Kodi mungamve bwanji ngati mutalandira chithandizo chachikulu monga kuikidwa kwa mafupa a khansa ya m'magazi ndi kuganiza kuti, "Zonse zili bwino tsopano," kenako n’kumva kuti khansa yabwerera? N’zomvetsa chisoni kwambiri komanso zomvetsa chisoni kwambiri. Koma musataye mtima. Lero tikulankhula za chithandizo chapadera chomwe chingathandize pazochitika ngati izi. Chimatchedwa DLI, chomwe chimatanthauza Donor Lymphocyte Infusion.
Mwachidule, kodi DLI ndi chiyani?
Chabwino, tiyeni tinene mwachidule. Ma lymphocyte ndi mtundu wa maselo oyera m'magazi mwanu. Ali ngati asilikali m'matupi mwathu. Ndi gawo lalikulu la chitetezo chathu chamthupi, chomwe chimalimbana ndi majeremusi akunja, matenda, ndi maselo a khansa.
Tsopano, DLI (Donor Lymphocyte Infusion) ndi njira yomwe ma lymphocyte ena amatengedwa kuchokera kwa wopereka wathanzi yemweyo amene adapereka kale mafuta anu a m'mafupa (maselo oyambira) ndikubayidwa m'thupi lanu. 'Asilikali' atsopano, athanzi komanso amphamvu awa amafunafuna ndikuwononga maselo aliwonse a khansa omwe angakhale atabisala m'thupi lanu. Ndicho cholinga chachikulu cha chithandizochi.
Ndi nthawi ziti pamene chithandizo cha DLI chimalimbikitsidwa?
Dokotala wanu nthawi zambiri angakuuzeni za chithandizochi ngati khansa ya m'magazi mwanu yabwereranso (kubwerera m'mbuyo) mutapatsidwa fupa la mafuta.
Nazi zina mwa matenda omwe DLI imagwiritsidwa ntchito kwambiri:
- Matenda a Myeloid Leukemia (AML)
- Matenda a Leukemia Osatha a Lymphocytic (CLL)
- Matenda a Myeloid Leukemia Osatha (CML)
- Myeloma yambiri
- Myelodysplasia (MDS)
- Lymphoma Yosakhala ya Hodgkin
Chinthu china n'chakuti, nthawi zina mukatha kuyika mafupa, thupi lanu likhoza kukhala ndi maselo osiyanasiyana a donor ndi maselo anu akale. Timatcha izi (mixed chimerism) . Izi zimawonjezeranso chiopsezo cha khansa kubwerera. Chifukwa chake, DLI ikhoza kuchitidwa kuti maselo onse m'thupi lanu akhale maselo ochokera kwa woperekayo.
Kodi mumakonzekera bwanji chithandizochi?
Musanayambe kulandira chithandizo cha DLI, dokotala wanu adzakuyang'anirani mosamala, adzakambirana za zizindikiro zanu, ndikuyitanitsa mayeso angapo.
- Kufufuza za mafupa: Chitsanzo chaching'ono cha mafupa chimatengedwa kuti chione ngati pali maselo ena a khansa otsala.
- Kuchuluka kwa Magazi Onse (CBC):Chiwerengero cha maselo m'magazi chikuyesedwa.
- Mayeso a ntchito ya impso ndi chiwindi.
Ngati biopsy ikuwonetsa kuti mulingo wa maselo a khansa ndi wokwera kwambiri, dokotala wanu angasankhe kukupatsani chemotherapy musanachite DLI. Izi ndi cholinga chochepetsa kuchuluka kwa maselo a khansa ndikuwonjezera kupambana kwa chithandizo cha DLI.
Kodi maselo a lymphocyte amapezeka bwanji kuchokera kwa wopereka?
Ichi ndi chinthu chapadera kwambiri chomwe chimachitika. Wopereka amene anakupatsani moyo, kutanthauza wopereka amene anakupatsani mafupa, nayenso amathandiza pa izi. Chubu chaching'ono (catheter) chimalowetsedwa mu mtsempha womwe uli m'dzanja lake ndipo magazi ena amatengedwa. Magazi awa amadutsa mu makina apadera. Chomwe makinawo amachita ndikupatula maselo a lymphocyte omwe timafunikira okha, ndikutumiza magazi otsalawo ku thupi kudzera mu mtsempha womwe uli m'dzanja lina la woperekayo. Njirayi imatchedwa apheresis . Nthawi zina, mukayamba kupereka mafupa, maselo ena a lymphocyte awa amatha kutengedwa ndikusungidwa mufiriji kuti akagwiritsidwe ntchito pambuyo pake.
Kodi mumalandira bwanji chithandizo cha DLI?
Izi zimamveka ngati chinthu chophweka monga kukupatsani yankho la saline.
1. Dokotala kapena namwino adzaika chubu chaching'ono (catheter) mu mtsempha womwe uli m'dzanja lanu kapena pachifuwa chanu.
2. Kenako, paketi yokhala ndi maselo a lymphocyte olekanitsidwa ndi woperekayo imalumikizidwa ku chubu chimenecho ndikulowetsedwa m'magazi anu.
3. Ntchitoyi imatenga pafupifupi mphindi 30 .
4. Ntchito ikatha, chubucho chimachotsedwa.
Nthawi zina mungapereke mlingo wosiyanasiyana ngati uwu kwa milungu ingapo kapena miyezi ingapo.
Maselo atsopano akalowetsedwa m'thupi mwanjira imeneyi, chimodzi mwa zinthu zofunika kwambiri chimatchedwa graft vs. tumor effect (GvT) . Izi zikutanthauza kuti maselo athanzi awa (graft) ochokera kwa woperekayo amafunafuna maselo otsala a khansa (chotupa) m'thupi lanu, kuwaukira, ndikuwononga. Umu ndi momwe khansa imathera kwathunthu.
Kodi ubwino ndi zoopsa za chithandizo cha DLI ndi ziti?
Ubwino waukulu wa izi
Kale, ngati khansa inabweranso mutaika mafupa, njira yokhayo inali kuyika mafupa ena. Koma chiopsezo cha mavuto chinali chachikulu kwambiri ndi kuika mafupa ena kachiwiri. DLI ndi njira yabwino komanso yotsika mtengo yochepetsera khansa popanda mankhwala oletsa chitetezo cha mthupi.
Zoopsa ndi zovuta zomwe zingachitike
Monga momwe zimakhalira ndi mankhwala ena onse, pali zoopsa zina. Gulu lanu lachipatala lidzakuyang'anirani mosamala kuti mudziwe ngati muli ndi vutoli.
| Mavuto | Kufotokozera ndi zizindikiro |
|---|---|
| Matenda a Graft vs. Host (GvHD) | Apa ndi pamene maselo ochokera kwa wopereka (graft) amaona maselo athanzi a thupi lanu (wolandira) ngati mdani ndipo amawaukira. Zizindikiro: kutsegula m'mimba, chikasu cha khungu (jaundice), nseru ndi kusanza, zilonda pakhungu kapena ziphuphu. |
| Kuponderezedwa kwa Myelosuppression | Uku ndi kuchepa kwakanthawi kwa ntchito ya mafuta m'mafupa, zomwe zingayambitse kuchepa kwa chiwerengero cha maselo a magazi. - Maselo ofiira ochepa m'magazi (Anemia): kutopa, kupuma movutikira. - Kuchepa kwa maselo oyera m'magazi (Leukopenia): Kuwonjezeka kwa chiopsezo cha matenda opatsirana. - Ma platelet otsika: Kuwonjezeka kwa chiopsezo chotuluka magazi. |
Kodi mungachite chiyani ngati mavuto abuka?
Musadandaule. Pali mankhwala ochizira zonsezi.
- Ngati GvHD ichitika: Dokotala wanu adzakupatsani mankhwala oletsa chitetezo chamthupi .
- Ngati maselo anu a m'magazi ali ochepa: Maselo oyera otsika nthawi zambiri amatha okha. Ngati sichoncho, pali mankhwala ochizira. Kuikidwa magazi kungaperekedwe ngati kuli kofunikira pochiza maselo ofiira ndi ma platelet otsika.
Pambuyo pa chithandizo ndi za kupambana
Lankhulani ndi dokotala wanu za nthawi yomwe zingatenge kuti mubwererenso ku thanzi lanu mukalandira chithandizo. Mudzafunika kutsatiridwa nthawi zonse ndi kuyezetsa magazi.
Kupambana kwa chithandizochi kungasiyane malinga ndi munthu. Pali zinthu zingapo zomwe zimakhudza:
- Gawo la khansa.
- Thanzi la chitetezo chamthupi chanu.
- Mtundu wa kuikidwa kwa chiberekero komwe kunachitika kale.
- Kaya chemotherapy idachitidwa DLI isanachitike kapena ayi.
Chofunika kwambiri: Ngati mukupeza zizindikiro za GvHD monga kutentha thupi, kutuluka magazi kosazolowereka, kupuma movutikira, kutsegula m'mimba, ziphuphu pakhungu, kapena zizindikiro zina zosazolowereka , dziwitsani dokotala wanu kapena kuchipatala chomwe chikukuthandizani nthawi yomweyo.
Kodi DLI ndi chithandizo cha immunotherapy?
Inde, DLI ndi chithandizo cha immunotherapy.Ndi mtundu wa chithandizo. Chifukwa chomwe mukuchita ndikupatsa chitetezo chanu chamthupi chathanzi ma T-cell ochokera kunja kuti chithandizire kulimbana ndi khansa. Zimenezo n'zolimbikitsa kwambiri.
Uthenga Wopita Nawo Kunyumba
- DLI ndi mankhwala apadera a khansa ya m'magazi yomwe imabwereranso pambuyo poika mafupa enaake.
- Izi zimagwiritsa ntchito maselo otchedwa ma lymphocyte ochokera kwa wopereka wathanzi yemweyo amene adapereka mafuta anu a m'mafupa poyamba.
- Cholinga cha izi ndi chakuti maselo atsopanowa afufuze ndikuwononga maselo otsala a khansa m'thupi (GvT effect).
- Zoopsa zazikulu ndi GvHD (Graft vs. Host Disease) ndi kuchepa kwa maselo m'magazi, koma izi zimatha kuchiritsidwa.
- Uwu ndi mtundu wa chithandizo cha chitetezo chamthupi chomwe chimapereka chiyembekezo popanda zoopsa zazikulu za kusamutsidwa kwachiwiri kwa mafupa.
- Lankhulani ndi dokotala wanu nthawi yomweyo za zizindikiro kapena mavuto atsopano.
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