Kodi mudamvapo za matenda a Chronic Lymphocytic Leukemia (CLL)? Tiyeni tikambirane mwatsatanetsatane!

Kodi nthawi zina mumangomva kutopa kwambiri? Kapena nthawi zambiri mumadwala malungo? Kodi muli ndi zotupa zazing'ono zomwe zimamveka ngati zili pakhosi panu, m'khwapa, kapena m'mimba mwanu? Izi zitha kukhala zizindikiro za Chronic Lymphocytic Leukemia, kapena CLL mwachidule. Koma musadandaule, chifukwa kukhala ndi zizindikiro zonsezi sikutanthauza kuti muli ndi matendawa. Koma ndikofunikira kwambiri kudziwa zinthu ngati izi. Choncho tiyeni tikambirane za CLL m'njira yosavuta lero, chabwino?

Kodi khansa ya m'magazi yotchedwa chronic lymphocytic leukemia (CLL) ndi chiyani? Mwachidule...

Matenda a khansa ya m'magazi otchedwa chronic lymphocytic leukemia (CLL) ndi mtundu wa khansa ya m'magazi . Ndi mtundu wofala kwambiri wa khansa ya m'magazi mwa akuluakulu. Maselo a m'magazi amapangidwa mu fupa la mafupa. Matendawa amapezeka pamene ma lymphocytes, mtundu wa maselo oyera athanzi m'fupa la mafupa, amakhala osazolowereka, zomwe zikutanthauza kuti amasintha n'kukhala khansa. Maselo a khansa amenewa amachulukana mosalamulirika, kutseka maselo athanzi a m'magazi ndi ma platelet, omwe amathandiza magazi kuundana.

Matenda a CLL nthawi zambiri amapezeka mwa anthu azaka zopitilira 65. Komabe, nthawi zina amatha kupezeka mwa anthu azaka zapakati pa 30. Komanso, anthu ena amatha kukhala ndi CLL popanda zizindikiro zilizonse . Anthu ambiri amadziwa za matendawa akamayesedwa magazi kuti adziwe vuto lina kapena akamayesedwa ndi dokotala chaka chilichonse.

Pakadali pano, palibe mankhwala a CLL. Koma zimenezo si chifukwa chodera nkhawa. M'zaka khumi zapitazi, madokotala apanga njira zatsopano zochizira CLL ndikuyipangitsa kuti ichepe . Mankhwalawa athandiza anthu omwe ali ndi CLL kukhala ndi moyo wautali.

Kodi mitundu ikuluikulu ya CLL ndi iti?

Pali mitundu iwiri ikuluikulu ya maselo oyera m'thupi lathu, yotchedwa lymphocytes. CLL imatha kufalikira mu imodzi mwa mitundu iwiriyi yokha.

• Ma B-lymphocytes (ma B-cell): Awa ndi maselo omwe amapanga ma antibodies, mtundu wa mapuloteni omwe amazindikira ndikulimbana ndi majeremusi oopsa, mabakiteriya, mavairasi, komanso maselo a khansa.
• Ma T-lymphocytes (ma T-cell): Awa amalamulira momwe chitetezo cha mthupi lathu chimayankhira. Amapezanso ndikuwononga mwachindunji maselo osazolowereka, monga maselo a khansa.

Mtundu wofala kwambiri wa CLL ndi B-cell CLL . Pali vuto lina lomwe limakhudza maselo a T, lotchedwa T-cell prolymphocytic leukemia (PLL). Komabe, anthu omwe ali ndi PLL amadwala zizindikiro mofulumira kuposa anthu omwe ali ndi B- cell CLL.

Kodi vuto limeneli lotchedwa CLL ndi lofala bwanji?

Ndipotu, khansa ya m'magazi yosatha (CLL) ndi imodzi mwa mitundu yofala kwambiri ya khansa ya m'magazi mwa akuluakulu. Ku United States, matendawa amakhudza anthu pafupifupi 5 mwa anthu 100,000. Bungwe la American Cancer Society likuyerekeza kuti padzakhala milandu yatsopano pafupifupi 18,700 ya CLL mu 2023 yokha. Kuti timvetse bwino izi, milandu yatsopano yoposa 238,000 ya khansa ya m'mapapo (imodzi mwa khansa yofala kwambiri) ikuyembekezeka kunenedwa mu 2023. Chifukwa chake, ngakhale kuti CLL singawoneke yofala kwambiri, ndi imodzi mwa mitundu yofala kwambiri ya khansa ya m'magazi.

Kodi zizindikiro za CLL ndi ziti?

Monga tanenera kale, anthu ena amatha kukhala ndi CLL popanda zizindikiro zilizonse . Zingatenge miyezi kapena zaka kuti zizindikiro ziwonekere. Zizindikiro zodziwika bwino ndi izi:

• Kutopa: CLL ingakhudze maselo ofiira a magazi anu, zomwe zimayambitsa kuchepa kwa magazi m'thupi. Kutopa ndi chizindikiro chofala cha kuchepa kwa magazi m'thupi.
• Malungo: Malungo ndi chizindikiro cha matenda. Popeza CLL imakhudza maselo oyera athanzi, mumakhala ndi mwayi wopeza matenda.
• Kutupa kwa ma lymph nodes m'khosi, m'khwapa, m'mimba, kapena m'mimba.
• Thukuta la usiku.
• Kuchepetsa thupi kosamveka bwino.
• Ululu kapena kumva kukhuta pansi pa nthiti zanu: CLL ingakhudze chiwindi kapena ndulu yanu. Maselo a khansa akasonkhana m'ziwalo zimenezi, amatha kutupa.

N’chifukwa chiyani CLL imayamba? Kodi zinthu zoopsa ndi ziti?

Matenda a chronic lymphocytic leukemia (CLL) amayamba pamene kusintha kwina, kapena kusintha, kumachitika m'ma chromosome ndi majini athu m'moyo wathu wonse. Komabe, ofufuza zachipatala sakudziwabe chomwe chimayambitsa kusinthaku. Komabe, apeza zinthu zingapo zomwe zingakhudze izi:

• Mbiri ya Banja: Kafukufuku wasonyeza kuti ngati wachibale wanu wapafupi, kutanthauza amayi anu, abambo anu, abale anu, kapena ana anu, ali ndi CLL, chiopsezo chanu chokhala ndi CLL chingakwere kawiri kapena kanayi.
• Zaka: Pa avareji, odwala ali ndi zaka pafupifupi 71 akapezeka ndi CLL.
• Kugonana: Amuna ali ndi mwayi waukulu wopeza matenda a CLL.
• Kukumana ndi Agent Orange: Kafukufuku wasonyeza kuti pali kugwirizana pakati pa Agent Orange, mankhwala omwe amagwiritsidwa ntchito pa Nkhondo ya Vietnam, ndi CLL.
• Maselo a B-monoclonal lymphocytosis:Mu mkhalidwe uwu, muli ndi mtundu umodzi wa maselo a B m'magazi mwanu kuposa mwachibadwa. Ngati muli ndi vutoli, muli ndi chiopsezo chochepa chotenga CLL.

Kodi mavuto omwe angakhalepo chifukwa cha CLL ndi ati?

CLL imakhudza maselo anu ofiira a magazi, maselo oyera a magazi, ndi ma platelet. Taganizirani izi, maselo ofiira a magazi amanyamula mpweya m'thupi lonse. Maselo oyera a magazi amatiteteza ku matenda. Ma platelet amathandiza magazi kuundana. Chifukwa chake, mukataya maselo athanzi awa a magazi ndi ma platelet, mutha kukhala ndi mavuto monga:

• Lymphoma: Pakati pa 2% ndi 10% ya anthu omwe ali ndi CLL akhoza kudwala khansa yotchedwa lymphoma.
• Khansa ya pakhungu, khansa ya m'mapapo, kapena khansa ya m'matumbo: CLL imafooketsa chitetezo cha mthupi, zomwe zimapangitsa kuti chisathe kukutetezani ku zinthu zowononga, kuphatikizapo maselo a khansa. Izi zitha kuwonjezera chiopsezo chanu chokhala ndi mitundu ina ya khansa.
• Kuchepa kwa magazi m'thupi: Kuchepa kwa magazi m'thupi kungachitike ngati palibe maselo ofiira okwanira onyamula mpweya m'thupi lonse.
• Thrombocytopenia: CLL ingakhudze kuchuluka kwa ma platelet m'magazi. Izi zingayambitse kutuluka magazi.
• Matenda ofala: Popanda maselo oyera athanzi okwanira, mumakhala ndi mwayi waukulu wopeza matenda a bakiteriya, bowa, kapena mavairasi.
• Matenda a Autoimmune: Anthu ena omwe ali ndi CLL amatha kukhala ndi matenda monga autoimmune hemolytic anemia.

Kodi matenda a CLL amachiritsidwa bwanji?

Mukapita kukaonana ndi dokotala, adzakufunsani za zizindikiro zanu. Kenako, adzakuyesani thupi ndipo angakupatseni mayeso ena, monga:

• Kuchuluka kwa magazi (CBC) ndi kusiyana kwake: Kuyeza kumeneku kumayesa kuchuluka kwa maselo ofiira a magazi, maselo oyera a magazi, ndi ma platelet m'magazi anu. Kumayesanso kuchuluka kwa hemoglobin (puloteni yomwe imanyamula mpweya) m'maselo ofiira a magazi anu.
• Kuyeza magazi m'mbali mwa thupi: Katswiri wa labotale yachipatala amafufuza maselo a magazi anu pogwiritsa ntchito maikulosikopu kuti aone ngati ali ndi maselo a khansa.
• Kuyeza kwa magazi m'magazi: Kuyeza kumeneku kungapereke chidziwitso chochuluka chokhudza maselo anu a m'magazi. Mu CLL, kumagwiritsidwa ntchito kudziwa ngati maselo anu oyera a m'magazi ali ndi maselo a CLL.
• Mayeso a majini:Madokotala amagwiritsa ntchito mayeso monga fluorescent in situ hybridization (FISH) ndi immunoglobulin heavy chain (IGHV) kuti aone ma chromosome ndi majini anu. Kumvetsetsa kusintha komwe kwachitika mu ma chromosome ndi majini awa kumathandiza madokotala kusankha momwe angachiritsire CLL.

Magawo a CLL

Madokotala amasankha gawo la khansa kuti akonze chithandizo ndi kuneneratu za nthawi yomwe khansa idzachitike. Pali njira ziwiri zazikulu zomwe zimagwiritsidwa ntchito pokonza CLL: Rai staging system ndi Binet staging system .

Nthawi zina, mukawerenga magawo awa m'malembo ndi manambala, mungamve mantha pang'ono komanso osamasuka. Mungaganize kuti, "Kodi umu ndi momwe matenda anga amafotokozedwera mu fomula?" Madokotala akumvetsa zimenezo. Ngati simukumvetsa bwino zomwe zikunenedwa, kapena ngati zikukulemetsani, chonde funsani dokotala wanu kuti akufotokozereni momwe dongosololi limagwirira ntchito pa vuto lanu.

Dongosolo la Rai lokonzekera

Njira iyi imagawa CLL malinga ndi kuthekera kwake kuti ikule komanso ngati chithandizo chidzafunika:

• Chiwopsezo chochepa (chomwe kale chinkadziwika kuti Rai stage 0): Muli ndi lymphocytosis (kuwonjezeka kwa ma lymphocytes), ndipo pali maselo oyera amagazi osazolowereka m'magazi ndi/kapena m'mafupa.
• Chiwopsezo chapakati (chomwe kale chinkadziwika kuti Rai stage I kapena steji II): Muli ndi lymphocytosis, lymph nodes zotupa, komanso ndulu yokulirapo ndi/kapena chiwindi.
• Chiwopsezo chachikulu (chomwe kale chinkadziwika kuti Rai Stage III): Muli ndi vuto la kuchepa kwa magazi m'thupi kapena thrombocytopenia (kuchuluka kwa ma platelet m'magazi).

Dongosolo la Binet staging

Njirayi imachokera ku kuchuluka kwa maselo a m'magazi ndi ma platelet, komanso kuchuluka kwa madera omwe ali ndi ma lymph nodes otupa m'thupi lanu:

• Gawo A: Mulibe kuchepa kwa magazi m'thupi (kuchepa kwa maselo ofiira m'magazi) kapena kuchepa kwa ma platelet. Komabe, muli ndi ma lymph node otupa m'malo osachepera awiri pathupi lanu. Mwachitsanzo, mungakhale ndi ma lymph node otupa m'khosi ndi m'mimba mwanu.
• Gawo B: Pali ma lymph nodes otupa m'malo atatu pa thupi, kapena chiwindi kapena ndulu yatupa. Komabe, palibe kuchepa kwa magazi m'thupi, ndipo kuchuluka kwa ma platelet kumakhala koyenera.
• Gawo C: Muli ndi vuto la kuchepa kwa magazi m'thupi komanso kutupa kwa ma lymph nodes m'malo atatu kapena kuposerapo m'thupi lanu.

Kodi CLL imachiritsidwa bwanji?

Njira zochiritsira zimatsimikiziridwa ndi zizindikiro zanu ndi zotsatira za mayeso. Mwachitsanzo, ngati muli ndi CLL yoyambirira, dokotala wanu angakulangizeni "kudikira mosamala/kuyang'anira mwachangu."Mukhoza kugwiritsa ntchito njira yotchedwa "monitoring." Izi zikuphatikizapo kuyang'anira mosamala thanzi lanu lonse, zizindikiro, ndi zotsatira za mayeso popanda kuyamba kulandira chithandizo.

Zotsatira za mayeso a majini zingakhudzenso zisankho za chithandizo. Mwachitsanzo, kusintha kwina kwa majini kungatanthauze kuti vuto lanu lingaipe msanga, kapena kuti mankhwala ochiritsira a CLL sangagwire ntchito bwino monga momwe amayembekezera.

Mankhwala odziwika bwino a CLL ndi chithandizo cholunjika ndi chemotherapy . Nthawi zina chithandizo cha radiation chimagwiritsidwa ntchito kuchepetsa zizindikiro za CLL. Chithandizo chilichonse mwa izi chingayambitse zotsatira zosiyana. Dokotala wanu adzafotokoza momveka bwino ubwino, zotsatira zake, ndi mavuto omwe angakhalepo kwa nthawi yayitali chifukwa cha chithandizo chomwe mukulandira.

Chithandizo cholunjika

Mankhwalawa amagwira ntchito polimbana ndi maselo a khansa. Mu khansa ya m'magazi ya lymphocytic yosatha, mankhwalawa amagwira ntchito poletsa kukula kwa maselo oyera amagazi omwe ali ndi khansa. Mankhwala ena ochizira amapha maselo a khansa popanda kuvulaza maselo athanzi. Mankhwala ena omwe amagwiritsidwa ntchito pa izi ndi awa:

• Chithandizo cha Bruton's tyrosine kinase (BTK) choletsa: Chithandizochi chimatseka enzyme yomwe imathandiza maselo a B kupanga maselo oyera ambiri. Zitsanzo: ibrutinib (Imbruvica®) , acalabrutinib (Calquence®) , ndi zanubrutinib (Brukinsa ®) .
• Chithandizo cha BCL2 inhibitor: Mankhwala a venetoclax (Venclexta®) amaletsa puloteni yotchedwa BCL2 yomwe imapezeka m'maselo a leukemia, kuphatikizapo maselo a CLL. Chithandizochi chingaphe maselo a leukemia kapena kuwapangitsa kukhala omasuka kwambiri ndi mankhwala ena oletsa khansa.
• Mankhwala a monoclonal antibody: Uwu ndi mtundu wa chithandizo cha immunotherapy. Ma antibodies a monoclonal ndi mtundu wa antibody wopangidwa mu labotale. Amaletsa kukula kwa maselo a khansa kapena kupha maselo a khansa. Zitsanzo: rituximab (Rituxan®) ndi obinutuzumab (Gazyva®) .

Mankhwala a Chemotherapy

Dokotala wanu angagwiritse ntchito mankhwala a chemotherapy ngati chithandizo chachikulu cha khansa ya m'magazi yosatha. Ena mwa mankhwala a chemotherapy omwe amagwiritsidwa ntchito kwambiri pa CLL ndi awa:

• Fludarabine (Fludarabine - Fludara®)
• Chlorambucil (Chlorambucil-Leukeran®)
• Cyclophosphamide (Cytoxan®)
• Bendamustine (Bendamustine - Treanda®)

Chithandizo cha Immunotherapy

Njira yochizira iyi imagwira ntchito pobwezeretsa kapena kulimbitsa chitetezo cha mthupi lanu, kuthandiza kuwononga maselo a khansa kapena kuchepetsa kukula kwawo.

Kwa CLL yomwe sinayankhe mankhwala a chemotherapy, yabwerera (yobwerezabwereza) CLL, kapena ikuipiraipira, madokotala angagwiritse ntchito mankhwala a immunotherapy a lenalidomide (Revlimid®) .

Ofufuza zachipatala akuphunziranso za chithandizo cha chimeric antigen receptor (CAR-T) kwa odwala CLL omwe salabadira chithandizo chamankhwala wamba.

Kodi mungakhale ndi moyo wautali bwanji ndi CLL?

Matenda a chronic lymphocytic leukemia (CLL) nthawi zambiri amakula pang'onopang'ono. Mutha kukhala ndi CLL kwa zaka zambiri musanayambe zizindikiro. Zizindikiro zikayamba kuonekera, madokotala amakhala ndi mankhwala othandiza kwambiri omwe angayambitse CLL kuchira . Kuchira kumeneku kuchokera ku CLL nthawi zambiri kumatenga zaka zingapo matendawa asanabwererenso. Komabe, dokotala wanu angakulangizeni mankhwala ena omwe angayambitsenso CLL kuchira. CLL sichitha kuchiritsidwa, koma anthu omwe ali ndi matendawa amatha kukhala ndi moyo wautali komanso wathunthu.

Bungwe la National Cancer Institute likuyerekeza kuti 87.9% ya odwala omwe ali ndi CLL amakhala ndi moyo zaka zisanu kuchokera pamene adapezeka ndi matendawa. Komabe, poganizira kuchuluka kwa anthu omwe ali ndi matendawa, ndikofunikira kukumbukira kuti izi ndi ziwerengero zochokera ku zomwe gulu lalikulu la odwala omwe ali ndi CLL lakumana nazo. Zinthu zambiri zingakhudze kuchuluka kwa anthu omwe ali ndi matendawa, kuphatikizapo thanzi lanu lonse, gawo la matenda anu omwe adapezeka ndi matendawa, komanso momwe matenda anu amayankhira bwino akalandira chithandizo. Ngati muli ndi mafunso, funsani dokotala wanu zomwe mungayembekezere kutengera momwe zinthu zilili.

Kodi chimachitika ndi chiyani kumapeto kwa CLL?

Mawu akuti "gawo lomaliza" amatanthauza kuti mankhwala sagwiranso ntchito poletsa kapena kuletsa matenda a CLL. Pa nthawi imeneyo, mungakhale ndi matenda oopsa kapena kutuluka magazi kosalamulirika omwe madokotala sangathe kuchiritsa.

Kodi vutoli lingapewedwe?

Pakadali pano palibe njira yodziwika yopewera CLL.

Kodi zimakhala bwanji kukhala ndi CLL?

Zimadalira momwe mulili. Mutha kukhala ndi CLL popanda zizindikiro zilizonse. Ngati muli ndi zizindikiro, pali mankhwala ochepetsa matendawa ndikusamalira matendawa. Komabe, matendawa sadzatha konse.

Nazi malingaliro ena omwe angakuthandizeni pamene mukukhala ndi CLL:

• Dzitetezeni ku matenda:Anthu omwe ali ndi CLL ali pachiwopsezo chachikulu chotenga matenda. Matenda ena akhoza kukhala pachiwopsezo cha moyo. Funsani dokotala wanu za katemera woyenera kwa inu.
• Dziwani thanzi lanu lonse: Mungakhale pachiwopsezo chachikulu chotenga khansa ya pakhungu, khansa ya m'mapapo, kapena khansa ya m'matumbo. Funsani dokotala wanu za mayeso oyezetsa khansa.
• Kusamalira kupsinjika maganizo: Anthu ambiri omwe ali ndi CLL amachira pang'onopang'ono ndipo amabwereranso m'mbuyo. Pamene matendawa akupita patsogolo, mungakhale ndi nkhawa komanso mantha. Ngati ndi choncho, funsani dokotala wanu za mapulogalamu kapena mautumiki omwe angakuthandizeni kuthana ndi kupsinjika maganizo kwanu.
• Idyani zakudya zabwino: Zizindikiro zina za CLL zingakupangitseni kutaya chilakolako chanu. Lankhulani ndi dokotala wanu za kupeza upangiri kuchokera kwa katswiri wa zakudya. Ngati chilakolako chanu chili chabwino, yesani kudya zakudya zopatsa thanzi zomwe zimaphatikizapo mapuloteni opanda mafuta ambiri, tirigu wonse, zipatso ndi ndiwo zamasamba, ndi mafuta abwino. Izi zingakuthandizeni kukhala ndi thanzi labwino.
• Kuchita Masewera Olimbitsa Thupi: Kuchita masewera olimbitsa thupi kumakuthandizani kuchepetsa nkhawa komanso kukhala osangalala.
• Musamavutike: CLL ingakupangitseni kumva kutopa kwambiri. Pumulani mukafuna thandizo.
• Dziwani zomwe mungayembekezere: Chidziwitso ndi mphamvu. Funsani dokotala wanu kuti akuuzeni zizindikiro zosonyeza kuti vuto lanu likuipiraipira. Ngati ndi choncho, dokotala wanu angakulangizeni njira zina zothandizira CLL yanu bwino.

Ndi mafunso ati omwe ndiyenera kufunsa dokotala wanga?

Mungafune kufunsa mafunso ngati awa:

• Kodi ndili ndi mtundu wanji wa khansa ya m'magazi yosatha ya lymphocytic?
• Ndilibe zizindikiro. Kodi ndiyenera kuyamba liti kulandira chithandizo?
• Kodi ndi njira ziti zochiritsira zomwe ndili nazo?
• Kodi ndiyenera kumwa mankhwala kwamuyaya?
• Kodi chithandizo chidzathandiza kuti vuto langa likhale bwino?

Pomaliza, zinthu zoti muzikumbukira (Uthenga Wopita Nawo Kunyumba)

Matenda a khansa ya m'magazi (CLL) ndi mtundu wa khansa ya m'magazi yomwe imapezeka kwambiri mwa akuluakulu. Mutha kukhala ndi vutoli kwa zaka zambiri popanda zizindikiro zilizonse. Ngati muli ndi CLL, simungafunike kuyamba kulandira chithandizo nthawi yomweyo. Ngakhale madokotala sangathe kuchiza matendawa kwathunthu, pali mankhwala omwe angathandize kuchepetsa zizindikiro za CLL ndikupangitsa kuti matendawa achepe . Anthu ena omwe ali ndi CLL amakhala ndi moyo kwa zaka zambiri.

Kukhala ndi matenda osatha monga CLL sikophweka nthawi zonse. Mutha kudutsa m'njira zingapo zochira ndikubwereranso. Pa nthawi iliyonse, mutha kuda nkhawa ndi zomwe zidzachitike pambuyo pake. Madokotala anu amamvetsetsa momwe zimakhalira kukhala ndi matenda osatha. Adzakhala okondwa kuyankha mafunso aliwonse omwe mungakhale nawo ndikukuthandizani mwanjira iliyonse yomwe angathe. Chifukwa chake, musaope kulankhula ndi dokotala wanu za nkhawa zanu.

Khansa ya m'magazi , CLL, khansa ya m'magazi, zizindikiro, chithandizo, ma lymphocyte, kuchira