Ingabe i-leukemia iyisimo esingajwayelekile esibangelwa imithi? Ake sixoxe nge-Differentiation Syndrome!

Uma wena noma umuntu omaziyo elashelwa isifo esifana ne-leukemia, ungase ube nemiphumela emibi engalindelekile. Namuhla, sizokhuluma ngenhlanganisela yemiphumela emibi engenzeka ngemithi, ikakhulukazi leyo enikezwa izinhlobo ezimbili zomdlavuza wegazi. Odokotela babiza lokhu ngokuthi i-Differentiation Syndrome . Ngenxa yokuthi kungaba kubi kakhulu, odokotela bavame ukuqala ukwelapha izimpawu ngaphambi kokuba baqinisekise ngokuqinisekile, okunganciphisa ingozi yezinkinga ezisongela ukuphila.

Iyini i-Differentiation Syndrome?

Kalula nje, i-Differentiation Syndrome iyiqembu lezimpendulo ezinzima umzimba onazo emithini ethile esetshenziselwa ukwelapha izinhlobo ezimbili zomdlavuza wegazi, okuyi- Acute Promyelocytic Leukemia (APL) kanye ne -Acute Myeloid Leukemia (AML) . Kunjengokungathi amanye amangqamuzana emzimbeni wethu "ayahlanya" ngale mithi bese eqala ukukhulula izinto eziningi ngesikhathi esisodwa. Yilokhu okubangela uphawu ngalunye.

Cabanga ngomngane wakho otholakale ene-APL bese eqala ukwelashwa. Ezinsukwini ezimbalwa nje, uba nomkhuhlane, abe nobunzima bokuphefumula, futhi avuvuke kancane. Ngaleso sikhathi, odokotela basola ukuthi lokhu kuyi-Differentiation Syndrome.

Ziyini lezi Zindlela Zokuhlukanisa?

Ama-differentiation agents uhlobo lwemithi esetshenziswa odokotela ukwelapha i-APL. I-APL ishesha kakhulu kunezinye izinhlobo ze-AML emithini ebangela ukuba amaseli avuthwe, noma ahluke . Le mithi isiza amaseli omdlavuza (isigaba se-blast cell) ukuba akhule abe amaseli egazi amhlophe ajwayelekile, anempilo. Yingakho odokotela besebenzisa le mithi yokuhlukanisa esikhundleni sokubanika imithi ye-chemotherapy ngqo.

Njengeminye imithi yomdlavuza, le mithi isiza ekumiseni noma ekubambezeleni ukukhula kwamaseli omdlavuza. Odokotela bangase basebenzise lawa ma-differentiation agents bodwa, ngokuhlanganiswa, noma ngokuhlanganiswa ne-chemotherapy. Bangayiphatha ngempumelelo i-APL. Kodwa-ke, abanye abantu abane-APL bangaba nemiphumela emibi kakhulu evela kule mithi.

Yimiphi imithi engabangela i-Differentiation Syndrome?

Lesi simo singabangelwa ama-differentiation agents anikezwa i-APL. Izibonelo zifaka:

• I-All-trans-retinoic acid (ATRA) uhlobo lwevithamini A.
• I-Arsenic Trioxide (ATO) uhlobo lwe-arsenic.

Futhi, kwabanye abantu abane-AML, odokotelaAma-Isocitrate Dehydrogenase (IDH) inhibitors ayizinhlobo zemithi yamakhemikhali esetshenziswayo. Lawa ma-IDH inhibitors (ivosidenib) kanye (enasidenib) nawo angabangela i-Differentiation Syndrome. Akukhona lokho kuphela, kodwa nama -FLT3 inhibitors (isb. (midostaurin) , (gilteritinib) ) angabangela lesi simo.

Ubani ongadinga ama-IDH inhibitors?

• Abantu abanomdlavuza obuye wavela.
• Abantu abanomdlavuza okunzima ukuwelapha.
• Abantu abanokuguqulwa kwezakhi zofuzo ezithile (i-IDH1 noma i-IDH2 mutation).
• Labo abangakwazi ukubekezelela ukwelashwa okujwayelekile kwe-chemotherapy.

Ubani onamathuba amaningi okuthola i-Differentiation Syndrome?

Abantu abaningi abane-APL banenani eliphansi lamaseli amhlophe egazi (i-WBC) . Kodwa-ke, labo abanenani eliphezulu lama-WBC basengozini enkulu yokuthola i-Differentiation Syndrome. Kulezi zimo, odokotela bavame ukunikeza umuthi obizwa ngokuthi i-Prednisone noma i-Dexamethasone ukunciphisa ingozi yalesi sifo.

Ivame kangakanani i-Differentiation Syndrome?

Empeleni lesi yisimo esingavamile kakhulu. I-AML uhlobo oluvame kakhulu lwe-leukemia kubantu abadala, yize ibangela cishe u-1% wabo bonke umdlavuza. E-United States, i-APL yenzeka cishe koyedwa kubantu abangu-250,000.

Kulabo abane-AML kanye ne-APL:

• Cishe ama-25% eziguli ze-APL ezithole imithi ye-ATRA kanye ne-ATO sezine-Differentiation Syndrome.
• Lesi simo sibikwe phakathi kuka-14% no-19% weziguli ze-AML ezithatha ama-IDH inhibitors.

Yini ebangela le Differentiation Syndrome?

Abacwaningi abakakazi kahle ukuthi kungani abanye abantu besabela ekwelashweni kwe-APL ngale ndlela. Izifundo zakuqala zisikisela ukuthi imithi yomdlavuza ibangela ukuthi amangqamuzana e-leukemia akhiphe ngokuzumayo inani elikhulu lamakhemikhali omzimba. Lokhu kubizwa ngokuthi i-cytokine release syndrome . Lokhu kuvuvukala okungalawulwayo kubangela izimpawu ezahlukahlukene, kusukela kokuncane kuya kokubi kakhulu.

Ziyini izimpawu ze-Differentiation Syndrome?

Umuntu one-APL uvame ukuqala ukuba nezimpawu ze-Differentiation Syndrome zingakapheli isonto noma amabili kusukela eqale i-ATRA kanye/noma i-Arsenic Trioxide. Kodwa-ke, uma uthatha ukwelashwa kwe-IDH inhibitor ye-AML, kungathatha isikhathi eside ukuthi izimpawu zivele.Kungaphela (lezi zimpawu zingavela noma kuphi kusukela osukwini olulodwa kuya ezinyangeni ezinhlanu kuya kweziyisithupha ngemuva kokuqala ukusebenzisa umuthi).

Lezi yizimpawu ezivame ukubonakala:

• Ukukhwehlela .
• Ukwakheka koketshezi oluningi oluzungeze inhliziyo namaphaphu akho (i-Pleural Effusion) .
• Ukwehluleka Kwezinso .
• Umfutho wegazi ophansi (i-Hypotension) .
• Amazinga aphansi omoya-mpilo egazini (i-Hypoxemia) .
• Ubunzima bokuphefumula (i-Dyspnea) .
• Ukuvuvukala (ukuvuvukala) kwezandla, izinyawo, kanye nentamo.
• Umkhuhlane ngaphandle kwesizathu.
• Ukwanda kwesisindo ngaphandle kwesizathu.

Okubalulekile: Uma unesinye noma ngaphezulu salezi zimpawu, akusho ukuthi nakanjani une-Differentiation Syndrome. Kodwa-ke, kubalulekile ukwazisa udokotela wakho ngokushesha uma ubona noma yiziphi zalezi zimpawu.

Yiziphi izinkinga ezingaba khona ze-Differentiation Syndrome?

Lesi simo ngezinye izikhathi singaholela ezimweni ezibucayi kakhulu. Isibonelo:

• Ukwehluleka Kwenhliziyo .
• Ukwehluleka Kwezinso .
• Ukwehluleka Kwamaphaphu .
• Ukopha okuvela emaphashini (Ukopha Kwegazi Emaphashini) .
• Inyumoniya .
• I-Sepsis ( ukutheleleka okukhulu okusakazeka emzimbeni wonke).

Uma uhlangabezana nanoma yiziphi zalezi zimpawu, shayela udokotela wakho ngokushesha . Uma unenkinga yokuphefumula noma ubuhlungu besifuba, shayela u-911 (noma inombolo yakho yesimo esiphuthumayo yendawo) ngokushesha . Abantu abane-APL bavame ukwelashwa esibhedlela kuze kube yilapho ingozi ye-differentiation syndrome idlula.

I-Differentiation Syndrome ihlolwa kanjani?

Kungaba nzima ukuthola lesi simo kumuntu one-APL, njengoba kunezinye izimo eziningi ezingabangela izimpawu ezifanayo. Ezimweni ezimbi kakhulu, odokotela bangase baqale ukwelapha izimpawu ngokushesha nje lapho besola ukuthi kukhona i-Differentiation Syndrome, ngisho nangaphambi kokuba baqinisekise ukuthi yiyona efanele.

Udokotela wakho uzoncoma ukuhlolwa okuningana ukuqinisekisa isimo futhi akhiphe ezinye izimo zezokwelapha. Lokhu kungafaka:

• Inani Eliphelele Legazi (i-CBC) .
• I-X-ray yesifuba .
• I-Echocardiogram (ukuhlolwa okuhlola ukusebenza kwenhliziyo).
• I-CT scan yesifuba .
• I-Bronchoscopy (ukuhlolwa okusebenzisa ikhamera ukubheka ngaphakathi kwamaphaphu).
• Okunye ukuhlolwa kwegazi (Ukuhlolwa kwegazi).

Ingabe ikhona ikhambi le-Differentiation Syndrome?

Ezimweni eziningi, abantu abane-acute promyelocytic leukemia (APL) bangalulama ngokuphelele kwi-differentiation syndrome uma bethola ukwelashwa okusheshayo nokufanelekile . I-APL manje isiyisifo esingelapheka kakhulu. Ngakho-ke akukho okufanele kwesatshwe.

Iphathwa kanjani i-Differentiation Syndrome?

Odokotela bavame ukwelapha izimpawu ze-differentiation syndrome ngemithi ye -corticosteroid noma ye-glucocorticoid , njenge- dexamethasone . Ezimweni ezimbi kakhulu, udokotela wakho angase futhi ancome ukuyeka okwesikhashana ukwelashwa kwakho komdlavuza kuze kube yilapho izimpawu zakho ziphela.

Iningi labantu abane-APL belashwa esibhedlela kuze kube yilapho ingozi ye-differentiation syndrome isidlulile. Uma ungumuntu ohlala esibhedlela futhi kusolwa ukuthi une-differentiation syndrome, odokotela bakho bangase banqume ukukugcina esibhedlela ubusuku bonke ukuze baphathwe noma babhekwe. Ithimba lakho lezokwelapha lizokusiza ukuqinisekisa ukuxilongwa kwakho futhi lelaphe kahle noma yiziphi izimo ezibangela izimpawu zakho.

Yini engingayenza ukuze nginciphise ingozi yami yokuthola i-Differentiation Syndrome?

Akukho lutho ongakwenza ukunciphisa ingozi yakho yalesi simo. Uma uthatha i-chemotherapy noma eminye imithi yomdlavuza, tshela udokotela wakho ngokushesha nganoma yiziphi izimpawu ozizwayo . Futhi, qaphela ukuthi yiziphi izimpawu okufanele uziqaphele (njengoba sixoxile ngenhla) bese ukhuluma nodokotela wakho uma unenkinga. Lena yinto ebaluleke kakhulu.

Iyini inhloso ye-Differentiation Syndrome?

Umbono we-differentiation syndrome ngokuvamile muhle kubantu abaningi. Ezimweni eziningi, ungaqhubeka nokwelashwa kwakho okulwa nomdlavuza, kungaba ngesikhathi noma ngemva kokwelashwa ngama-steroid. Ithimba lakho lezokwelapha lizokhuluma nawe ngezinketho zakho zokwelapha.

Kunini lapho kufanele uthole khona iseluleko sezokwelapha nge-Differentiation Syndrome?

Uma uhlangabezana nanoma yiziphi izimpawu ze-differentiation syndrome ngenkathi welashwa umdlavuza, shayela udokotela wakho ngokushesha . Kungaba nzima kuwe noma kudokotela wakho ukubona ukuthi izimpawu zakho zibangelwa ukwelashwa komdlavuza noma esinye isimo. Ukwelashwa kusenesikhathi kungasiza ekunciphiseni izimpawu futhi kunciphise ingozi yezinkinga.

Ukwelashwa komdlavuza kungaba yinselele. Kodwa-ke, kungadumaza ukwazi ukuthi ukwelashwa ngokwako kunemiphumela emibi. I-Differentiation Syndrome iyiqembu lezimpendulo ezingase zisongele impilo ekwelashweni komdlavuza wegazi. Kodwa-ke, ingelashwa uma itholakala futhi yelashwa kusenesikhathi . Ngenxa yokuthi izimpawu zingaba zimbi kakhulu ngokushesha, odokotela bangase baqale ukukwelapha ngaphambi kokuba imiphumela yokuhlolwa kwakho iqinisekise ukuthi une-Differentiation Syndrome. Ukwelashwa kusenesikhathi kungasiza ekunciphiseni izimpawu zakho futhi kukubuyisele endleleni yokululama.

Umlayezo Wokuya Nawe Ekhaya

• I-Differentiation Syndrome iwukusabela okubi kakhulu okungenzeka ngenxa yemithi ethile esetshenziselwa ukwelapha i-leukemia njenge-APL ne-AML.
• Izimpawu ezifana nomkhuhlane, ubunzima bokuphefumula, kanye nokuvuvukala komzimba kungase kube khona.
• Uma ubona lezi zimpawu, kubalulekile ukwazisa udokotela wakho ngokushesha .
• Uma kutholakale kusenesikhathi futhi kwelashwa ngemithi efana ne -Dexamethasone, ngokuvamile kungalapheka.
• Ungakhathazeki uma uzwa lokhu. Ithimba lakho lezokwelapha lizokusiza. Into ebaluleke kakhulu ukubazisa nganoma yiziphi izinguquko, noma yiziphi izimpawu.

I- Differentiation syndrome, i-leukemia, ukwelashwa komdlavuza, imiphumela emibi, i-APL, i-AML, i-ATRA, izimpawu