Ubungazizwa kanjani uma ungenwe ukwelashwa okukhulu njengokufakelwa umnkantsha wegazi bese ucabanga ukuthi, "Konke sekulungile manje," bese uzwa ukuthi umdlavuza ubuyile? Kuyadabukisa ngempela futhi kuyadabukisa kakhulu. Kodwa ungalilahli ithemba. Namuhla sikhuluma ngokwelashwa okukhethekile okungasiza ezimweni ezinjengalezi. Kubizwa ngokuthi i-DLI, okusho ukuthi i-Donor Lymphocyte Infusion.
Kalula nje, iyini i-DLI?
Kulungile, ake sikubeke kalula lokhu. Ama-lymphocyte awuhlobo lweseli elimhlophe egazini lakho. Afana namasosha emizimbeni yethu. Ayingxenye enkulu yesimiso sethu somzimba sokuzivikela, alwa namagciwane angaphandle, izifo, kanye namaseli omdlavuza.
Manje, i-DLI (Donor Lymphocyte Infusion) inqubo lapho amanye ala ma-lymphocyte ethathwa kumuntu ofanayo ophilile owake wanikela ngomnkantsha wakho wamathambo (amaseli esiqu) futhi wafakwa emzimbeni wakho. Lawa 'masosha' amasha, anempilo futhi aqinile afuna futhi abhubhise noma yimaphi amangqamuzana omdlavuza asele angase afihleke emzimbeni wakho. Yilowo umgomo oyinhloko walokhu kwelashwa.
Kukuziphi izimo lapho ukwelashwa nge-DLI kunconywa khona?
Udokotela wakho cishe uzokutshela ngalokhu kwelashwa uma umdlavuza wegazi lakho ubuya (uphindela emuva) ngemva kokufakelwa umongo wamathambo.
Nazi ezinye zezimo ezivame ukusetshenziswa kuzo ukwelashwa kwe-DLI:
- I-Acute Myeloid Leukemia (AML)
- I-Chronic Lymphocytic Leukemia (CLL)
- I-Chronic Myeloid Leukemia (CML)
- I-Multiple Myeloma
- I-Myelodysplasia (MDS)
- I-Non-Hodgkin Lymphoma
Enye into ukuthi, ngezinye izikhathi ngemva kokufakelwa umongo wethambo, umzimba wakho ungase ube nengxube yamaseli anikelayo kanye namaseli akho amadala. Lokhu sikubiza ngokuthi (i-mixed chimerism) . Lokhu kwandisa nengozi yokuthi umdlavuza uphinde ubuye. Ngakho-ke, i-DLI ingenziwa ukuguqula wonke amaseli emzimbeni wakho abe amaseli avela kumnikeli.
Ulungiselela kanjani lokhu kwelashwa?
Ngaphambi kokuqala ukwelashwa kwe-DLI, udokotela wakho uzokuxilonga ngokucophelela, axoxe ngezimpawu zakho, bese eyala ukuhlolwa okuningana.
- I-Bone Marrow Biopsy: Kuthathwa isampula encane yomongo ukuze kuhlolwe noma yimaphi amangqamuzana omdlavuza asele.
- Inani Eliphelele Legazi (i-CBC):Inani lamaseli egazini liyahlolwa.
- Ukuhlolwa kokusebenza kwezinso kanye nesibindi.
Uma ukuhlolwa kwegazi kubonisa ukuthi izinga lamaseli omdlavuza liphezulu kakhulu, udokotela wakho angase anqume ukukunikeza i-chemotherapy ngaphambi kwe-DLI. Lokhu kwenzelwa ukunciphisa inani lamaseli omdlavuza nokwandisa impumelelo yokwelashwa kwe-DLI.
Amaseli e-lymphocyte atholakala kanjani kumuntu onikelayo?
Lokhu kuyinto ekhethekile kakhulu eyenzekayo. Umnikeli owakunika impilo, okungukuthi, umnikeli owakunika umongo wamathambo, naye uyasiza ngalokhu. Ithubhu elincane (i-catheter) lifakwa emthanjeni engalweni yakhe bese kuthathwa igazi elithile. Leli gazi lidlula emshinini okhethekile. Lokho okwenziwa yilowo mshini ukuhlukanisa amaseli e-lymphocyte esiwadingayo kuphela, bese uthumela lonke igazi emzimbeni ngomthambo osengalweni yomunye umnikeli. Le nqubo ibizwa ngokuthi i-apheresis . Ngezinye izikhathi, lapho unikela ngomongo wamathambo okokuqala, amanye ala maseli e-lymphocyte angathathwa futhi aqandiswe ukuze asetshenziswe kamuva.
Uthola kanjani ukwelashwa kwe-DLI?
Lokhu kuzwakala sengathi kuyinto elula njengokukunikeza isisombululo se-saline.
1. Udokotela noma umhlengikazi uzofaka ipayipi elincane (i-catheter) emthanjeni ongalweni noma esifubeni sakho.
2. Ngemuva kwalokho, iphakethe eliqukethe amaseli e-lymphocyte ahlukaniswe nomnikeli lixhunywe kulelo payipi bese lifakwa egazini lakho.
3. Lo msebenzi uthatha cishe imizuzu engama-30 .
4. Uma umsebenzi usuqediwe, ithubhu liyasuswa.
Ngezinye izikhathi unganikeza imithamo eminingana efana nalena esikhathini esingamasonto noma izinyanga eziningana.
Uma amangqamuzana amasha efakwa emzimbeni ngale ndlela, enye yezinto ezibaluleke kakhulu ibizwa ngokuthi i-graft vs. tumor effect (GvT) . Lokhu kusho ukuthi lawa maseli aphilile (i-graft) avela kumuntu onikelayo afuna amangqamuzana omdlavuza asele (i-tumor) emzimbeni wakho, awahlasele, futhi awabhubhise. Yile ndlela umdlavuza onyamalala ngayo ngokuphelele.
Yiziphi izinzuzo nezingozi zokwelashwa nge-DLI?
Izinzuzo eziyinhloko zalokhu
Esikhathini esidlule, uma umdlavuza ubuya ngemva kokufakelwa umongo wethambo, okuwukuphela kwendlela kwakuwukwenza okunye ukufakelwa umongo wethambo. Kodwa ingozi yezinkinga yayiphezulu kakhulu ngokufakelwa okwesibili. I-DLI iyindlela enhle nenengozi encane yokubeka umdlavuza esimeni esihle ngaphandle kwemithi yokucindezela amasosha omzimba.
Izingozi ezingaba khona kanye nezinkinga
Njengakuzo zonke izindlela zokwelapha, kunezingozi ezithile. Ithimba lakho lezokwelapha lizokuqapha eduze ukuze lithole lezi zingozi.
| Inkinga | Incazelo kanye nezimpawu |
|---|---|
| Isifo Sokuxhunyelelwa Kwegciwane (GvHD) | Yilapho amaseli avela kumhlinzeki (i-graft) ebona amaseli omzimba wakho aphilile (umnikazi) njengesitha bese ewahlasela. Izimpawu: uhudo, ukuphuzi kwesikhumba (i-jaundice), isicanucanu nokuhlanza, izilonda zesikhumba noma ukuqubuka. |
| Ukucindezeleka kwe-Myelosuppression | Lokhu ukwehla kwesikhashana kokusebenza komnkantsha wethambo, okungaholela ekunciphiseni inani lamaseli egazi. - Amangqamuzana abomvu egazi aphansi (i-Anemia): ukukhathala, ukuphelelwa umoya. - Ukwehla kwamangqamuzana amhlophe egazi (i-Leukopenia): Ingozi eyengeziwe yokutheleleka. - Ama-platelet aphansi: Ingozi eyandayo yokopha. |
Yini okufanele uyenze uma kuvela izinkinga?
Ungakhathazeki. Kukhona izindlela zokwelapha konke lokhu.
- Uma kwenzeka i-GvHD: Udokotela wakho uzokunikeza imithi yokucindezela amasosha omzimba .
- Uma amangqamuzana akho egazi ephansi: Amangqamuzana amhlophe egazi aphansi avame ukuziphelela. Uma kungenjalo, kunemithi yokuwelapha. Ukumpontshelwa igazi kungenziwa uma kudingeka ukuze kwelashwe amangqamuzana abomvu egazi nama-platelet aphansi.
Ngemva kokwelashwa kanye nempumelelo
Khuluma nodokotela wakho ngokuthi kuzothatha isikhathi esingakanani ukubuyela esimweni esijwayelekile ngemva kokwelashwa. Uzodinga ukulandelwa njalo nokuhlolwa kwegazi.
Impumelelo yalokhu kwelashwa ingahluka kumuntu nomuntu. Kunezici eziningana ezikuthintayo:
- Isigaba somdlavuza.
- Impilo yesimiso sakho somzimba sokuzivikela.
- Uhlobo lokufakelwa okwenziwe ngaphambilini.
- Ukuthi i-chemotherapy yenziwe ngaphambi kwe-DLI noma cha.
Okubaluleke kakhulu: Uma uthola noma yiziphi izimpawu ze-GvHD njengomkhuhlane, ukopha okungavamile, ubunzima bokuphefumula, isifo sohudo, ukuqubuka kwesikhumba, noma ezinye izimpawu ezingavamile , yazisa udokotela wakho noma isibhedlela esikwelapha ngokushesha.
Ingabe i-DLI iyindlela yokwelapha nge-immunotherapy?
Yebo, i-DLI iyindlela yokwelapha nge-immunotherapy.Kuluhlobo lokwelashwa. Ngoba lokho okwenzayo ukunikeza amasosha omzimba wakho ama-T-cell aphilile avela ngaphandle ukuze asisize silwe nomdlavuza. Lokho kuyathembisa ngempela.
Umlayezo Wokuya Nawe Ekhaya
- I-DLI iyindlela ekhethekile yokwelapha umdlavuza wegazi ophinde uvele ngemva kokufakelwa umongo wamathambo.
- Lokhu kusebenzisa amangqamuzana abizwa ngokuthi ama-lymphocyte avela kumuntu ofanayo onempilo owanikela ngomnkantsha wakho kwasekuqaleni.
- Inhloso yalokhu ukuthi la maseli amasha afune futhi abhubhise amangqamuzana omdlavuza asele emzimbeni (umphumela we-GvT).
- Izingozi ezinkulu yi-GvHD (Graft vs. Host Disease) kanye nenani eliphansi lamaseli egazi, kodwa lokhu kuyelapheka.
- Lolu uhlobo lokwelashwa nge-immunotherapy olunikeza ithemba ngaphandle kwezingozi eziphezulu zokufakelwa umnkantsha wesibili.
- Khuluma nodokotela wakho ngokushesha nganoma yiziphi izimpawu noma izinkinga ezintsha.
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