Uma uthola ukuthi unomdlavuza, uzizwa ukwesaba okukhulu nokukhathazeka. Kodwa ngokuthuthuka kwesayensi yezokwelapha, namuhla kunezindlela zokwelapha ezithuthukisiwe kakhulu zokulwa nomdlavuza. Namuhla, sizokhuluma ngendlela entsha nenamandla kakhulu yokwelapha eye yaba nempumelelo enkulu ekwelapheni izinhlobo eziningana zomdlavuza , ikakhulukazi lezo ezikhula egazini.
Kuyini Ukwelashwa Nge-CAR T-Cell?
Kalula nje, i-CAR T-Cell Therapy iwukwelashwa nge -immunotherapy okusetshenziselwa ukwelapha izinhlobo ezithile zomdlavuza wegazi . Amaseli ethu omzimba afana namasosha emizimbeni yethu. Lokhu kwelashwa okwenziwa yilokhu kuthatha amanye ala masosha emzimbeni wakho, abizwa ngokuthi ama-T cell ( ama-T cell noma ama-T lymphocytes ) , bese ewaguqula abe ama-super fighter abhubhisa amaseli omdlavuza.
Cabanga ngokuthatha amaseli akho e-T uwayise elebhu , ufaka i-gene entsha kuwo, bese uwanikeza “ilensi ekhethekile” engakwazi ukubona amangqamuzana omdlavuza. Sibiza lawa maseli e-T aguquliwe ngokuthi amaseli e-CAR T. I-'CAR' imele i-'Chimeric Antigen Receptor'. Ngemuva kwalokho, izigidi zalawa maseli e-super-fighter zenziwa futhi zibuyiselwe emzimbeni wakho. Lawa maseli abese ehamba emzimbeni wakho wonke, efuna futhi ebhubhisa amangqamuzana omdlavuza. Ngezinye izikhathi, lokhu kwelashwa kungaze kwelaphe umdlavuza wegazi ngokuphelele.
Lolu hlobo lokwelapha lusetshenziselwa ziphi izinhlobo zomdlavuza?
Njengamanje, i-CAR T-Cell Therapy isetshenziswa kuphela ezinhlotsheni ezithile zomdlavuza wegazi lapho ezinye izindlela zokwelapha zehlulekile noma lapho umdlavuza ubuyile khona. Ithebula elingezansi libala ezinye zalezi zinhlobo zomdlavuza.
| Uhlobo Lomdlavuza | Isingeniso esifushane |
|---|---|
| I-B-cell acute lymphoblastic leukemia (YONKE) | I-leukemia ye-lymphoblastic ebukhali evela kuma-B-cell. |
| Ukusabalalisa i-lymphoma enkulu ye-B-cell | Uhlobo lwe-lymphoma olukhula ngokushesha. |
| I-follicular lymphoma | Uhlobo lwe-lymphoma ekhula kancane. |
| I-Mantle cell lymphoma | Uhlobo olungavamile, kodwa olunolaka lwe-lymphoma. |
| I-myeloma eminingi | Umdlavuza womnkantsha oqala kumaseli e-plasma. |
| I-lymphoma ye-mediastinal enkulu ye-B-cell eyinhloko | Uhlobo lwe-lymphoma oluvela engxenyeni ephakathi yesifuba. |
Kulungile, manje ake sibone ukuthi lokhu kusebenza kanjani.
Ukuze siqonde lokhu, ake siqale sifunde okwengeziwe ngamaseli e-T ohlelweni lwethu lokuzivikela komzimba. Wonke amaseli emzimbeni wethu anamaprotheni abizwa ngokuthi ama-antigen ebusweni bawo. Lawa afana nekhadi lomazisi elinawo wonke amaseli. Amaseli omdlavuza anekhadi lomazisi elishintshiwe nelingajwayelekile.
Amaseli ethu e-T anama -receptor . Lawa ma-receptor yiwo abona abahlaseli njengamaseli omdlavuza anamakhadi omazisi angavamile (ama-antigen). Kodwa ngezinye izikhathi amaseli omdlavuza anobuqili obukhulu. Acasha kula maseli e-T.
Yilapho sidinga khona usizo lwamaseli e-CAR T. Lawa ngamaseli akho e-T aqeqeshwe ngokukhethekile elabhorethri futhi aguqulwa ukuze aqaphele leyo antigen ethile kumaseli omdlavuza .
Lokhu kwelashwa kuvumela la maseli ukuthi angagcini nje ngokubulala amangqamuzana omdlavuza, kodwa futhi ahlukane futhi aphindaphindeke emzimbeni. Lokhu kusho ukuthi uthola ukutholakala kwesikhathi eside kwamangqamuzana alwa nomdlavuza. Yingakho odokotela bebiza lokhu kwelashwa ngokuthi “umuthi ophilayo.”
Isebenza kanjani inqubo yokwelapha?
Lonke lolu hlelo lwenzeka ngezigaba eziningana.
Ngaphambi kokwelashwa
Okokuqala, udinga ukuqoqa amangqamuzana amhlophe egazi, ikakhulukazi amaseli e-T, emzimbeni wakho. Lokhu kubizwa ngokuthi i-leukapheresis.Lena inqubo efana nokunikela ngegazi. Umshini uthatha ingxenye yegazi lakho, uhlukanise amangqamuzana egazi amhlophe kuphela, bese ubuyisela lonke igazi emzimbeni wakho.
Lawa maseli e-T aqoqiwe abese ethunyelwa elabhorethri ekhethekile ukuze aguqulwe abe amaseli e-CAR T. Le nqubo ingathatha cishe amasonto amathathu kuya kwayisithupha. Phakathi nalesi sikhathi, unganikezwa ezinye izindlela zokwelapha, njenge -chemotherapy, ukulawula umdlavuza.
Uma usukulungele ukuthola amaseli e-CAR T, uzonikezwa ukwelashwa okubizwa ngokuthi i-lymphodepleting chemotherapy ukuvimbela umzimba wakho ekwenqabeni amaseli amasha.
Ngesikhathi sokwelashwa
Ukwelashwa kwangempela kulula kakhulu. Njengokunikeza usawoti, lawa maseli e-CAR T asanda kudalwa afakwa emzimbeni wakho ngomthambo (umugqa we-IV) esikhathini esingangemizuzu emi-5 kuya kwengama-30. Phakathi nalesi sikhathi, kuzodingeka uhlale esibhedlela.
Ngemva kokwelashwa
Ngenxa yokuthi lokhu kuyindlela yokwelapha enamandla kakhulu, ngezinye izikhathi imiphumela emibi ingaba khona. Ngakho-ke, kungase kudingeke uhlale esibhedlela cishe izinsuku eziyi-7-10 ngemva kokwelashwa. Kubaluleke kakhulu ukuhlala useduze nesibhedlela lapho uthole khona ukwelashwa ngenyanga yokuqala, ngisho nangemva kokuphuma esibhedlela. Futhi,
- Kufanele kube nomuntu ohlala nawe amahora angama-24 ngosuku ukuze akunakekele uma unemiphumela emibi.
- Ungashayeli izinyanga ezimbili ngemuva kokwelashwa. Udinga omunye umuntu ozokwenza lokho.
Iyini imiphumela emibi yalokhu kwelashwa?
Kunezinhlobo ezimbili zemiphumela emibi ezivame kakhulu futhi okufanele ziqashelwe kulokhu kwelashwa. Eminye imiphumela emibi evamile ingase ivele.
| Uhlobo lomphumela ongemuhle | Izici ezibonakalayo |
|---|---|
| I-Cytokine Release Syndrome | Umkhuhlane, ubunzima bokuphefumula (ukuphelelwa umoya), umfutho wegazi ophansi. (Lokhu kungaba kubi kakhulu) |
| Izinkinga Zezinzwa | Ukudideka, ubunzima bokukhuluma (i-aphasia), ubunzima bokubhala (i-dysgraphia), ikhanda elibuhlungu, ukuxhuzula, nokuthuthumela. |
| Okunye | Ngesikhathi sokwelashwa, kunengozi yokungezwani komzimba, ukukhathala, ukopha, ingozi eyengeziwe yokutheleleka, kanye namazinga aphansi e-potassium (hypokalemia) kanye ne-sodium (hyponatremia). |
Yiziphi izinzuzo kanye namazinga empumelelo alokhu kwelashwa?
Inzuzo enkulu ye-CAR T-Cell Therapy ukuthi inikeza ithemba elisha ezigulini ezihlulekile kwezinye izindlela zokwelapha. Ngezinye izikhathi ingayelapha ngokuphelele umdlavuza (ukuxolelwa). Ngaphandle kwalokho, lokhu kwelashwa kungandisa impilo yeziguli.
Isibonelo, ucwaningo lwango-2020 lubonise ukuthi izingane ezingaphezu kuka-85% ezithole lokhu kwelashwa kwe-acute lymphoblastic leukemia (ALL) zelapheka ngokuphelele ngemva kokwelashwa. Futhi, u-60% wazo wayesengenawo umdlavuza ngemva konyaka. Kodwa kubalulekile ukukhumbula ukuthi lokhu akuyona ukwelashwa okuphumelelayo okungu-100% kwawo wonke umuntu, ikhambi lawo wonke umuntu. Kodwa-ke, lesi yisinyathelo esikhulu esiqhubekela phambili emkhakheni wokwelashwa komdlavuza.
Kufanele ubonane nini nodokotela?
Lokhu kubaluleke kakhulu. Eminye yemiphumela emibi ye-CAR T-Cell Therapy, ikakhulukazi i-Cytokine Release Syndrome kanye nezinkinga zesimiso sezinzwa, ingaba yingozi empilweni .
Ngakho-ke ngaphambi kokuba uphume esibhedlela, qiniseka ukuthi ubuza udokotela wakho ukuthi yiziphi izimpawu okufanele uzikhathaze kakhulu ngazo. Uma izimpawu ezifana nomkhuhlane, ukubanda, ikhanda elibuhlungu , kanye nesicanucanu ziqhubeka, shayela udokotela wakho ngokushesha, noma uye eMnyangweni Wezimo Eziphuthumayo wesibhedlela (ETU).
Lokhu kwelashwa kuseyinsimu entsha esathuthuka. Ngakho-ke uma unomdlavuza wegazi, khuluma nodokotela wakho mayelana nokuthi lokhu kwelashwa kukufanele yini.
Umlayezo Wokuya Nawe Ekhaya
- I-CAR T-Cell Therapy iyindlela yokwelapha i-immunotherapy enamandla kakhulu futhi eyenzelwe wena uqobo esetshenziselwa izinhlobo ezithile zomdlavuza wegazi .
- Lokhu kuhilela ukuguqula ama-T-cell akho elebhu bese uwabuyisela emzimbeni wakho ukuze abulale amaseli omdlavuza.
- Lokhu kwelashwa kusebenza “njengomuthi ophilayo,” olwa nomdlavuza isikhathi eside emzimbeni.
- Okubi kakhulu ngemva kokwelashwaUkubhekwa eduze kwezokwelapha kubalulekile njengoba imiphumela emibi ingase ivele. Noma yiziphi izimpawu ezisolisayo kufanele zibikwe kudokotela ngokushesha.
- Nakuba lokhu kunikeza ithemba elisha ezigulini ezihlulekile kwezinye izindlela zokwelapha, udokotela wakho kuphela onganquma ukuthi kulungile yini kuwe.
Ukwelashwa ngamaseli e-CAR T, ukwelashwa komdlavuza, umdlavuza wegazi, ukwelashwa ngama-immunotherapy, ukwelashwa ngama-immune, amaseli e-T, eSri Lanka
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