Uke wezwa nge-Chronic Lymphocytic Leukemia (CLL)? Ake sixoxe ngayo ngokuningiliziwe!

Ingabe ngezinye izikhathi uzizwa ukhathele kakhulu? Noma uvame ukuba nomkhuhlane? Ingabe unezigaxa ezincane ezizwakala sengathi zisentanyeni yakho, emakhwapheni, noma embotsheni? Lokhu kungaba izimpawu ze-Chronic Lymphocytic Leukemia, noma i-CLL ngamafuphi. Kodwa ungakhathazeki, ngoba ukuba nazo zonke lezi zimpawu akusho ukuthi unalesi sifo. Kodwa kubaluleke kakhulu ukuqaphela izinto ezinjengalezi. Ngakho ake sixoxe nge-CLL ngendlela elula namuhla, kulungile?

Kuyini i-chronic lymphocytic leukemia (CLL)? Kalula nje...

I-chronic lymphocytic leukemia (CLL) uhlobo lomdlavuza wegazi . Luhlobo oluvame kakhulu lwe-leukemia kubantu abadala. Amaseli egazi akhiqizwa emnkantsheni. Lesi simo senzeka lapho ama-lymphocyte, uhlobo lweseli legazi elimhlophe eliphilile emnkantsheni, eba yinto engajwayelekile, okusho ukuthi ayashintsha abe ngumdlavuza. Lawa maseli anomdlavuza anda ngokungalawuleki, aminyanise amaseli egazi anempilo nama-platelet, asiza ukugoqa igazi.

I-CLL ivame ukwenzeka kubantu abaneminyaka engaphezu kwengu-65. Kodwa-ke, ngezinye izikhathi ingenzeka kubantu abaneminyaka engu-30. Ngaphezu kwalokho, abanye abantu bangaba ne-CLL ngaphandle kwezimpawu . Abantu abaningi bathola ngalesi simo lapho behlolwa igazi lesinye isimo noma ngesikhathi sokuhlolwa kwezokwelapha okuvamile konyaka.

Okwamanje, alikho ikhambi le-CLL. Kodwa lokho akusona isizathu sokukhathazeka. Eminyakeni eyishumi edlule, odokotela basungule izindlela ezintsha zokwelapha ezingalawula i-CLL futhi ziyibuyisele esimweni sayo esijwayelekile . Lezi zindlela zokwelapha zivumele abantu abane-CLL ukuba baphile isikhathi eside kakhulu.

Yiziphi izinhlobo eziyinhloko ze-CLL?

Kunezinhlobo ezimbili eziyinhloko zamaseli amhlophe egazi emizimbeni yethu, okuthiwa ama-lymphocyte. I-CLL ingakhula kolunye lwalezi zinhlobo ezimbili kuphela.

• Ama-B-lymphocyte (ama-B-cell): Lawa amaseli akhiqiza ama-antibodies, uhlobo lweprotheni olubona futhi lulwe namagciwane ayingozi, amabhaktheriya, amagciwane, ngisho namaseli omdlavuza.
• Ama-T-lymphocyte (ama-T-cell): Lawa alawula izimpendulo zesimiso somzimba wethu sokuzivikela. Athola futhi abhubhise ngqo amaseli angajwayelekile, njengamaseli omdlavuza.

Uhlobo oluvame kakhulu lwe-CLL yi-B-cell CLL . Kukhona isimo esihlobene esithinta ama-T-cell, esibizwa ngokuthi i-T-cell prolymphocytic leukemia (PLL). Kodwa-ke, abantu abane-PLL baqala izimpawu ngokushesha kunabantu abane-B- cell CLL.

Sivame kangakanani lesi simo esibizwa ngokuthi i-CLL?

Eqinisweni, i-chronic lymphocytic leukemia (CLL) ingenye yezinhlobo ezivame kakhulu ze-leukemia kubantu abadala. E-United States, lesi sifo sithinta abantu abangaba ngu-5 kwabangu-100,000. I-American Cancer Society ilinganisela ukuthi kuzoba namacala amasha angaba ngu-18,700 e-CLL ngo-2023 kuphela. Ukuze sikubeke lokhu endaweni efanele, kulindeleke ukuthi kubikwe amacala amasha angaphezu kuka-238,000 omdlavuza wamaphaphu (omunye womdlavuza ovame kakhulu) ngo-2023. Ngakho-ke, yize i-CLL ingase ingabonakali ivamile kangako, ingenye yezinhlobo ezivame kakhulu ze-leukemia.

Ziyini izimpawu ze-CLL?

Njengoba sishilo ekuqaleni, abanye abantu bangaba ne-CLL ngaphandle kwezimpawu . Kungathatha izinyanga noma ngisho neminyaka ukuthi izimpawu zivele. Izimpawu ezivame kakhulu yilezi:

• Ukukhathala: I-CLL ingathinta amangqamuzana akho abomvu egazi, ibangele i-anemia. Ukukhathala kuwuphawu oluvamile lwe-anemia.
• Umkhuhlane: Umkhuhlane uwuphawu lokutheleleka. Ngenxa yokuthi i-CLL ithinta amangqamuzana amhlophe egazi aphilile, kungenzeka kakhulu ukuthi uthole izifo.
• Ama-lymph node avuvukele entanyeni, emakhwapheni, embotsheni, noma esiswini.
• Ukujuluka ebusuku.
• Ukwehlisa isisindo okungachazeki.
• Ubuhlungu noma umuzwa wokugcwala ngaphansi kwezimbambo zakho: I-CLL ingathinta isibindi sakho noma ubende. Lapho amangqamuzana omdlavuza eqoqana kulezi zitho, angavuvukala.

Kungani i-CLL ikhula? Yiziphi izici eziyingozi?

I-chronic lymphocytic leukemia (CLL) iqala lapho kwenzeka izinguquko ezithile, noma izinguquko, kuma-chromosome ethu nezakhi zofuzo phakathi nesikhathi sethu sokuphila. Kodwa-ke, abacwaningi bezokwelapha abakaqiniseki ukuthi yini ebangela lezi zinguquko. Kodwa-ke, bathole izici eziningana eziyingozi ezingase zithinte:

• Umlando womndeni: Ucwaningo lukhombisile ukuthi uma omunye wezihlobo zakho eziseduze, okungukuthi, umama wakho, ubaba wakho, izingane zakini, noma izingane zakho, ene-CLL, ingozi yakho yokuthola i-CLL inganda ngokuphindwe kabili kuya kane.
• Ubudala: Ngokwesilinganiso, iziguli zineminyaka engaba ngu-71 ubudala lapho zitholakala zine-CLL.
• Ubulili: Amadoda anamathuba amaningi okuthola i-CLL.
• Ukuchayeka ku-Agent Orange: Ucwaningo lubonise ukuxhumana phakathi kwe-Agent Orange, ikhemikhali esetshenziswa ngesikhathi seMpi yaseVietnam, kanye ne-CLL.
• I-lymphocytosis yamaseli e-B e-monoclonal:Kulesi simo, unezinhlobo eziningi ze-B-cell egazini lakho kunokuvamile. Uma unalesi simo, unengozi encane yokuthola i-CLL.

Yiziphi izinkinga ezingaba khona ze-CLL?

I-CLL ithinta amangqamuzana akho abomvu egazi, amangqamuzana amhlophe egazi, nama-platelet. Cabanga ngakho, amangqamuzana abomvu egazi athwala umoya-mpilo kuwo wonke umzimba. Amangqamuzana amhlophe egazi asivikela ezifweni. Ama-platelet asiza ukujiya kwegazi. Ngakho-ke, uma ulahlekelwa yilawa maseli egazi anempilo nama-platelet, ungaba nezinkinga ezifana nalezi:

• I-Lymphoma: Phakathi kuka-2% no-10% wabantu abane-CLL bangase babe nohlobo lomdlavuza olubizwa ngokuthi i-lymphoma.
• Umdlavuza wesikhumba, umdlavuza wamaphaphu, noma umdlavuza wamathumbu amakhulu: I-CLL yenza buthaka amasosha omzimba wakho, okwenza angakuvikeli kubahlaseli, okuhlanganisa namaseli omdlavuza. Lokhu kungandisa ingozi yakho yokuthola ezinye izinhlobo zomdlavuza.
• I-anemia: I-anemia ingavela uma kungekho amangqamuzana abomvu egazi anele ukuthwala umoya-mpilo emzimbeni wonke.
• I-Thrombocytopenia: I-CLL ingathinta ukunikezwa kwama-platelet akho. Lokhu kungabangela ukopha.
• Ukutheleleka okuvamile: Ngaphandle kwamaseli amhlophe egazi anempilo eyanele, kungenzeka kakhulu ukuthi ube nokutheleleka ngamagciwane, isikhunta, noma amagciwane.
• Izifo ezizenzakalelayo: Abanye abantu abane-CLL bangase babe nezimo ezifana ne-autoimmune hemolytic anemia.

I-CLL itholakala kanjani?

Uma uya kudokotela, uzokubuza ngezimpawu zakho. Ngemuva kwalokho, bazokwenza ukuhlolwa ngokomzimba futhi bangase bacele ukuhlolwa okuthile, okufana nalokhu:

• Ukubalwa kwegazi okuphelele (i-CBC) kanye nomehluko: Lokhu kuhlolwa kulinganisa inani lamaseli abomvu egazi, amaseli amhlophe egazi, nama-platelet egazini lakho. Kuhlola nenani le-hemoglobin (iphrotheni ethwala umoya-mpilo) kumaseli akho abomvu egazi.
• I-smear yegazi elingaphandle: Uchwepheshe welabhorethri yezokwelapha uhlola amangqamuzana egazi lakho ngaphansi kwesibonakhulu ukuze ahlole amangqamuzana omdlavuza.
• I-Flow cytometry: Lokhu kuhlolwa kwelebhu kungakunikeza ulwazi olwengeziwe mayelana namaseli akho egazi. Ku-CLL, kusetshenziselwa ukuthola ukuthi amaseli akho amhlophe egazi aqukethe yini amaseli e-CLL.
• Ukuhlolwa kofuzo:Odokotela basebenzisa izivivinyo ezifana ne-fluorescent in situ hybridization (FISH) kanye ne-immunoglobulin heavy chain (IGHV) ukuhlola ama-chromosome akho nezakhi zofuzo. Ukuqonda ukuthi yiziphi izinguquko ezenzekile kula ma-chromosome nezakhi zofuzo kusiza odokotela ukuthi banqume ukuthi bangayiphatha kanjani i-CLL.

Izigaba ze-CLL

Odokotela banquma isigaba somdlavuza ukuze bahlele ukwelashwa futhi babikezele ukubikezela. Kunezindlela ezimbili eziyinhloko ezisetshenziswayo ukuhlukanisa i-CLL: uhlelo lwe-Rai staging kanye nohlelo lwe-Binet staging .

Ngezinye izikhathi, uma ufunda lezi zigaba ngezinombolo nangezinhlamvu, ungase uzizwe wesaba futhi ungakhululekile. Ungase ucabange nokuthi, "Ingabe yile ndlela ukugula kwami ​​​​okuchazwa ngayo ngendlela ethile?" Odokotela bayakuqonda lokho. Uma ungacaci ngalokho okushiwoyo, noma uma kukucindezela, sicela ucele udokotela wakho ukuthi akuchazele ukuthi lesi simiso sesigaba sisebenza kanjani esimweni sakho.

Uhlelo lokubeka isiteji lwe-Rai

Le ndlela ihlukanisa i-CLL ngokwezinga okungenzeka ukuthi iba yimbi nokuthi ngabe ukwelashwa kuzodingeka yini:

• Ingozi ephansi (eyayaziwa ngokuthi i-Rai stage 0): Une-lymphocytosis (ukwanda kwenani lama-lymphocyte), futhi kukhona amaseli amhlophe egazi angajwayelekile egazini kanye/noma emnkantsheni.
• Ingozi ephakathi nendawo (eyayaziwa ngokuthi iRai stage I noma isigaba II): Une-lymphocytosis, ama-lymph node avuvukele, kanye ne-spleen ekhulisiwe kanye/noma isibindi.
• Ingozi ephezulu (eyayaziwa ngokuthi iRai Stage III): Une-anemia noma i-thrombocytopenia (inani eliphansi lama-platelet).

Uhlelo lokulinganisa i-binet

Le ndlela isekelwe ekubalweni kwamaseli egazi lakho kanye nama-platelet, kanye nenani lezindawo ezinama-lymph node avuvukele emzimbeni wakho:

• Isigaba A: Awunayo i-anemia (inani eliphansi lamaseli abomvu egazi) noma inani eliphansi lama-platelet. Kodwa-ke, unama-lymph node avuvukele okungenani ezindaweni ezimbili emzimbeni wakho. Isibonelo, ungase ube nama-lymph node avuvukele entanyeni yakho nasesinqeni.
• Isigaba B: Kukhona ama-lymph node avuvukele ezindaweni ezintathu emzimbeni, noma isibindi noma i-spleen ivuvukile. Kodwa-ke, akukho ukuntuleka kwegazi, futhi izinga lama-platelet lijwayelekile.
• Isigaba C: Une-anemia kanye nama-lymph node avuvukele ezindaweni ezintathu noma ngaphezulu emzimbeni wakho.

Iphathwa kanjani i-CLL?

Izinketho zokwelapha zinqunywa yizimpawu zakho kanye nemiphumela yokuhlolwa. Isibonelo, uma une-CLL yesigaba sokuqala, udokotela wakho angase ancome "ukulinda ngokuqaphela/ukuqapha okusebenzayo."Ungakhetha indlela ebizwa ngokuthi "ukuqapha." Lokhu kuhilela ukuqapha ngokucophelela impilo yakho jikelele, izimpawu, kanye nemiphumela yokuhlolwa ngaphandle kokuqala ukwelashwa.

Imiphumela yokuhlolwa kwezakhi zofuzo ingathinta nezinqumo zokwelapha. Isibonelo, izinguquko ezithile zezakhi zofuzo zingasho ukuthi isimo sakho singase sibe sibi ngokushesha, noma ukuthi ukwelashwa okujwayelekile kwe-CLL kungase kungasebenzi kahle njengoba kulindelekile.

Izindlela zokwelapha ezivame kakhulu ze-CLL ukwelashwa okuqondiwe kanye ne -chemotherapy . Ngezinye izikhathi ukwelashwa ngemisebe kusetshenziswa ukunciphisa izimpawu ze-CLL. Ngayinye yalezi zindlela zokwelapha ingabangela imiphumela emibi ehlukene. Udokotela wakho uzochaza ngokucacile izinzuzo, imiphumela emibi, kanye nezinkinga ezingaba khona zesikhathi eside zokwelashwa okutholayo.

Ukwelashwa okuqondiwe

Lokhu kwelashwa kusebenza ngokugxila kumaseli omdlavuza. Ku-leukemia ye-lymphocytic engapheli, lokhu kwelashwa kusebenza ngokuvimbela ukukhula kwamaseli amhlophe egazi anomdlavuza. Ezinye izindlela zokwelapha eziqondisiwe zibulala amaseli omdlavuza ngaphandle kokulimaza amaseli anempilo. Eminye yemithi esetshenziswa kulokhu yile:

• Ukwelashwa kwe-Bruton's tyrosine kinase (BTK) inhibitor: Lokhu kwelashwa kuvimbela i-enzyme esiza amaseli e-B ukwenza amaseli egazi amhlophe engeziwe. Izibonelo: i-ibrutinib (Imbruvica®) , i-acalabrutinib (Calquence®) , kanye ne -zanubrutinib (Brukinsa ®) .
• Ukwelashwa kwe-BCL2 inhibitor: Umuthi i-venetoclax (i-Venclexta®) uvimba iphrotheni ebizwa ngokuthi i-BCL2 etholakala kumaseli e-leukemia, kufaka phakathi amaseli e-CLL. Lokhu kwelashwa kungawabulala amaseli e-leukemia noma kuwenze azwele kakhulu kweminye imithi yokulwa nomdlavuza.
• Ukwelashwa ngama-antibody e-Monoclonal: Lolu uhlobo lokwelashwa ngama-immunotherapy. Ama-antibody e-Monoclonal uhlobo lwama-antibody enziwa elabhorethri. Avimba ukukhula kwamaseli omdlavuza noma abulale amaseli omdlavuza. Izibonelo: i-rituximab (Rituxan®) kanye ne -obinutuzumab (Gazyva®) .

Ukwelashwa ngamakhemikhali

Udokotela wakho angase asebenzise i-chemotherapy njengokwelashwa okuyinhloko kwe-chronic lymphocytic leukemia. Eminye yemithi ye-chemotherapy evame kakhulu esetshenziselwa i-CLL yile:

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

Ukwelashwa nge-immunotherapy

Le ndlela yokwelapha isebenza ngokuvuselela noma ukuqinisa amasosha omzimba wakho, isize ekubhubhiseni amangqamuzana omdlavuza noma ekubambezeleni ukukhula kwawo.

Ku-CLL engaphendulanga ku-chemotherapy, ebuye (ephindaphindayo) i-CLL, noma eba yimbi kakhulu, odokotela bangasebenzisa umuthi we-immunotherapy i-lenalidomide (Revlimid®) .

Abacwaningi bezokwelapha nabo bafunda ukwelashwa kwe-chimeric antigen receptor (CAR-T) kweziguli ze-CLL ezingasabeli ekwelashweni okujwayelekile.

Ungaphila isikhathi esingakanani ne-CLL?

I-chronic lymphocytic leukemia (CLL) ivame ukuqhubeka kancane kakhulu. Ungaphila ne-CLL iminyaka eminingi ngaphambi kokuba ube nezimpawu. Uma izimpawu sezivele, odokotela banezindlela zokwelapha ezisebenza kahle kakhulu ezingabeka i-CLL esimeni esihle . Lokhu kuphumula okuvela ku-CLL kuvame ukuhlala iminyaka eminingana ngaphambi kokuba lesi sifo sibuye. Kodwa-ke, udokotela wakho angase ancome ezinye izindlela zokwelapha ezingabeka i-CLL esimeni esihle futhi. I-CLL ayilapheki, kodwa abantu abanalesi sifo bangaphila impilo ende, egcwele.

I-National Cancer Institute ilinganisela ukuthi ama-87.9% eziguli ezine-CLL ayaphila eminyakeni emihlanu ngemva kokuxilongwa. Kodwa-ke, uma ucabangela la mazinga okusinda, kubalulekile ukukhumbula ukuthi lawa ayizilinganiso ezisekelwe kokuhlangenwe nakho kweqembu elikhulu leziguli ezine-CLL. Izici eziningi zingathinta la mazinga okusinda, okuhlanganisa impilo yakho iyonke, isigaba sesifo sakho lapho uxilongwa, kanye nokuthi isifo sakho sisabela kahle kangakanani ekwelashweni. Uma unemibuzo, buza udokotela wakho ukuthi yini ongayilindela ngokusekelwe esimweni sakho.

Kwenzekani esigabeni sokugcina se-CLL?

Igama elithi "isigaba sokugcina" lisho ukuthi ukwelashwa akusasebenzi ekulawuleni noma ekumiseni isifo se-CLL. Ngaleso sikhathi, ungase ube nezifo ezisongela ukuphila noma ukopha okungalawuleki odokotela abangase bangakwazi ukukwelapha.

Ingabe lesi simo singavinjelwa?

Okwamanje ayikho indlela eyaziwayo yokuvimbela i-CLL.

Kunjani ukuphila ne-CLL?

Kuya ngesimo sakho. Ungaba ne-CLL ngaphandle kwezimpawu. Uma unezimpawu, kunezindlela zokwelapha zokunciphisa nokuphatha lesi sifo. Kodwa-ke, lesi sifo ngeke siphele ngokuphelele.

Nazi ezinye iziphakamiso ezingakusiza ngenkathi uhlala ne-CLL:

• Zivikele ezifweni:Abantu abane-CLL basengozini enkulu yokuthola izifo. Ezinye izifo zingaba yingozi empilweni. Buza udokotela wakho ukuthi yimiphi imigomo efanele wena.
• Qaphela impilo yakho iyonke: Ungase ube sengozini enkulu yokuba nomdlavuza wesikhumba, umdlavuza wamaphaphu, noma umdlavuza wamathumbu amakhulu. Buza udokotela wakho mayelana nokuhlolwa kokuhlolwa komdlavuza.
• Lawula ukucindezeleka: Abantu abaningi abane-CLL badlula emijikelezweni yokululama nokubuyela emuva. Njengoba lesi sifo siqhubeka, ungase uzizwe ukhathazekile futhi wesaba. Uma kunjalo, buza udokotela wakho ngezinhlelo noma izinsizakalo ezingakusiza ukuphatha ukucindezeleka kwakho.
• Yidla ukudla okunempilo: Ezinye izimpawu ze-CLL zingabangela ukuthi ulahlekelwe yisifiso sokudla. Khuluma nodokotela wakho mayelana nokuthola iseluleko kuchwepheshe wezokudla. Uma isifiso sakho sokudla sihle, zama ukudla ukudla okulinganiselayo okuhlanganisa amaprotheni angenamafutha amaningi, okusanhlamvu okuphelele, izithelo nemifino, namafutha anempilo. Lokhu kungathuthukisa impilo yakho iyonke.
• Ukuzivocavoca: Ukuzivocavoca kukusiza ukuthi ulawule ukucindezeleka futhi kukugcine ujabule.
• Ukuphumula: I-CLL ingakwenza uzizwe ukhathele kakhulu. Phumula uma uzizwa sengathi udinga ukuphumula.
• Yazi ukuthi yini ongayilindela: Ulwazi lungamandla. Cela udokotela wakho izimpawu zokuthi isimo sakho singase sibe sibi kakhulu. Uma kunjalo, udokotela wakho angase ancome ezinye izindlela zokwelapha ezingasiza ekuphatheni i-CLL yakho kangcono.

Yimiphi imibuzo okufanele ngiyibuze udokotela wami?

Ungase ufune ukubuza imibuzo efana nale:

• Nginaluphi uhlobo lwe-leukemia ye-lymphocytic engamahlalakhona?
• Anginazo izimpawu. Kufanele ngiqale nini ukwelashwa?
• Yiziphi izindlela zokwelapha enginazo?
• Ingabe kuzodingeka ngithathe ukwelashwa unomphela?
• Ingabe ukwelashwa kuzongisiza ngilulame?

Okokugcina, izinto okufanele uzikhumbule (Umyalezo Wokuya Ekhaya)

I-chronic lymphocytic leukemia (CLL) uhlobo lwe-leukemia oluvame kakhulu kubantu abadala. Ungaba nalesi simo iminyaka eminingi ngaphandle kwezimpawu. Uma une-CLL, kungase kungadingeki ukuthi uqale ukwelashwa ngokushesha. Nakuba odokotela bengenakuyelapha ngokuphelele, kunezindlela zokwelapha ezinganciphisa izimpawu ze-CLL futhi zenze lesi sifo siphumule . Abanye abantu abane-CLL baphila iminyaka eminingi.

Ukuphila nesifo esingamahlalakhona njenge-CLL akulula ngaso sonke isikhathi. Ungase udlule emijikelezweni eminingana yokululama nokubuyela emuva. Phakathi nomjikelezo ngamunye, ungase ukhathazeke ngokuthi kuzokwenzekani ngokulandelayo. Odokotela bakho bayaqonda ukuthi kunjani ukuphila nesifo esingamahlalakhona. Bazokujabulela ukuphendula noma yimiphi imibuzo ongase ube nayo futhi bakusize nganoma iyiphi indlela abangayenza. Ngakho-ke, ungesabi ukukhuluma nodokotela wakho ngezinto ezikukhathazayo.

I- Leukemia, i-CLL, umdlavuza wegazi, izimpawu, ukwelashwa, ama-lymphocyte, ukululama