali birungi - naye ku nkomerero biwona. Ebika ebirala biyinza obuteetaaga bujjanjabi bwa mangu, naye bijja kwetaaga okuddukanyizibwa okumala ebbanga eddene. Tewali kuddamu kwangu n’okuzuula kuno.

Omusawo asobola okunnyonnyola engeri okuzuulibwa kwo okwa NHL gye kunaakwata ku bulamu bwo mu biseera eby’omu maaso. Mu kiseera kino, jjukira nti abantu abalina obulwadde buno kati bawangaala. Buuza omusawo wo ku prognose yo okusinziira ku mbeera yo.

Ensonga enkulu z'olina okukuuma mu birowoozo (Take-Home Message)

Wadde ng’obulwadde bwa Non-Hodgkin Lymphoma (NHL) kintu kya kutya, kikulu okubumanya n’okunoonya amagezi mu bwangu omusawo. Okujjukira:

• Bw’oba ​​olina obubonero ng’okuzimba okutategeerekese, okukoowa okutambula obutasalako, okutuuyana ekiro, oba okugejja mu ngeri etategeerekeka , laba omusawo.
• Obujjanjabi obulungi ku NHL kati buliwo, era abantu bangi bawangaala bulungi n’obulwadde buno.
• Yogerako mu lwatu n’omusawo wo era obuuze ebibuuzo byo byonna.
• Okusigala nga oli mu mbeera nnungi n’okwefaako obulungi kikulu nnyo mu lugendo luno.

Toli wekka. Tusuubira nti amawulire gano gajja kukuwa amaanyi.

` Non-Hodgkin Lymphoma, Lymphoma, Kookolo, Ennywanto z’omusaayi, Obubonero, Obujjanjabi, NHL