Ngaba ukhe weva ngeChronic Lymphocytic Leukemia (CLL)? Makhe sithethe ngayo ngokweenkcukacha!

Ngaba ngamanye amaxesha uziva udiniwe kakhulu? Okanye udla ngokuba nomkhuhlane? Ngaba unamaqhuqhuva amancinci avakala ngathi asentanyeni yakho, emakhwapheni, okanye emqolo? Ezi zinokuba ziimpawu zeChronic Lymphocytic Leukemia, okanye i-CLL ngamafutshane. Kodwa ungakhathazeki, kuba ukuba nazo zonke ezi mpawu akuthethi ukuba unesi sifo. Kodwa kubaluleke kakhulu ukuqaphela izinto ezinje. Ngoko masithethe nge-CLL ngendlela elula namhlanje, kulungile?

Yintoni i-chronic lymphocytic leukemia (CLL)? Ngamafutshane...

I-chronic lymphocytic leukemia (CLL) luhlobo lomhlaza wegazi . Lolona hlobo luqhelekileyo lwe-leukemia kubantu abadala. Iiseli zegazi ziveliswa kumongo wethambo. Le meko yenzeka xa ii-lymphocytes, uhlobo lweseli emhlophe yegazi esempilweni kumongo wethambo, zisiba zingaqhelekanga, nto leyo ethetha ukuba ziyatshintsha zibe ngumhlaza. Ezi seli zomhlaza zanda ngokungalawulekiyo, ziminyanisa iiseli zegazi ezisempilweni kunye neeplatelets, ezinceda ukujiya kwegazi.

I-CLL idla ngokuvela kubantu abaneminyaka engaphezu kwama-65 ubudala. Nangona kunjalo, ngamanye amaxesha inokwenzeka nakubantu abaneminyaka engama-30 ubudala. Ngaphezu koko, abanye abantu banokuba ne-CLL ngaphandle kweempawu . Abantu abaninzi bafumanisa ngale meko xa bevavanywa igazi lesinye isifo okanye ngexesha lokuhlolwa kwezonyango rhoqo ngonyaka.

Okwangoku, akukho nyango lwe-CLL. Kodwa oko akusosizathu sokukhathazeka. Kwiminyaka elishumi edlulileyo, oogqirha baye baphuhlisa unyango olutsha olunokulawula i-CLL kwaye luyibuyisele kwimeko yesiqhelo . Olu nyango luye lwavumela abantu abane-CLL ukuba baphile ixesha elide.

Ziziphi iintlobo eziphambili ze-CLL?

Kukho iintlobo ezimbini eziphambili zeeseli ezimhlophe zegazi emizimbeni yethu, ezibizwa ngokuba zii-lymphocytes. I-CLL inokukhula kwenye yezi ntlobo zimbini kuphela.

• Ii-B-lymphocytes (ii-B-cells): Ezi ziiseli ezivelisa ii-antibodies, uhlobo lweproteni oluqaphela kwaye lulwa neentsholongwane eziyingozi, iibhaktheriya, iintsholongwane, kwaneeseli zomhlaza.
• Ii-T-lymphocytes (ii-T-cells): Ezi zilawula indlela amajoni omzimba asabela ngayo emzimbeni wethu. Zikwafumana kwaye zitshabalalise iiseli ezingaqhelekanga, ezifana neeseli zomhlaza.

Uhlobo oluqhelekileyo lwe-CLL yi-B-cell CLL . Kukho imeko enxulumene nayo echaphazela ii-T-cells, ebizwa ngokuba yi -T-cell prolymphocytic leukemia (PLL). Nangona kunjalo, abantu abane-PLL babonakalisa iimpawu ngokukhawuleza kunabantu abane-B- cell CLL.

Ixhaphake kangakanani le meko ibizwa ngokuba yi-CLL?

Enyanisweni, i-chronic lymphocytic leukemia (CLL) yenye yezona ntlobo zixhaphakileyo ze-leukemia kubantu abadala. E-United States, esi sifo sichaphazela abantu abamalunga naba-5 kwabayi-100,000. I-American Cancer Society iqikelela ukuba kuya kubakho iimeko ezintsha ezimalunga ne-18,700 ze-CLL ngo-2023 kuphela. Ukuze sikubone oku, kulindeleke ukuba kuxelwe iimeko ezintsha ezingaphezu kwama-238,000 zomhlaza wemiphunga (omnye wemimhlaza eqhelekileyo) ngo-2023. Ngoko ke, nangona i-CLL isenokungabonakali ixhaphakile kangako, yenye yezona ntlobo zixhaphakileyo ze-leukemia.

Ziziphi iimpawu ze-CLL?

Njengoko besitshilo ngaphambili, abanye abantu banokuba ne-CLL ngaphandle kweempawu . Kungathatha iinyanga okanye iminyaka ukuba iimpawu zibonakale. Iimpawu eziqhelekileyo zezi:

• Ukudinwa: I-CLL inokuchaphazela iiseli zakho ezibomvu zegazi, ibangele i-anemia. Ukudinwa luphawu oluqhelekileyo lwe-anemia.
• Umkhuhlane: Umkhuhlane luphawu losulelo. Ngenxa yokuba i-CLL ichaphazela iiseli ezimhlophe zegazi ezisempilweni, unamathuba amaninzi okufumana usulelo.
• Ii-lymph nodes ezidumbileyo entanyeni, emakhwapheni, emqolo, okanye esiswini.
• Ukubila ebusuku.
• Ukunciphisa umzimba ngendlela engachazekiyo.
• Intlungu okanye ukuziva ugcwele phantsi kweembambo zakho: I-CLL inokuchaphazela isibindi sakho okanye i-spleen. Xa iiseli zomhlaza ziqokelelana kwezi zitho, zinokudumba.

Kutheni i-CLL ikhula? Zithini izinto ezibangela umngcipheko?

I-Chronic lymphocytic leukemia (CLL) ikhula xa kukho utshintsho oluthile, okanye utshintsho, kwiichromosomes zethu nakwiijini zethu ngexesha lobomi bethu. Nangona kunjalo, abaphandi bezonyango abakaqiniseki ukuba yintoni ebangela olu tshintsho. Nangona kunjalo, bachonge izinto ezininzi ezinobungozi ezinokuluchaphazela:

• Imbali yosapho: Uphando lubonise ukuba ukuba omnye wezalamane zakho ezisondeleyo, oko kukuthi, umama wakho, utata wakho, abantakwenu, okanye abantwana bakho, une-CLL, umngcipheko wakho wokuba ne-CLL unokunyuka kabini ukuya kane.
• Ubudala: Ngokomyinge, izigulane zimalunga neminyaka engama-71 ubudala xa zifunyaniswa zine-CLL.
• Isini: Amadoda anamathuba amaninzi okufumana i-CLL.
• Ukuvezwa kwi-Agent Orange: Uphando lubonise unxibelelwano phakathi kwe-Agent Orange, ikhemikhali esetyenziswa ngexesha leMfazwe yaseVietnam, kunye ne-CLL.
• I-lymphocytosis ye-B-cell ye-Monoclonal:Kule meko, unohlobo olunye lweeseli ze-B egazini lakho ngaphezu kwesiqhelo. Ukuba unale meko, usemngciphekweni omncinci wokufumana i-CLL.

Ziziphi iingxaki ezinokubakho ze-CLL?

I-CLL ichaphazela iiseli zakho ezibomvu zegazi, iiseli ezimhlophe zegazi, kunye neeplatelets. Cinga ngayo, iiseli ezibomvu zegazi zithwala ioksijini emzimbeni wonke. Iiseli ezimhlophe zegazi zisikhusela kwizifo. Iiplatelets zinceda ukujiya kwegazi. Ngoko ke, xa ulahlekelwa zezi seli zegazi ziphilileyo kunye neeplatelets, unokuba neengxaki ezifana nezi:

• I-Lymphoma: Phakathi kwe-2% kunye ne-10% yabantu abane-CLL banokufumana uhlobo lomhlaza olubizwa ngokuba yi-lymphoma.
• Umhlaza wolusu, umhlaza wemiphunga, okanye umhlaza wamathumbu amakhulu: I-CLL yenza amasosha omzimba abe buthathaka, nto leyo eyenza ukuba angakwazi ukukukhusela kwiintsholongwane, kuquka neeseli zomhlaza. Oku kunokunyusa umngcipheko wakho wokufumana ezinye iintlobo zomhlaza.
• I-anemia: I-anemia inokuvela xa kungekho ziseli zegazi ezibomvu ezaneleyo zokuthwala ioksijini emzimbeni wonke.
• I-Thrombocytopenia: I-CLL inokuchaphazela ukuhanjiswa kweeplatelet zakho. Oku kunokubangela ukopha.
• Usulelo oluqhelekileyo: Ukuba iiseli ezimhlophe zegazi azinazo ngokwaneleyo, unamathuba amaninzi okufumana usulelo lweebhaktiriya, ifungus, okanye iintsholongwane.
• Izifo ezizikhusela ngokuzenzekelayo: Abanye abantu abane-CLL banokuba neemeko ezifana ne-autoimmune hemolytic anemia.

Ifunyaniswa njani i-CLL?

Xa usiya kugqirha, uza kukubuza ngeempawu zakho. Emva koko, baza kwenza uvavanyo lomzimba baze bacele uvavanyo oluthile, olufana nolu:

• Ubalo lwegazi olupheleleyo (i-CBC) kunye nomahluko: Olu vavanyo lulinganisa inani leeseli ezibomvu zegazi, iiseli ezimhlophe zegazi, kunye neeplatelets egazini lakho. Lukwajonga ubungakanani be-hemoglobin (iproteni ethwala ioksijini) kwiiseli zakho ezibomvu zegazi.
• I-smear yegazi engaphandle: Ingcali yelabhoratri yezonyango ihlola iiseli zakho zegazi phantsi kwemakroskopu ukujonga iiseli zomhlaza.
• I-Flow cytometry: Olu vavanyo lwelebhu lunokubonelela ngolwazi oluthe kratya malunga neeseli zakho zegazi. Kwi-CLL, lusetyenziselwa ukumisela ngokuchanekileyo ukuba iiseli zakho ezimhlophe zegazi zinazo na iiseli ze-CLL.
• Uvavanyo lwe-genetic:Oogqirha basebenzisa iimvavanyo ezifana ne-fluorescent in situ hybridization (FISH) kunye ne-immunoglobulin heavy chain (IGHV) ukuze bahlole ii-chromosomes kunye nee-genes zakho. Ukuqonda ukuba loluphi utshintsho olwenzekileyo kwezi chromosomes kunye nee-genes kunceda oogqirha ukuba bagqibe ngendlela yokunyanga i-CLL.

Amanqanaba e-CLL

Oogqirha bamisela inqanaba lomhlaza ukuze bacebe unyango baze baqikelele ukuba ingakanani na ingozi. Kukho iindlela ezimbini eziphambili ezisetyenziswayo ukumisela inqanaba le-CLL: inkqubo yokumisela inqanaba le-Rai kunye nenkqubo yokumisela inqanaba le-Binet .

Ngamanye amaxesha, xa ufunda la manqanaba ngamanani nangoonobumba, ungaziva uloyiko kwaye ungakhululekanga. Usenokude ucinge, "Ngaba le yindlela ukugula kwam okuchazwa ngayo kwifomyula?" Oogqirha bayayiqonda loo nto. Ukuba awucaci kakuhle ngento ethethwayo, okanye ukuba inzima kuwe, nceda ucele ugqirha wakho ukuba akuchazele indlela le nkqubo yesigaba esebenza ngayo kwimeko yakho.

Inkqubo yokucwangcisa iRai

Le ndlela ihlela i-CLL ngokwezinga lokuba mandundu kwaye ingaba unyango luya kufuneka na:

• Umngcipheko ophantsi (owawusaziwa njengeRai stage 0): Une-lymphocytosis (ukwanda kwenani lee-lymphocytes), kwaye kukho iiseli ezimhlophe zegazi ezingaqhelekanga egazini kunye/okanye kumongo wethambo.
• Umngcipheko ophakathi (owawusaziwa njengeRai stage I okanye stage II): Une-lymphocytosis, ii-lymph nodes ezivuvukileyo, kunye ne-spleen ekhulisiweyo kunye/okanye isibindi.
• Umngcipheko ophezulu (owawusaziwa njengeRai Stage III): Une-anemia okanye i-thrombocytopenia (inani eliphantsi leeplatelet).

Inkqubo yokucwangcisa i-binet

Le ndlela isekelwe kumanani eeseli zakho zegazi kunye neeplatelet, kunye nenani leendawo ezinee-lymph nodes ezidumbileyo emzimbeni wakho:

• Inqanaba A: Awuna-anemia (umlinganiselo ophantsi weeseli ezibomvu zegazi) okanye inani eliphantsi leeplatelet. Nangona kunjalo, une-lymph nodes ezivuvukileyo ubuncinane kwiindawo ezimbini emzimbeni wakho. Umzekelo, usenokuba ne-lymph nodes ezivuvukileyo entanyeni yakho nasemqolo.
• Inqanaba B: Kukho ii-lymph nodes ezivuvukileyo kwiindawo ezintathu emzimbeni, okanye isibindi okanye i-spleen ivuvukile. Nangona kunjalo, akukho anemia, kwaye amanqanaba eeplatelet aqhelekile.
• Inqanaba C: Une-anemia kunye ne-lymph nodes ezivuvukileyo kwiindawo ezintathu nangaphezulu emzimbeni wakho.

Iphathwa njani i-CLL?

Iindlela zonyango zimiselwa ziimpawu zakho kunye neziphumo zovavanyo. Umzekelo, ukuba une-CLL ekwinqanaba lokuqala, ugqirha wakho unokucebisa "ukulinda ngononophelo/ukubeka esweni okusebenzayo."Ungakhetha indlela ebizwa ngokuba yi-"monitoring." Oku kubandakanya ukujonga impilo yakho ngokubanzi, iimpawu kunye neziphumo zovavanyo ngaphandle kokuqala unyango.

Iziphumo zovavanyo lwemfuza nazo zinokuchaphazela izigqibo zonyango. Umzekelo, utshintsho oluthile lwemfuza lunokuthetha ukuba imeko yakho inokuba mandundu ngokukhawuleza, okanye ukuba unyango oluqhelekileyo lwe-CLL lusenokungasebenzi kakuhle njengoko bekulindelwe.

Unyango oluqhelekileyo lwe-CLL lunyango olujoliswe kulo kunye ne-chemotherapy . Ngamanye amaxesha unyango lwe-radiation lusetyenziselwa ukunciphisa iimpawu ze-CLL. Ngalunye lwale nyango lunokubangela iziphumo ebezingalindelekanga ezahlukeneyo. Ugqirha wakho uza kuchaza ngokucacileyo iingenelo, iziphumo ebezingalindelekanga, kunye neengxaki ezinokubakho zexesha elide zonyango olufumanayo.

Unyango olujoliswe kulo

Olu nyango lusebenza ngokujolisa kwiiseli zomhlaza. Kwi-chronic lymphocytic leukemia, olu nyango lusebenza ngokumisa ukukhula kweeseli ezimhlophe zegazi ezinomhlaza. Ezinye iindlela zonyango ezijolisiweyo zibulala iiseli zomhlaza ngaphandle kokulimaza iiseli eziphilileyo. Amanye amayeza asetyenziswa koku ngala:

• Unyango lwe-Bruton's tyrosine kinase (BTK) inhibitor: Olu nyango luthintela i-enzyme enceda ii-B-cells ukuba zenze ii-white blood cells ezingaphezulu. Imizekelo: i-ibrutinib (Imbruvica®) , i-acalabrutinib (Calquence®) , kunye ne -zanubrutinib (Brukinsa ®) .
• Unyango lwe-BCL2 inhibitor: Iyeza i -venetoclax (Venclexta®) lithintela iproteni ebizwa ngokuba yi-BCL2 efumaneka kwiiseli ze-leukemia, kuquka neeseli ze-CLL. Olu nyango lunokubulala iiseli ze-leukemia okanye luzenze zibe novelwano ngakumbi kwamanye amayeza okulwa nomhlaza.
• Unyango lwe-antibody ye-Monoclonal: Olu luhlobo lwe-immunotherapy. Ii-antibody ze-Monoclonal luhlobo lwe-antibody eyenziwe kwilebhu. Ziyayimisa ukukhula kweeseli zomhlaza okanye zibulale iiseli zomhlaza. Imizekelo: i-rituximab (Rituxan®) kunye ne -obinutuzumab (Gazyva®) .

Unyango ngamakhemikhali

Ugqirha wakho angasebenzisa i-chemotherapy njengonyango oluphambili lwe-chronic lymphocytic leukemia. Amanye amayeza e-chemotherapy aqhelekileyo asetyenziswa kwi-CLL ngala:

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

Unyango lwe-immunotherapy

Le ndlela yonyango isebenza ngokubuyisela okanye ukuqinisa inkqubo yakho yomzimba yokuzikhusela, inceda ekutshabalaliseni iiseli zomhlaza okanye ekucothiseni ukukhula kwazo.

Kwi-CLL engaphendulanga kwi-chemotherapy, ebuye yabuya (iphinda ivele) i-CLL, okanye esiya isiba mandundu, oogqirha banokusebenzisa iyeza le-immunotherapy i-lenalidomide (Revlimid®) .

Abaphandi bezonyango bafunda nonyango lwe-chimeric antigen receptor (CAR-T) kwizigulane ze-CLL ezingaphenduliyo kunyango oluqhelekileyo.

Ungaphila ixesha elingakanani ne-CLL?

I-chronic lymphocytic leukemia (CLL) idla ngokuqhubeka kancinci kakhulu. Ungaphila ne-CLL iminyaka ngaphambi kokuba ube neempawu. Xa iimpawu zibonakala, oogqirha baneendlela zonyango ezisebenzayo kakhulu ezinokubangela ukuba i-CLL ibuyele kwimeko yesiqhelo . Olu nyango luhlala iminyaka eliqela ngaphambi kokuba isifo sibuye. Nangona kunjalo, ugqirha wakho unokucebisa ezinye iindlela zonyango ezinokubangela ukuba i-CLL iphinde ibuyele kwimeko yesiqhelo. I-CLL ayinyangeki, kodwa abantu abanesifo banokuphila ubomi obude, obupheleleyo.

I-National Cancer Institute iqikelela ukuba ama-87.9% ezigulana ezine-CLL ziyaphila emva kweminyaka emihlanu zixilongiwe. Nangona kunjalo, xa ucinga ngala mazinga okusinda, kubalulekile ukukhumbula ukuba la ngamava asekelwe kumava eqela elikhulu lezigulana ezine-CLL. Izinto ezininzi zinokuchaphazela la mazinga okusinda, kuquka impilo yakho ngokubanzi, inqanaba lesifo sakho ekuxilongweni, kunye nendlela isifo sakho esisabela ngayo kunyango. Ukuba unemibuzo, buza ugqirha wakho into omawuyilindele ngokusekelwe kwimeko yakho.

Kwenzeka ntoni kwisigaba sokugqibela se-CLL?

Igama elithi "isigaba sokugqibela" lithetha ukuba unyango alusasebenzi ekulawuleni okanye ekupheliseni isifo se-CLL. Ngelo xesha, usenokuba nezifo ezisongela ubomi okanye ukopha okungalawulekiyo okungekho mfuneko koogqirha abasenokungakwazi ukuzinyanga.

Ngaba le meko ingathintelwa?

Okwangoku akukho ndlela eyaziwayo yokuthintela i-CLL.

Kunjani ukuhlala ne-CLL?

Kuxhomekeke kwimeko yakho. Ungaba ne-CLL ngaphandle kweempawu. Ukuba uneempawu, kukho unyango lokunciphisa nokulawula isifo. Nangona kunjalo, esi sifo asiyi kuphela ngokupheleleyo.

Nazi ezinye iingcebiso ezinokukunceda ngelixa uhlala ne-CLL:

• Zikhusele kwiintsholongwane:Abantu abane-CLL basengozini enkulu yokufumana usulelo. Ezinye iintsholongwane zinokuba yingozi ebomini. Buza ugqirha wakho malunga nokuba zeziphi izitofu ezifanelekileyo kuwe.
• Lumka ngempilo yakho ngokubanzi: Usenokuba sengozini enkulu yokuba nomhlaza wolusu, umhlaza wemiphunga, okanye umhlaza wamathumbu amakhulu. Buza ugqirha wakho malunga novavanyo lokuhlolwa komhlaza.
• Lawula uxinezeleko: Abantu abaninzi abane-CLL badlula kwimijikelo yokululama nokubuyela umva. Njengoko isifo siqhubeka, unokuziva uxhalabile kwaye uloyiko. Ukuba kunjalo, buza ugqirha wakho ngeenkqubo okanye iinkonzo ezinokukunceda ulawule uxinezeleko lwakho.
• Yitya ukutya okunempilo: Ezinye iimpawu ze-CLL zinokubangela ukuba ulahlekelwe kukutya. Thetha nogqirha wakho malunga nokufumana ingcebiso kwingcali yesondlo. Ukuba ukutya kwakho kulungile, zama ukutya ukutya okunesondlo okuquka iiproteni ezingenamafutha, iinkozo ezipheleleyo, iziqhamo nemifuno, kunye namafutha anempilo. Oku kungayiphucula impilo yakho iyonke.
• Ukuzilolonga: Ukuzilolonga kukunceda ukuba ulawule uxinzelelo kwaye kukugcine wonwabile.
• Ukuphumla: I-CLL ingakwenza uzive udiniwe kakhulu. Phumla xa uziva ngathi ufuna ukuphumla.
• Yazi into omawuyilindele: Ulwazi lunamandla. Cela ugqirha wakho ukuba akunike iimpawu zokuba imeko yakho isenokuba mandundu. Ukuba kunjalo, ugqirha wakho unokucebisa ezinye iindlela zonyango ezinokukunceda ulawule i-CLL yakho ngcono.

Ndingayibuza yiphi imibuzo ugqirha wam?

Usenokufuna ukubuza imibuzo efana nale:

• Luhlobo luni lwe-chronic lymphocytic leukemia endinayo?
• Andinazo iimpawu. Ndifanele ndiqale nini unyango?
• Ziziphi iindlela zonyango endinazo?
• Ngaba kuya kufuneka ndithathe unyango ngonaphakade?
• Ngaba unyango luza kuyibuyisela imeko yam esimeni esilungileyo?

Okokugqibela, izinto ekufuneka uzikhumbule (Umyalezo Wokuya Ekhaya)

I-chronic lymphocytic leukemia (CLL) luhlobo lwe-leukemia oluxhaphakileyo kubantu abadala. Ungaba nale meko iminyaka emininzi ngaphandle kweempawu. Ukuba une-CLL, usenokungadingi ukuqala unyango ngoko nangoko. Nangona oogqirha bengenakuyinyanga ngokupheleleyo, kukho unyango olunokunciphisa iimpawu ze-CLL kwaye lubuyisele esi sifo esiqhelekileyo . Abanye abantu abane-CLL baphila iminyaka emininzi.

Ukuphila nesifo esinganyangekiyo njenge-CLL akulula rhoqo. Ungadlula kwimijikelo emininzi yokuxolelwa nokubuyela kwimeko yesiqhelo. Ngexesha ngalinye lomjikelo, unokukhathazeka ngento eza kwenzeka emva koko. Oogqirha bakho bayaqonda ukuba kunjani ukuphila nesifo esinganyangekiyo. Baya kukuvuyela ukuphendula nayiphi na imibuzo onokuba nayo kwaye bakuncede nangayiphi na indlela abanayo. Ngoko ke, ungaze woyike ukuthetha nogqirha wakho malunga neenkxalabo zakho.

I- Leukemia, i-CLL, umhlaza wegazi, iimpawu, unyango, ii-lymphocytes, ukuchacha