Ngaba kufuneka siqaphele i-PTLD (Post-Transplant Lymphoproliferative Disorders) emva kokufakelwa ilungu?

Wena okanye umntu omaziyo mhlawumbi ukhe wenziwa utyando olukhulu olusindisa ubomi, njengokufakelwa amalungu omzimba. Okanye ukufakelwa i-stem cell. Emva kwezi zinto, kubakho iingxaki ezingaqhelekanga nezingalindelekanga. Enye ingxaki enjalo yi-PTLD, okanye i-Post-Transplant Lymphoproliferative Disorders. Ekubeni oku kunokuba nzulu kancinci, masithethe ngako ngendlela elula onokuyiqonda.

Yintoni kanye kanye iPTLD?

Ngamafutshane, i-PTLD yingxaki esongela ubomi enokwenzeka emva kokufakelwa amalungu omzimba okanye ukufakelwa i-allogeneic stem cell. Okwenzekayo apha kukuba uhlobo lweseli emhlophe yegazi emzimbeni wethu, olubizwa ngokuba yi-lymphocytes, lwahlukana ngokukhawuleza kwaye lwanda ngokungalawulekiyo.

Le meko ibizwa ngokuba yi-PTLD ngokwenene luhlobo lwe-lymphoma . I-Lymphoma luhlobo lomhlaza oluvela kwinkqubo yethu ye-lymphatic. Le meko yenzeka xa iiseli ezimhlophe zegazi ziba ngumhlaza kwaye zikhula ngokukhawuleza ngaphandle kokufa.

I-PTLD idla ngokubangelwa yi -Epstein-Barr Virus (EBV) . Le yintsholongwane esinayo sonke emizimbeni yethu. Kukho iintlobo ezahlukeneyo ze-PTLD, kwaye indlela echaphazela ngayo umntu inokwahluka. Iindaba ezimnandi zezokuba oogqirha banokuyinyanga. Nangona kunjalo, ngamanye amaxesha imeko inokubuya.

Ziziphi iintlobo eziphambili ze-PTLD?

Oogqirha bahlula i-PTLD kwiintlobo ezine eziphambili ngokusekelwe kwindlela iiseli ze-lymphoma ezibonakala ngayo phantsi kwe-microscope:

• Ukudumba Kwasekuqaleni: Aba bantu bafumana iimpawu ezifana nezo zibonwa yintsholongwane ye-Epstein-Barr (EBV).
• I-Polymorphic PTLD: Apha, iiseli ze-lymphoma zixutywe nezinye iintlobo zeeseli ezimhlophe zegazi, njengee-lymphocytes eziqhelekileyo kunye neeseli ze-plasma.
• I-Monomorphic PTLD: Olu lolona hlobo luqhelekileyo lwe-PTLD . Iiseli ze-lymphoma apha ziyafana nezo zifumaneka kwezinye iintlobo ze-lymphoma, ezifana ne-"Non-Hodgkin Lymphomas". Umzekelo, i-"Diffuse Large B-cell Lymphoma" okanye i-"Burkitt Lymphoma".
• Uhlobo lwe-Classic Hodgkin Lymphoma - PTLD: Olu lolona hlobo lungaqhelekanga lwe-PTLD .

Ixhaphake kangakanani le meko ibizwa ngokuba yi-PTLD?

Njengoko bekutshiwo ngaphambili, i-PTLD yimeko engaqhelekanga kakhulu . Oko kuthetha ukuba ayenzeki kuwo wonke umntu. Xa sithetha nje, malunga nabantu ababini kwabayi-100 abaye bafakelwa i-stem cell (`(2%)`) baya kuba ne-PTLD. Abantu abaye bafakelwa amalungu omzimba banamathuba amancinci okuba ne-PTLD. Kodwa oko kuyahluka ngokuxhomekeke kwilungu elifakelweyo.

Cinga ngale ndlela, ngelixa malunga nabantu abathathu kwabayi-100 abaye bafakelwa izintso (`(3%)`) befumana le meko, iingcali zithi malunga nabantu abalishumi kwabayi-100 abaye bafakelwa imiphunga (`(10%)`) banokufumana le meko. Ngoko ke, akukho nto inokubangela ixhala, le asiyonto yenzekayo kubantu abaninzi.

Ziziphi iimpawu ezinokubakho ze-PTLD?

Abanye abantu basenokungabi nazo iimpawu ekuqaleni. Iimpawu ze-PTLD zinokuvela nangaliphi na ixesha, ukususela kwiinyanga ezimbalwa ukuya kwiminyaka eliqela emva kokufakelwa isitho. Ukuba iimpawu ziyavela, zingabandakanya:

• Ukuziva udiniwe kakhulu (`Ukudinwa`) : Kukuziva nje ungenabomi.
• Umkhuhlane ngaphandle kwesizathu .
• Ukutya akunancasa .
• Ukunciphisa umzimba ngokungalindelekanga .
• Ukubila kakhulu ebusuku (`Ukubila ebusuku`) .
• Ii-lymph nodes ezidumbileyo : Zivakala ngathi ziqhuma entanyeni nasemakhwapheni.

Kutheni le nto i-PTLD isenzeka? Zithini izizathu?

Oku kunzima ukukuqonda. I-PTLD yenzeka kuba intsholongwane eqhelekileyo isebenzisa ubuthathaka kwi-immune system yethu .

Khawucinge ukuba ulungiselela ukufakelwa i-stem cell. Ngaphambi koko, uza kunikwa i-chemotherapy yokubulala iiseli zomhlaza kumongo wakho wethambo. Oku kubizwa ngokuba yi-conditioning. Oku kwenza buthathaka amandla omzimba wakho okukukhusela kwizifo. Ngokukodwa, i-conditioning inciphisa umsebenzi wee-T cells (ii-T-cells) eziye zosulelwa yi-EBV kwaye ziphinde zingasebenzi.

Emva koko, emva kokuba iiseli ze-stem okanye ilungu lomzimba zityaliwe, umzimba wakho unikwa amayeza okuthintela ukungasebenzi kakuhle komzimba ukuze ungavumi into entsha. Nangona la mayeza ekhusela ilungu lomzimba elitsha okanye iiseli, akwawenza buthathaka amasosha omzimba ethu, nto leyo eyenza ukuba abe sesichengeni ngakumbi kumaxhoba angaphandle afana neentsholongwane.

Kwi-PTLD, intsholongwane eyintloko yi -Epstein-Barr virus (EBV) . I-EBV inxulunyaniswe ne-PTLD ekhula kungekapheli nonyaka okanye emibini emva kokufakelwa iseli ye-stem okanye ilungu. Nangona kunjalo, unobangela ochanekileyo we-PTLD okhula kwiminyaka emva kokufakelwa ayikaziwa. Iingcali zikwaphanda nokuba iintsholongwane ezifana ne-cytomegalovirus (CMV) okanye i-adenovirus (Adenovirus) zinokudlala indima na.

Ngokutsho kweengcali, malunga ne-90% yabemi bethu baye bosulelwa yi-EBV ngexesha elithile ebuntwaneni okanye ebusheni babo. Usenokuba unentsholongwane ngaphandle kweempawu, kwaye usenokungazi nokuba unayo. Intsholongwane ye-EBV ihlasela iiseli zethu ze-B kwaye ihlala "ilele" ngaphakathi emzimbeni, oko kukuthi, kwimeko "yokungafihlisi", ngaphandle kokubangela naziphi na iingxaki. (Usenokuba ufumene intsholongwane kumntu onikelayo.)

Ngenxa yokuba usela loo mayeza okunciphisa amasosha omzimba, inkqubo yakho yomzimba yokuzikhusela ayikwazi ukulawula loo EBV ingasebenziyo. Emva koko, iiseli ze-B ezine-EBV ziqala ukwahlukana kwaye ziphindaphindeke ngokukhawuleza. Yiloo nto ekhokelela kwi-PTLD.

Ngubani osengozini enkulu yokuhlaselwa yi-PTLD?

Umngcipheko wakho wokufumana i-PTLD unokwanda ngenxa yezi zizathu zilandelayo:

• Ukuba ne-Epstein-Barr virus (EBV) emzimbeni wakho okanye emzimbeni womntu okunike isitho/iiseli (`(uMniki)`).
• Emva kokuba ufumene unyango (`Pre-transplant conditioning') olunciphisa ukusebenza okuqhelekileyo kwee-T cells zakho ngaphambi kokuba utyandwe.
• Ukusela amayeza okunciphisa amasosha omzimba ukuthintela umzimba wakho ukuba ungalamkeli ilungu okanye iiseli ezintsha.
• Ukuba notshintsho kwiijini ezithile (`(iiJini)`) okwandisa umngcipheko wokufumana i-PTLD.

Oogqirha bayixilonga njani le meko ibizwa ngokuba yi-PTLD?

Oogqirha baza kuqala benze uvavanyo lomzimba baze bajonge imbali yakho yezonyango ngononophelo. Ukongeza, badla ngokwenza olu vavanyo lulandelayo:

• Ubalo lweGazi olupheleleyo (`Ubalo lweGazi olupheleleyo - CBC`) .
• Iphaneli ebanzi yeMetabolic .
• Inqanaba le -lactate dehydrogenase (LDH) .
• Uhlalutyo lomchamo , kuquka namanqanaba e-uric acid.
• Uvavanyo lokufumanisa ii-antibodies eziveliswa emzimbeni ngokuchasene ne-EBV virus .
• I-CT scan (`I-Computed Tomography - I-CT scan`) .
• Iskeni se-MRI (Umfanekiso weMagnetic Resonance - MRI) .
• Iskeni yePET (`I-Positron Emission Tomography - Iskeni yePET`) .
• I-biopsy yomongo wethambo .

Olu vavanyo luvumela oogqirha ukuba baqinisekise ukuba i-PTLD ikhona okanye ayikho, kwaye ukuba ikhona, ukuba ibukeka njani.

Ziziphi iindlela zonyango ze-PTLD?

Oogqirha badla ngokuqala ngokunciphisa inani lamayeza okunciphisa amasosha omzimba abawasebenzisayo . Ngamanye amaxesha oku kunokwenza umahluko omkhulu. Ukongeza, kukho nezinye iindlela zonyango ezifana nezi:

• I-Chemotherapy : Iyeza elibulala iiseli zomhlaza.
• Unyango lwemitha : Ukutshabalalisa iiseli zomhlaza kusetyenziswa imitha enamandla aphezulu.
• Unyango lwe-immunotherapy olune-monoclonal antibodies : Oku kuquka ukusebenzisa iiproteni ezithile (ii-monoclonal antibodies) ukuhlasela iiseli zomhlaza.
• Utyando : Oku akwenzeki rhoqo. Utyando luqwalaselwa kuphela ukuba i-PTLD ikwindawo ethile kwaye inokususwa ngokukhuselekileyo. Umzekelo, ukuba iitoni zichaphazeleka yi-PTLD, iitoni zingasuswa.

Ngaba kukho into esinokuyenza ukuthintela ukuphuhliswa kwe-PTLD?

Akukho nto sinokuyenza ukuthintela ngokuthe ngqo i-PTLD. Nangona kunjalo, oogqirha kunye nabaphandi bajonga amayeza athile angasetyenziswa ngaphambi nasemva kokufakelwa ukuze kuncitshiswe umngcipheko we-PTLD. Ngoko ke, kukho ithemba lokuba kuya kubakho izisombululo ezingcono zoku kwixesha elizayo.

Kwenzeka ntoni ukuba une-PTLD? Ngaba inganyangeka?

Indlela oza kusabela ngayo kwi-PTLD inokwahluka kumntu nomntu. Kuxhomekeke kwizinto ezininzi.

Umzekelo, ngamanye amaxesha i-PTLD iyaphucuka nokuba oogqirha bayayinciphisa nje imithi yokunciphisa amajoni omzimba.

Izifundo zakutshanje zibonise ukuba phakathi kwama-60% nama-70% abantu abafumana i-lymphoma emva kokufakelwa amalungu omzimba baze banyangwe nge-immunotherapy kunye ne-chemotherapy baye bahlangabezana nokuncipha okanye ukuphela kweempawu (ukuxolelwa) .

Ngaba i-PTLD inokunyangeka? Ewe, i-PTLD inokunyangeka nge-'Immunotherapy' yodwa okanye idityaniswe ne-'Chemotherapy'. Izifundo zibonise ukuba phakathi kwama-50% nama-60% abantu abafumana olu nyango bayaphila ngokupheleleyo . Ngoko ke, le yinto onokuba nethemba ngayo.

Zeziphi imibuzo ebalulekileyo ekufuneka ndiyibuze ugqirha wam?

Ukuba une-PTLD, kungcono ukubuza ugqirha wakho imibuzo efana nale:

• Kutheni oku kwenzeke kum?
• Iphathwa njani i-PTLD?
• Ukuba ndinciphisa amayeza am okunciphisa amasosha omzimba, lingakanani ithuba lokuba umzimba wam ungawamkeli amalungu/iiseli ezintsha?
• Ukuba unyango lwam luphumelele, angakanani amathuba okuba le meko ibuye?

Ukongeza kule mibuzo, ungoyiki ukubuza ugqirha nantoni na ocinga ngayo.

Ndifanele ndimbone nini ugqirha?

Ukuba une-PTLD, ugqirha wakho uza kujonga impilo yakho iyonke ngokusondeleyo . Baza kukhangela iimpawu zokuba imeko yakho iya isiba mandundu. Ukuba unyangwa i-PTLD, ugqirha wakho uza kuchaza ukuba loluphi utshintsho olufumanayo okanye ukuba iimpawu zakho ziya ziba mandundu. Kubalulekile ukuxelela ugqirha wakho ngoko nangoko ukuba oku kuyenzeka.

Okokugqibela, izinto ekufuneka uzikhumbule

Ukufakelwa amalungu omzimba kunye nokufakelwa kweeseli zesiqu ngamanye amaxesha kunokusindisa ubomi okanye kwandise ubomi . Nangona kunjalo, kuba ezi ziinkqubo zonyango eziphambili, zinokuza neengozi. I-PTLD yenye yeengxaki ezingaqhelekanga, kodwa ezinokuba yingozi.

Ukuba ungumntu oza kufakelwa amalungu omzimba okanye iiseli ze-stem, iqela lakho lezempilo liza kuthetha nawe malunga nomngcipheko wakho we-PTLD , kunye nezinye izinto ezininzi ezinobungozi. Oogqirha nabaphandi bafuna iindlela zokunciphisa umngcipheko we-PTLD. Eyona nto ibalulekileyo kukwazi oku kwaye ubuze iqela lakho lezempilo nayiphi na imibuzo onokuba nayo.

"I-PTLD, Iingxaki zeLymphoproliferative emva kokufakelwa, ukufakelwa kwamalungu omzimba, iLymphoma, i-Epstein-Barr Virus, i-Immunology, umhlaza