Wake wacabanga ukuthi imizimba yethu ingalwa nomdlavuza ngokwayo? Eqinisweni, imizimba yethu inesimiso sokuzivikela esihlakaniphe kakhulu esibizwa ngokuthi isimiso sokuzivikela. Inengxenye ekhethekile yaso ebizwa ngokuthi ama-T-cell, afana namasosha. Umsebenzi wawo ukuthola nokubhubhisa amagciwane angaphandle kanye namaseli aguqukile angena emzimbeni. Kodwa ngezinye izikhathi, amangqamuzana omdlavuza anobuqili obukhulu. Acasha kula maseli e-T, awakhohlise futhi akhule ngaphakathi emzimbeni. Ngezikhathi ezinjalo, sizokhuluma ngokwelashwa okusha, okumangalisayo okusiza amangqamuzana ethu e-T ukuthi aqaphele futhi abhubhise amangqamuzana omdlavuza ngokuwanika "ukuqeqeshwa okukhethekile."
Kalula nje, kuyini ukwelashwa ngamaseli e-CAR T?
Nakuba igama lingase lizwakale liyinkimbinkimbi, lo mqondo ulula impela. Ukwelashwa ngamaseli e-CAR T uhlobo lokwelashwa nge-immunotherapy. Kuhilela ukuthatha amanye amaseli akho e-T bese uwaguqula ngokwezakhi zofuzo elabhorethri.
Cabanga ngamaseli akho e-T njengamaphoyisa. Amaseli omdlavuza afana namasela azifihle. Ngokuvamile, amaphoyisa awakwazi ukuwabona lawa masela. Ukwelashwa ngamaseli e-CAR T kufana nokunikeza amaphoyisa akho (amaseli e-T) izibuko ezikhethekile. Lesi sibuko sibizwa ngokuthi 'i-Chimeric Antigen Receptor' (CAR) . Senziwa elabhorethri futhi sinamathiselwe kumaseli e-T.
Manje, uma lesi sibuko esikhethekile sigqokwa, amaseli e-T ayakwazi ukubona ngokunembile amaprotheni athile (ama-antigen) ebusweni bamaseli omdlavuza. Amaseli omdlavuza afihliwe ngaphambilini manje abonakala ngokucacile. Amaseli e-T, athole la mandla amakhulu, abe eseya ngqo ukuyohlasela amaseli omdlavuza futhi awabhubhise. Lokhu kwelashwa kuwusizo olukhulu ekwelapheni ngokuphelele ezinye izinhlobo zomdlavuza wegazi nasekusizeni abanye ukuba baphile isikhathi eside nomdlavuza.
Yiziphi izinhlobo zomdlavuza wegazi eziphathwa yilolu hlobo lokwelashwa?
Njengamanje, ukwelashwa ngamaseli e-CAR T kusetshenziselwa kuphela izinhlobo ezithile zomdlavuza wegazi ezingasabelanga kwezinye izindlela zokwelapha (njenge-chemotherapy) noma ezibuye ngemva kokwelashwa. Njengoba kuseyindlela yokwelapha entsha kakhulu, ayinikezwa wonke umdlavuza.
Ithebula elingezansi libonisa ukuthi yiziphi izinhlobo zomdlavuza lolu hlobo lokwelashwa oluvunyelwe njengamanje.
| Uhlobo Lomdlavuza | Incazelo |
|---|---|
| I-B-cell acute lymphoblastic leukemia (YONKE) | I-B-cell acute lymphoblastic leukemia |
| Ukusabalalisa i-lymphoma enkulu ye-B-cell | Ukusabalalisa i-lymphoma enkulu ye-B-cell |
| I-follicular lymphoma | I-follicular lymphoma |
| I-B-cell lymphoma yezinga eliphezulu | I-B-cell lymphoma yezinga eliphezulu |
| I-Mantle cell lymphoma | I-Mantle cell lymphoma |
| I-myeloma eminingi | I-myeloma eminingi |
| I-lymphoma ye-mediastinal enkulu ye-B-cell eyinhloko | I-lymphoma ye-mediastinal enkulu ye-B-cell eyinhloko |
Le nqubo yokwelashwa yenzeka kanjani?
Lonke lolu hlelo lwenzeka ngezinyathelo eziningana. Kufana nokuqeqesha amasosha empini bese ewabuyisela enkundleni yempi.
1. Isinyathelo: Ukuqoqa amaseli akho e-T
Okokuqala, umzimba wakho udinga ukuqoqa amangqamuzana amhlophe egazi, ikakhulukazi amangqamuzana e-T. Lokhu kwenziwa ngenqubo ebizwa ngokuthi i-leukapheresis . Lokhu kuhilela ukuthumela igazi lakho ngomshini, ohlukanisa amangqamuzana amhlophe egazi kuphela, bese ubuyisela lonke igazi emzimbeni wakho. Lokhu kufana nokunikela ngegazi, kodwa kuthathwa ingxenye yegazi kuphela bese lonke elisele libuyiselwa.
2. Isinyathelo: Thumela amaseli e-T elabhorethri bese uwashintsha
Okulandelayo, amaseli e-T athathwe kuwe athunyelwa elabhorethri ekhethekile. Lapho, ososayensi basebenzisa ubunjiniyela bezakhi zofuzo ukufaka i-CAR (Chimeric Antigen Receptor) esikhulume ngayo ngaphambilini kumaseli e-T. Bese, lawa maseli e-CAR T amasha anamandla amakhulu akhuliswa elabhorethri aze abe nezigidi zawo. Le nqubo ithatha amasonto amathathu kuya kwayisithupha.Kungathatha isikhathi.
3. Isinyathelo: Ukulungiselela umzimba wakho
Kuze kube yilapho ama-CAR T-cells ekhiqizwa elabhorethri, udokotela wakho angakunikeza ezinye izindlela zokwelapha (ukwelashwa kokuhlanganisa), njengokwelashwa ngamakhemikhali, ukulawula umdlavuza wakho.
Ngemuva kwalokho, ezinsukwini ezimbalwa ngaphambi kokuba unikezwe amaseli e-CAR T asanda kudalwa, uzonikezwa i-chemotherapy ephansi. Ibizwa ngokuthi i-lymphodepleting chemotherapy . Lokhu kusebenza ngokuqeda amangqamuzana omzimba akhona emzimbeni wakho, kudala indawo engcono yokuthi amaseli e-CAR T amasha, anamandla kakhulu asebenze.
4. Isinyathelo: Ukubuyisela amaseli e-super T emzimbeni
Lesi yisenzakalo esiyinhloko. Njengokunikeza isisombululo se-saline, amaseli e-CAR T asanda kudalwa afakwa emzimbeni wakho ngomthambo (umugqa we-intravenous - IV). Lokhu kuthatha imizuzu emi-5 kuya kwengama-30. Uma lawa maseli engena emzimbeni, aqala ukwanda ngokwawo, efuna futhi abhubhise amangqamuzana omdlavuza. Ngenxa yokuthi lawa maseli ahlala emzimbeni isikhathi eside futhi alwa nomdlavuza, abanye babiza lokhu kwelashwa ngokuthi "umuthi ophilayo."
Kwenzekani ngemva kokwelashwa? Ziyini izingozi?
Ngenxa yokuthi lokhu kuyindlela yokwelapha enamandla kakhulu, ngezinye izikhathi imiphumela emibi ingaba khona. Ngakho-ke, kuzodingeka uhlale esibhedlela cishe isonto elilodwa kuya kwezinsuku eziyishumi ngemva kokwelashwa. Odokotela nabahlengikazi bazokuqapha ngokucophelela.
Into ebaluleke kakhulu ukuthi kufanele uhlale useduze nesibhedlela lapho uthole khona ukwelashwa inyanga yokuqala ngemuva kokuphuma esibhedlela. Futhi, kufanele ube nomuntu oseduze nawe amahora angama-24 ngosuku . Futhi, akuwona umqondo omuhle ukushayela izinyanga ezimbili .
Imiphumela Emibi Eyinhloko
Kunemiphumela emibi emibili eyinhloko nevame kakhulu yalokhu kwelashwa. Nakuba lokhu kungaba yingozi, amaqembu ezokwelapha ahlonyiselwe kahle ukuyelapha.
| Uhlobo lomphumela ongemuhle | Izimpawu ezingaba khona |
|---|---|
| I-Cytokine Release Syndrome Impendulo enamandla yokuzivikela komzimba eyenzeka emzimbeni lapho amaseli e-CAR T ebhubhisa amaseli omdlavuza. |
|
| Izinkinga Zezinzwa Imiphumela ebuchosheni kanye nasesimisweni sezinzwa. | |
| Eminye imiphumela emibi engaba khona | |
| |
Kuphumelela kangakanani lokhu kwelashwa?
Ukwelashwa ngamaseli e-CAR T kulethe ithemba elisha kubantu abaningi abalwa nomdlavuza wegazi, ikakhulukazi labo abangazange basabele kwezinye izindlela zokwelapha.
- Isibonelo, izingane ezingaphezu kuka- 85% ezithole lolu hlobo lokwelashwa kwe-acute lymphoblastic leukemia (ALL) ebuntwaneni zathola ukuphulukiswa okuphelele komdlavuza wazo ngemva kokwelashwa. Futhi, u-60% wazo zazingakabi nomdlavuza ngemva konyaka owodwa wokwelashwa.
Kodwa-ke, sidinga ukuqonda ukuthi lokhu akuyona ikhambi lomlingo - konke kuzosebenza ngokuphelele kuwo wonke umuntu. Kwabanye abantu, lokhu kwelashwa kuzowelapha ngokuphelele umdlavuza wabo. Kwabanye, kuzobasiza ukulawula umdlavuza wabo futhi baphile isikhathi eside. Futhi, kwabanye abantu, lokhu kwelashwa kungase kungasebenzi.
Lobu buchwepheshe busathuthuka. Abacwaningi emhlabeni wonke bazama njalo ukuthuthukisa lokhu kwelashwa, ukunciphisa imiphumela emibi, nokubona ukuthi kungasetshenziswa yini kwezinye izinhlobo zomdlavuza.
Kufanele ubonane nini nodokotela?
Imiphumela emibi yalokhu kwelashwa, ikakhulukazi i-Cytokine Release Syndrome nezinkinga zezinzwa, ingaba yingozi empilweni . Ngakho-ke ngaphambi kokuba uphume esibhedlela, buza udokotela wakho ukuthi yiziphi izimpawu okufanele uziqaphele kakhulu.
Uma izimpawu ezifana nomkhuhlane, ukubanda, ikhanda elibuhlungu, kanye nesicanucanu ziqhubeka, kungaba uphawu lwesimo esibucayi. Uma kunjalo, shayela udokotela wakho ngokushesha noma uye eMnyangweni Wezimo Eziphuthumayo (ETU) wesibhedlela.
Uma wena noma othile omaziyo enomdlavuza wegazi, khuluma nodokotela wakho mayelana nokuthi ukwelashwa nge-CAR T-cell kulungile yini kuwe. Nakuba lokhu kwelashwa kungekona okwawo wonke umuntu, kungaba yinto eshintsha impilo yomuntu ofanele.
Umlayezo Wokuya Nawe Ekhaya
- Ukwelashwa ngamaseli e-CAR T "kuyimithi ephilayo" eguqula amaseli akho e-T omzimba abe amaseli amakhulu abulala amaseli omdlavuza.
- Lokhu okwamanje kusetshenziselwa kuphela izinhlobo ezithile zomdlavuza wegazi lapho ezinye izindlela zokwelapha zehlulekile.
- Le nqubo ihilela ukuqoqa amaseli akho, ukuwaguqula elabhorethri, bese uwabuyisela emzimbeni wakho.
- Ngenxa yokuthi imiphumela emibi kakhulu ingase ivele ngemva kokwelashwa, kubalulekile ukuhlala uqashwe njalo esibhedlela.
- Nakuba lokhu kwelashwa kuletha ithemba elisha kwabaningi, kubalulekile ukuqonda ukuthi akunikezi ukwelashwa okuqinisekisiwe kuwo wonke umuntu.
- Udokotela wakho womdlavuza kuphela onganquma ukuthi lolu hlobo lokwelashwa lukulungele yini, ngakho-ke vuleka futhi uthembeke kuye ngakho konke.
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