Kodi tiyenera kudziwa za matenda a PTLD (Post-Transplant Lymphoproliferative Disorders) titaika chiwalo china?

Inu kapena munthu amene mumamudziwa mwina mwachitidwa opaleshoni yaikulu yopulumutsa moyo, monga kuikidwa chiwalo. Kapena kuikidwa maselo oyambira. Pambuyo pa izi, pamakhala mavuto osowa komanso osayembekezereka. Vuto limodzi lotere ndi PTLD, kapena Post-Transplant Lymphoproliferative Disorders. Popeza izi zitha kukhala zovuta pang'ono, tiyeni tikambirane za izi m'njira yosavuta yomwe mungamvetse.

Kodi PTLD kwenikweni ndi chiyani?

Mwachidule, PTLD ndi vuto lomwe lingayambitse imfa lomwe lingachitike mutaika chiwalo kapena mutaika maselo oyambira a allogeneic. Chomwe chimachitika apa ndichakuti mtundu wa maselo oyera m'thupi lathu, otchedwa ma lymphocytes, amagawikana mwachangu ndipo amakula mosalamulirika.

Matendawa otchedwa PTLD kwenikweni ndi mtundu wa lymphoma . Lymphoma ndi mtundu wa khansa yomwe imayamba m'thupi lathu. Matendawa amapezeka pamene maselo oyera a m'magazi amakhala khansa ndipo amakula mofulumira osafa.

PTLD nthawi zambiri imayamba chifukwa cha kachilombo ka Epstein-Barr (EBV) . Uwu ndi kachilombo komwe tonse tili nako m'thupi mwathu. Pali mitundu yosiyanasiyana ya PTLD, ndipo momwe imakhudzira munthu imatha kusiyana. Nkhani yabwino ndi yakuti madokotala amatha kuchiza. Komabe, nthawi zina vutoli lingabwererenso.

Kodi mitundu ikuluikulu ya PTLD ndi iti?

Madokotala amagawa PTLD m'magulu anayi akuluakulu kutengera momwe maselo a lymphoma amaonekera pansi pa maikulosikopu:

• Kutupa Koyambirira: Anthuwa amakumana ndi zizindikiro zofanana ndi zomwe zimawonedwa ndi kachilombo ka Epstein-Barr (EBV).
• PTLD Yopangidwa ndi Polymorphic: Pano, maselo a lymphoma amasakanikirana ndi mitundu ina ya maselo oyera amagazi, monga ma lymphocyte abwinobwino ndi maselo a plasma.
• Monomorphic PTLD: Uwu ndi mtundu wofala kwambiri wa PTLD . Maselo a lymphoma pano ndi ofanana ndi omwe amapezeka mu mitundu ina ya lymphoma, monga ``Non-Hodgkin Lymphomas''. Mwachitsanzo, ``Diffuse Large B-cell Lymphoma'' kapena ``Burkitt Lymphoma''.
• Mtundu wa Classic Hodgkin Lymphoma - PTLD: Uwu ndi mtundu wocheperako wa PTLD .

Kodi vuto limeneli lotchedwa PTLD ndi lofala bwanji?

Monga tanenera kale, PTLD ndi vuto losowa kwambiri . Izi zikutanthauza kuti sizichitika kwa aliyense. Mwachidule, pafupifupi anthu awiri mwa anthu 100 omwe adaikidwapo maselo oyambira (`(2%)`) adzadwala PTLD. Anthu omwe adaikidwapo ziwalo ali ndi mwayi wokulirapo wokhala ndi PTLD. Koma zimenezi zimasiyananso malinga ndi chiwalo chomwe chaikidwapo.

Taganizirani izi motere, pomwe anthu pafupifupi atatu mwa anthu 100 omwe adaikidwa impso (`(3%)`) amakhala ndi vutoli, akatswiri amati anthu pafupifupi khumi mwa anthu 100 omwe adaikidwa mapapo (`(10%)`) akhoza kukhala ndi vutoli. Chifukwa chake, palibe chodetsa nkhawa nacho, izi si zomwe zimachitikira anthu ambiri.

Kodi zizindikiro za PTLD ndi ziti?

Anthu ena sangakhale ndi zizindikiro poyamba. Zizindikiro za PTLD zimatha kuonekera nthawi iliyonse, kuyambira miyezi ingapo mpaka zaka zingapo mutabzala. Ngati zizindikirozo zionekera, zitha kuphatikizapo:

• Kumva kutopa kwambiri (`Kutopa`) : Kungokhala ngati munthu alibe moyo.
• Malungo popanda chifukwa .
• Chakudya chilibe kukoma .
• Kuchepetsa thupi mosayembekezereka .
• Kutuluka thukuta kwambiri usiku (`Thukuta la usiku`) .
• Ma lymph nodes otupa : Amamveka ngati ziphuphu m'khosi ndi m'khwapa.

N’chifukwa chiyani PTLD imeneyi imachitika? Kodi zimayambitsa chiyani?

Izi ndi zovuta kumvetsa. PTLD imachitika chifukwa kachilombo kofala kwambiri kamagwiritsa ntchito mwayi wofooka kwa chitetezo chamthupi chathu .

Tangoganizani kuti mukukonzekera kuikidwa maselo oyambira. Musanayambe kuchita zimenezi, mudzapatsidwa mankhwala a chemotherapy kuti muphe maselo a khansa m'mafupa anu. Izi zimatchedwa conditioning. Izi zimafooketsa mphamvu ya chitetezo cha mthupi lanu yoteteza ku matenda. Makamaka, conditioning imachepetsa ntchito ya maselo a T (maselo a T) omwe agwidwa ndi EBV ndipo sagwiranso ntchito.

Kenako, maselo oyambira kapena chiwalocho akaikidwa m'malo enaake, thupi lanu limapatsidwa mankhwala oletsa chitetezo chamthupi kuti lisakane chinthu chatsopanocho. Ngakhale kuti mankhwalawa amateteza chiwalo kapena maselo atsopano, amafooketsanso chitetezo cha thupi lathu, zomwe zimapangitsa kuti likhale lotetezeka kwambiri ku zilombo zakunja monga mavairasi.

Mu PTLD, kachilombo kamene kamayambitsa matendawa ndi kachilombo ka Epstein-Barr (EBV) . EBV yagwirizanitsidwa ndi PTLD yomwe imayamba mkati mwa chaka chimodzi kapena ziwiri kuchokera pamene selo loyambira kapena chiwalo chinaikidwa. Komabe, chifukwa chenicheni cha PTLD chomwe chimayamba zaka zambiri pambuyo poikidwa sichikudziwikabe. Akatswiri akufufuzanso ngati mavairasi monga cytomegalovirus (CMV) kapena adenovirus (Adenovirus) angathandize.

Malinga ndi akatswiri, pafupifupi 90% ya anthu athu adatenga kachilombo ka EBV nthawi ina ali ana kapena achinyamata. Mutha kukhala ndi kachilomboka popanda zizindikiro zilizonse, ndipo mwina simukudziwa. Kachilombo ka EBV kamalowa m'maselo athu a B ndipo kamakhalabe "kogona" mkati mwa thupi, kutanthauza kuti, mu mkhalidwe wa "Latent", popanda kuyambitsa mavuto aliwonse. (Mwinanso mudatenga kachilomboka kuchokera kwa wopereka.)

Chifukwa mukumwa mankhwala oletsa chitetezo chamthupi, chitetezo chamthupi chanu sichingathe kulamulira EBV yomwe siigwira ntchito. Kenako, maselo a B omwe ali ndi kachilombo ka EBV amayamba kugawikana ndikuchulukana mwachangu. Ndicho chimene chimayambitsa PTLD.

Ndani ali pachiwopsezo chachikulu chotenga PTLD?

Chiwopsezo chanu chokhala ndi PTLD chingawonjezeke pazifukwa zotsatirazi:

• Kukhala ndi kachilombo ka Epstein-Barr (EBV) m'thupi lanu kapena m'thupi la munthu amene anakupatsani chiwalo/maselo (`(Wopereka)`).
• Mukalandira chithandizo (`Pre-transplant conditioning') chomwe chimachepetsa ntchito ya T cells yanu musanayikemo.
• Kumwa mankhwala oletsa chitetezo chamthupi kuti thupi lanu lisakane chiwalo kapena maselo atsopano.
• Kukhala ndi mitundu yosiyanasiyana ya majini (`(majini)`) komwe kumawonjezera chiopsezo chotenga PTLD.

Kodi madokotala amazindikira bwanji vuto ili lotchedwa PTLD?

Madokotala amayamba kaye akuyang'ana mbiri yanu ya matenda. Kuphatikiza apo, nthawi zambiri amachita mayeso otsatirawa:

• Kuchuluka kwa Magazi Onse (`Kuchuluka kwa Magazi Onse - CBC`) .
• Gulu Lonse la Kagayidwe ka Metabolic .
• Mlingo wa lactate dehydrogenase (LDH) .
• Kusanthula mkodzo , kuphatikizapo kuchuluka kwa uric acid.
• Kuyesa kozindikira ma antibodies opangidwa m'thupi motsutsana ndi kachilombo ka EBV .
• Kujambula kwa CT (`Computed Tomography - Kujambula kwa CT`) .
• Kujambula kwa MRI (Maginito Oona Maonekedwe a Maginito - MRI) .
• Kujambula kwa PET (`Positron Emission Tomography - Kujambula kwa PET`) .
• Kufufuza za m'mafupa .

Mayeso amenewa ndi omwe amalola madokotala kudziwa ngati PTLD ilipo kapena ayi, ndipo ngati ndi choncho, momwe imaonekera.

Kodi mankhwala a PTLD ndi ati?

Madokotala nthawi zambiri amayamba ndi kuchepetsa kuchuluka kwa mankhwala oletsa chitetezo chamthupi omwe amamwa . Nthawi zina izi zimatha kusintha kwambiri. Kuphatikiza apo, palinso mankhwala ena monga:

• Chemotherapy : Mankhwala omwe amapha maselo a khansa.
• Chithandizo cha radiation : Kuwononga maselo a khansa pogwiritsa ntchito kuwala kwamphamvu kwambiri.
• Chithandizo cha immunotherapy chokhala ndi ma antibodies a monoclonal : Izi zimaphatikizapo kugwiritsa ntchito mapuloteni enaake (ma antibodies a monoclonal) kuti aukire maselo a khansa.
• Opaleshoni : Izi sizimachitika kawirikawiri. Opaleshoni imaganiziridwa kokha ngati PTLD ili pamalopo ndipo ingachotsedwe bwino. Mwachitsanzo, ngati ma tonsils akhudzidwa ndi PTLD, ma tonsils angachotsedwe.

Kodi pali chilichonse chomwe tingachite kuti tipewe kukula kwa PTLD?

Palibe chomwe tingachite kuti tipewe mwachindunji PTLD. Komabe, madokotala ndi ofufuza akufufuza mankhwala ena omwe angagwiritsidwe ntchito musanalowetsedwe kapena mutapatsidwa mankhwala ena kuti achepetse chiopsezo cha PTLD. Chifukwa chake, pali chiyembekezo chakuti padzakhala njira zabwino zothetsera vutoli mtsogolomu.

Kodi chimachitika ndi chiyani ngati muli ndi PTLD? Kodi ingachiritsidwe?

Momwe mungayankhire ku PTLD zingasiyane malinga ndi munthu ndi munthu. Zimadalira zinthu zambiri.

Mwachitsanzo, nthawi zina PTLD imakula ngakhale madokotala atangochepetsa mankhwala oletsa chitetezo chamthupi.

Kafukufuku waposachedwapa wasonyeza kuti pakati pa 60% ndi 70% ya anthu omwe amadwala lymphoma atapatsidwa chiwalo ndipo amalandira chithandizo cha immunotherapy ndi chemotherapy awona kuchepa kapena kutha kwa zizindikiro (kuchira) .

Kodi PTLD ingachiritsidwe? Inde, PTLD ingachiritsidwe ndi `Immunotherapy` yokha kapena kuphatikiza ndi `Chemotherapy`. Kafukufuku wasonyeza kuti pakati pa 50% ndi 60% ya anthu omwe amalandira chithandizochi amachira kwathunthu . Chifukwa chake, ichi ndi chinthu chodalirika.

Kodi ndi mafunso otani ofunika kwambiri omwe ndiyenera kufunsa dokotala wanga?

Ngati muli ndi PTLD, ndi bwino kufunsa dokotala wanu mafunso monga awa:

• N’chifukwa chiyani izi zinandichitikira ine?
• Kodi PTLD imachiritsidwa bwanji?
• Ngati ndichepetsa mankhwala oletsa chitetezo chamthupi, kodi pali mwayi wotani woti thupi langa lidzakana chiwalo/maselo atsopano?
• Ngati chithandizo changa chapambana, kodi pali mwayi woti vutoli libwererenso?

Kuwonjezera pa mafunso awa, musaope kufunsa dokotala chilichonse chomwe muli nacho m'maganizo mwanu.

Ndiyenera kupita kwa dokotala liti?

Ngati muli ndi PTLD, dokotala wanu adzayang'anira thanzi lanu lonse mosamala . Adzafufuza zizindikiro zosonyeza kuti vuto lanu likuipiraipira. Ngati mukulandira chithandizo cha PTLD, dokotala wanu adzakufotokozerani kusintha komwe mukukumana nako kapena ngati zizindikiro zanu zikuipiraipira. Ndikofunikira kuuza dokotala wanu nthawi yomweyo ngati izi zitachitika.

Pomaliza, zinthu zoti muzikumbukira

Kuika ziwalo ndi kuyika maselo oyambira nthawi zina kungapulumutse miyoyo kapena kukulitsa moyo . Komabe, chifukwa izi ndi njira zazikulu zamankhwala, zitha kukhala ndi zoopsa. PTLD ndi imodzi mwazovuta zosazolowereka, koma zomwe zingakhale zazikulu.

Ngati mukufuna kuikidwa ziwalo kapena maselo oyambira, gulu lanu lazaumoyo lidzakambirana nanu za chiopsezo chanu cha PTLD , komanso zinthu zina zambiri zomwe zingakuopsezeni. Madokotala ndi ofufuza akufunafuna njira zochepetsera chiopsezo cha PTLD. Chofunika kwambiri ndikudziwa izi ndikufunsa gulu lanu lazaumoyo mafunso aliwonse omwe mungakhale nawo.

'PTLD, Matenda a Lymphoproliferative Pambuyo pa Kuika Chiwalo, Kuika Ziwalo, Lymphoma, Kachilombo ka Epstein-Barr, Immunology, Khansa