Ingabe kufanele siqaphele i-PTLD (Post-Transplant Lymphoproliferative Disorders) ngemva kokufakelwa isitho?

Wena noma othile omaziyo kungenzeka ukuthi uke wahlinzwa kakhulu okusindisa impilo, njengokufakelwa isitho. Noma ukufakelwa i-stem cell. Ngemva kwalezi zinto, kuba nezinkinga ezingavamile nezingalindelekile. Enye yezinkinga ezinjalo yi-PTLD, noma i-Post-Transplant Lymphoproliferative Disorders. Njengoba lokhu kungaba yinto engathí sina, ake sixoxe ngakho ngendlela elula ongayiqonda.

Iyini ngempela i-PTLD?

Kalula nje, i-PTLD iyinkinga esongela ukuphila engenzeka ngemva kokufakelwa isitho noma ukufakelwa iseli le-stem le-allogeneic. Okwenzekayo lapha ukuthi uhlobo lweseli elimhlophe legazi emzimbeni wethu, olubizwa ngokuthi ama-lymphocyte, luhlukana ngokushesha futhi lwanda ngokungalawuleki.

Lesi simo esibizwa ngokuthi i-PTLD empeleni siwuhlobo lwe-lymphoma . I-Lymphoma uhlobo lomdlavuza oluvela ohlelweni lwethu lwe-lymphatic. Lesi simo senzeka lapho amangqamuzana amhlophe egazi eba umdlavuza futhi ekhula ngokushesha ngaphandle kokufa.

I-PTLD ivame ukubangelwa yi -Epstein-Barr Virus (EBV) . Leli yigciwane sonke esinalo emizimbeni yethu. Kunezinhlobo ezahlukene ze-PTLD, futhi indlela elithinta ngayo umuntu ingahluka. Izindaba ezinhle ukuthi odokotela bangayilapha. Kodwa-ke, ngezinye izikhathi lesi simo singabuya.

Yiziphi izinhlobo eziyinhloko ze-PTLD?

Odokotela bahlukanisa i-PTLD ngezinhlobo ezine eziyinhloko ngokusekelwe endleleni amangqamuzana e-lymphoma abukeka ngayo ngaphansi kwe-microscope:

• Ukuphuka Kwasekuqaleni: Laba bantu baba nezimpawu ezifana nalezo ezibonakala ngegciwane le-Epstein-Barr (EBV).
• I-Polymorphic PTLD: Lapha, amangqamuzana e-lymphoma axutshwa nezinye izinhlobo zamangqamuzana amhlophe egazi, njenge-lymphocytes evamile kanye namangqamuzana e-plasma.
• I-Monomorphic PTLD: Lolu uhlobo oluvame kakhulu lwe-PTLD . Amaseli e-lymphoma lapha afana nalawo atholakala kwezinye izinhlobo ze-lymphoma, njenge-"Non-Hodgkin Lymphomas". Isibonelo, i-"Diffuse Large B-cell Lymphoma" noma i-"Burkitt Lymphoma".
• I-Classic Hodgkin Lymphoma - Uhlobo lwe-PTLD: Lolu uhlobo olungavamile kakhulu lwe-PTLD .

Sivame kangakanani lesi simo esibizwa ngokuthi i-PTLD?

Njengoba kushiwo ngaphambili, i-PTLD iyisimo esingavamile kakhulu . Lokho kusho ukuthi akwenzeki kuwo wonke umuntu. Cishe, cishe abantu ababili kwabayi-100 abaye bafakelwa i-stem cell (`(2%)`) bazoba ne-PTLD. Abantu abaye bafakelwa isitho banamathuba amancane okuthola i-PTLD. Kodwa lokho kuyahlukahluka kuye ngokuthi isitho sifakwe kanjani.

Cabanga ngalokhu, kuyilapho cishe abantu abathathu kwabayi-100 abaye bafakelwa izinso (`(3%)`) bethola lesi simo, ochwepheshe bathi cishe abantu abayishumi kwabayi-100 abaye bafakelwa amaphaphu (`(10%)`) bangase babe nalesi simo. Ngakho-ke, akukho okufanele ukhathazeke ngakho, lokhu akuyona into eyenzeka kubantu abaningi.

Yiziphi izimpawu ezingaba khona ze-PTLD?

Abanye abantu bangase bangabi nazimpawu ekuqaleni. Izimpawu ze-PTLD zingavela nganoma yisiphi isikhathi, kusukela ezinyangeni ezimbalwa kuya eminyakeni eminingana ngemva kokufakelwa. Uma izimpawu zivela, zingase zihlanganise:

• Ukuzizwa ukhathele kakhulu (`Ukukhathala`) : Umuzwa nje wokuphelelwa yimpilo.
• Umkhuhlane ngaphandle kwesizathu .
• Ukudla akunambitheki .
• Ukwehlisa isisindo okungalindelekile .
• Ukujuluka ngokweqile ebusuku (`Ukujuluka ebusuku`) .
• Ama-lymph node avuvukele : Azwakala njengezigaxa entanyeni nasemakhwapheni.

Kungani le PTLD yenzeka? Ziyini izimbangela?

Lokhu kuyinto eyinkimbinkimbi okufanele uyiqonde. I-PTLD yenzeka ngoba igciwane elivame kakhulu lisebenzisa ubuthakathaka ohlelweni lwethu lokuzivikela komzimba .

Ake sithi ulungiselela ukufakelwa i-stem cell. Ngaphambi kwalokho, uzonikezwa i-chemotherapy yokubulala amangqamuzana omdlavuza emnkantsheni wakho wamathambo. Lokhu kubizwa ngokuthi i-conditioning. Lokhu kwenza buthaka amandla omzimba wakho okukuvikela ezifweni. Ngokukhethekile, i-conditioning inciphisa umsebenzi wamaseli e-T (amaseli e-T) atheleleke nge-EBV futhi aphinde angasebenzi.

Ngemuva kwalokho, ngemva kokuba amaseli okuqala noma isitho sesitshaliwe, umzimba wakho unikezwa imithi yokucindezela amasosha omzimba ukuze uvimbele ukuthi wenqabe into entsha. Nakuba le mithi ivikela isitho noma amaseli amasha, ibuye yenze buthaka isimiso sethu somzimba sokuzivikela, okwenza sibe sengozini enkulu kubahlaseli bakwamanye amazwe njengama-virus.

Ku-PTLD, igciwane eliyinhloko yigciwane i-Epstein-Barr (EBV) . I-EBV ixhunyaniswe ne-PTLD ekhula phakathi nonyaka noma emibili ngemva kokufakelwa kweseli lesitho noma isitho. Kodwa-ke, imbangela eqondile ye-PTLD ekhula eminyakeni eminingi ngemva kokufakelwa ayikakaziwa. Ochwepheshe baphenya nokuthi amagciwane anjenge-cytomegalovirus (CMV) noma i-adenovirus (Adenovirus) angadlala indima yini.

Ngokusho kochwepheshe, cishe abantu abangu-90% bakithi batheleleke nge-EBV ngesikhathi esithile besebancane noma besebancane. Ungase ube naleli gciwane ngaphandle kwezimpawu, futhi ungase ungazi nokuthi likhona. Igciwane le-EBV lithelela amangqamuzana ethu e-B futhi lihlala "lilele" emzimbeni, okungukuthi, lisesimweni "sokucasha", ngaphandle kokubangela izinkinga. (Kungenzeka ukuthi ulithole kumuntu onikelayo leli gciwane.)

Ngenxa yokuthi uthatha leyo mithi yokucindezela amasosha omzimba, amasosha omzimba wakho awakwazi ukulawula i-EBV engasebenzi. Ngemuva kwalokho, amaseli e-B atheleleke nge-EBV aqala ukuhlukana futhi aphindaphindeke ngokushesha. Yilokho okuholela ku-PTLD.

Ubani osengozini enkulu yokuthola i-PTLD?

Ingozi yakho yokuthola i-PTLD inganda ngenxa yezizathu ezilandelayo:

• Ukuba negciwane le-Epstein-Barr (EBV) emzimbeni wakho noma emzimbeni womuntu okunike isitho/amangqamuzana (`(Umnikeli)`).
• Ngemva kokuthola ukwelashwa (`Ukulungiswa kwangaphambi kokufakelwa') okunciphisa ukusebenza okuvamile kwamaseli akho e-T ngaphambi kokufakelwa.
• Ukuthatha imithi yokucindezela amasosha omzimba ukuvimbela umzimba wakho ekwenqabeni isitho noma amaseli amasha.
• Ukuba nokwehluka kwezakhi zofuzo ezithile (`(Izakhi zofuzo)`) okwandisa ingozi yokuthola i-PTLD.

Odokotela basithola kanjani lesi simo esibizwa ngokuthi i-PTLD?

Odokotela bazoqala ngokukwenza ukuhlolwa ngokomzimba futhi bahlole umlando wakho wezokwelapha ngokucophelela. Ngaphezu kwalokho, bavame ukwenza izivivinyo ezilandelayo:

• Inani Eliphelele Legazi (`Inani Eliphelele Legazi - CBC`) .
• Iphaneli Ephelele Ye-Metabolic .
• Izinga le-Lactate dehydrogenase (LDH) .
• Ukuhlolwa komchamo , okuhlanganisa namazinga e-uric acid.
• Ukuhlolwa kokuthola ama-antibodies akhiqizwa emzimbeni ngokumelene negciwane le-EBV .
• I-CT scan (`I-Computed Tomography - I-CT scan`) .
• Ukuskena kwe-MRI (I-Magnetic Resonance Imaging - i-MRI) .
• Ukuskena kwe-PET (`I-Positron Emission Tomography - Ukuskena kwe-PET`) .
• I-biopsy yomnkantsha wamathambo .

Lezi zivivinyo yizo ezivumela odokotela ukuthi banqume ukuthi i-PTLD ikhona noma cha, futhi uma kunjalo, ukuthi ibukeka kanjani.

Yiziphi izindlela zokwelapha i-PTLD?

Odokotela bavame ukuqala ngokunciphisa inani lemithi yokucindezela amasosha omzimba abayithathayo . Ngezinye izikhathi lokhu kungenza umehluko omkhulu. Ngaphezu kwalokho, kunezinye izindlela zokwelapha ezifana nalezi:

• Ukwelashwa ngamakhemikhali : Umuthi obulala amangqamuzana omdlavuza.
• Ukwelashwa ngemisebe : Ukubhubhisa amangqamuzana omdlavuza kusetshenziswa imisebe enamandla aphezulu.
• Ukwelashwa nge-immunotherapy ngama-antibody e-monoclonal : Lokhu kuhilela ukusebenzisa amaprotheni athile (ama-antibody e-monoclonal) ukuhlasela amangqamuzana omdlavuza.
• Ukuhlinzwa : Lokhu akuvamile ukwenziwa. Ukuhlinzwa kucatshangelwa kuphela uma i-PTLD isendaweni futhi ingasuswa ngokuphephile. Isibonelo, uma amathonsi ethintekile yi-PTLD, amathonsi angasuswa.

Ingabe kukhona esingakwenza ukuvimbela i-PTLD ukuthi ingakhuli?

Akukho lutho esingakwenza ukuvimbela i-PTLD ngqo. Kodwa-ke, odokotela nabacwaningi babheka eminye imithi engasetshenziswa ngaphambi kanye/noma ngemva kokufakelwa ukuze kuncishiswe ingozi ye-PTLD. Ngakho-ke, kunethemba lokuthi kuzoba nezixazululo ezingcono zalokhu esikhathini esizayo.

Kwenzekani uma uba ne-PTLD? Ingabe ingelapheka?

Indlela ozosabela ngayo ku-PTLD ingahluka kumuntu nomuntu. Kuncike ezintweni eziningi.

Isibonelo, ngezinye izikhathi i-PTLD iyathuthuka ngisho noma odokotela bemane benciphisa imithi yokucindezela amasosha omzimba.

Izifundo zakamuva zibonise ukuthi phakathi kuka-60% no-70% wabantu abathola i-lymphoma ngemva kokufakelwa isitho futhi belashwa nge-immunotherapy kanye ne-chemotherapy baye babhekana nokuncipha noma ukunyamalala kwezimpawu (ukuxolelwa) .

Ingabe i-PTLD ingelapheka? Yebo, i-PTLD ingelapheka nge-'Immunotherapy' yodwa noma ihlanganiswe ne-'Chemotherapy'. Izifundo zibonise ukuthi abantu abaphakathi kuka-50% no-60% abathola lokhu kwelashwa bayalulama ngokuphelele . Ngakho-ke, lokhu kuyinto okufanele ube nethemba ngayo.

Yimiphi imibuzo ebaluleke kakhulu okufanele ngiyibuze udokotela wami?

Uma une-PTLD, kuwumqondo omuhle ukubuza udokotela wakho imibuzo efana nale:

• Kungani lokhu kwenzeke kimi?
• Iphathwa kanjani i-PTLD?
• Uma nginciphisa imithi yami yokucindezela amasosha omzimba, lingakanani ithuba lokuthi umzimba wami uzokwenqaba isitho/amaseli amasha?
• Uma ukwelashwa kwami ​​​​kuphumelele, angakanani amathuba okuthi lesi simo sibuye?

Ngaphezu kwale mibuzo, ungesabi ukubuza udokotela noma yini onayo engqondweni yakho.

Kufanele ngimbone nini udokotela?

Uma une-PTLD, udokotela wakho uzoqapha impilo yakho iyonke eduze . Bazobheka izimpawu zokuthi isimo sakho siya siba sibi kakhulu. Uma welashwa i-PTLD, udokotela wakho uzochaza ukuthi yiziphi izinguquko ozizwayo noma uma izimpawu zakho ziba zimbi kakhulu. Kubalulekile ukutshela udokotela wakho ngokushesha uma lokhu kwenzeka.

Okokugcina, izinto okufanele uzikhumbule

Ukufakelwa kwezitho zomzimba kanye nokufakelwa kwamaseli e-stem ngezinye izikhathi kungasindisa izimpilo noma kwandise impilo . Kodwa-ke, ngoba lezi yizinqubo ezinkulu zezokwelapha, zingaba nezingozi. I-PTLD ingenye yezinkinga ezingavamile, kodwa ezingaba yingozi.

Uma ungumuntu ozofakelwa isitho noma i-stem cell, ithimba lakho lezokunakekelwa kwempilo lizokhuluma nawe ngengozi yakho ye-PTLD , kanye nezinye izinto eziningi eziyingozi. Odokotela nabacwaningi bafuna izindlela zokunciphisa ingozi ye-PTLD. Into ebaluleke kakhulu ukuqaphela lokhu nokubuza ithimba lakho lezokunakekelwa kwempilo noma yimiphi imibuzo ongase ube nayo.

'I-PTLD, Izinkinga ze-Lymphoproliferative Ngemva Kokufakelwa, Ukufakelwa Kwezitho, I-Lymphoma, I-Epstein-Barr Virus, I-Immunology, Umdlavuza