Chithandizo Chamakono ndi Chitukuko cha CLL

Zamkati

• Chidule
• Mankhwala a CLL omwe ali pachiwopsezo chochepa
• Kuchiza kwa CLL wapakatikati- kapena wowopsa
• Chemotherapy ndi immunotherapy
• Njira zochiritsira
• Kuikidwa magazi
• Mafunde
• Kusintha kwa khungu ndi mafupa
• Mankhwala opatsirana
• Kuphatikiza mankhwala
• Chithandizo cha CAR T-cell
• Mankhwala ena omwe amafufuzidwa
• Kutenga

Chidule

Matenda a lymphocytic leukemia (CLL) ndi khansa yomwe ikukula pang'onopang'ono ya chitetezo cha mthupi. Chifukwa ikukula pang'onopang'ono, anthu ambiri omwe ali ndi CLL sadzafunika kuyamba kumwa mankhwala kwa zaka zambiri atazindikira.

Khansara ikayamba kukula, pali njira zambiri zamankhwala zomwe zingathandize anthu kuti akhululukidwe. Izi zikutanthauza kuti anthu amatha kukhala ndi nthawi yayitali pomwe palibe chizindikiro cha khansa mthupi lawo.

Chithandizo chenicheni chomwe mungalandire chimadalira pazinthu zosiyanasiyana. Izi zikuphatikiza ngati CLL yanu ndi yodziwika kapena ayi, gawo la CLL kutengera zotsatira za kuyesa magazi ndikuwunika kwakuthupi, komanso msinkhu wanu komanso thanzi lanu lonse.

Ngakhale kulibe mankhwala a CLL pano, zopambana m'munda zili pafupi.

Mankhwala a CLL omwe ali pachiwopsezo chochepa

Madokotala nthawi zambiri amapanga CLL pogwiritsa ntchito njira yotchedwa Rai system. CLL yoopsa kwambiri imalongosola anthu omwe amagwera "gawo 0" pansi pa dongosolo la Rai.

Mu gawo la 0, ma lymph node, ndulu, ndi chiwindi sizimakulitsidwa. Maselo ofiira ofiira komanso kupatsidwa zinthu monga mbale yam'magazi ndi ofanana.

Ngati muli ndi chiopsezo cha CLL, dokotala wanu (nthawi zambiri hematologist kapena oncologist) angakulimbikitseni kuti "dikirani ndikuwonetsetsa" zizindikilo. Njirayi imatchedwanso kuti kuyang'anira mwakhama.

Wina yemwe ali ndi chiopsezo chotsika cha CLL sangafunikire chithandizo china kwazaka zambiri. Anthu ena sadzafunikira chithandizo. Mufunikabe kuonana ndi dokotala kukayezetsa pafupipafupi komanso kuyesa mayeso a labu.

Kuchiza kwa CLL wapakatikati- kapena wowopsa

Chiwopsezo chapakati CLL imafotokozera anthu omwe ali ndi gawo 1 mpaka 2 CLL, malinga ndi dongosolo la Rai. Anthu omwe ali ndi gawo 1 kapena 2 CLL akulitsa ma lymph node ndipo atha kukulitsa ndulu ndi chiwindi, koma pafupi ndi khungu lofiira la magazi ndi kuchuluka kwa ma platelet.

CLL yowopsa imalongosola odwala omwe ali ndi khansa ya 3 kapena siteji 4. Izi zikutanthauza kuti mutha kukhala ndi nthenda zokulitsa, chiwindi, kapena ma lymph node. Kuwerengera kwa maselo ofiira ofiira kumakhala kofala. Pamwamba kwambiri, kuwerengera kwa ma platelet kumakhala kotsika.

Ngati muli ndi CLL wapakatikati kapena woopsa, dokotala wanu angakulimbikitseni kuti muyambe kulandira chithandizo nthawi yomweyo.

Chemotherapy ndi immunotherapy

M'mbuyomu, chithandizo chamankhwala cha CLL chimaphatikizapo kuphatikiza mankhwala a chemotherapy ndi ma immunotherapy agents, monga:

• fludarabine ndi cyclophosphamide (FC)
• FC kuphatikiza anti antibody yotchedwa rituximab (Rituxan) ya anthu ochepera 65
• bendamustine (Treanda) kuphatikiza rituximab kwa anthu azaka zopitilira 65
• chemotherapy kuphatikiza ma immunotherapies ena, monga alemtuzumab (Campath), obinutuzumab (Gazyva), ndi ofatumumab (Arzerra). Izi zingagwiritsidwe ntchito ngati gawo loyamba la mankhwala siligwira ntchito.

Njira zochiritsira

Kwa zaka zingapo zapitazi, kumvetsetsa bwino za biology ya CLL kwadzetsa njira zochiritsira zingapo. Mankhwalawa amatchedwa chithandizo chamankhwala chifukwa amalunjika pamapuloteni ena omwe amathandiza maselo a CLL kukula.

Zitsanzo za mankhwala omwe akulimbana ndi CLL ndi awa:

• ibrutinib (Imbruvica): amalimbana ndi enzyme yotchedwa Bruton's tyrosine kinase, kapena BTK, yomwe ndi yofunika kwambiri kuti CLL isungunuke
• venetoclax (Venclexta): amalimbana ndi BCL2 protein, protein yomwe imapezeka ku CLL
• idelalisib (Zydelig) - amateteza puloteni ya kinase yotchedwa PI3K ndipo imagwiritsidwa ntchito kubwereranso ku CLL
• duvelisib (Copiktra): imayang'aniranso PI3K, koma imagwiritsidwa ntchito pokhapokha mankhwala ena atalephera
• acalabrutinib (Calquence): choletsa china cha BTK chovomerezeka kumapeto kwa 2019 kwa CLL
• venetoclax (Venclexta) kuphatikiza ndi obinutuzumab (Gazyva)

Kuikidwa magazi

Mungafunike kulandila magazi kudzera mumitsempha (IV) kuti muwonjezere kuchuluka kwama cell.

Mafunde

Thandizo la radiation limagwiritsa ntchito mphamvu yamagetsi kapena mafunde kuti athandize kupha ma cell a khansa ndikuchepetsa ma lymph node owonjezera. Mankhwala a radiation sagwiritsidwa ntchito kwambiri pakuthandizira CLL.

Kusintha kwa khungu ndi mafupa

Dokotala wanu akhoza kukulangizani kuti mupange khungu la tsinde ngati khansa yanu siyiyankha mankhwala ena. Kuika kwa cell cell kumakupatsani mwayi wolandila chemotherapy wambiri kupha ma cell ambiri a khansa.

Kuchuluka kwa chemotherapy kumatha kuwononga mafupa anu. Kuti mulowe m'malo mwa maselowa, muyenera kulandira ma stem cell kapena mafupa owonjezera kuchokera kwa wopereka wathanzi.

Mankhwala opatsirana

Njira zambiri zikufufuzidwa kuti zithandizire anthu omwe ali ndi CLL. Ena avomerezedwa posachedwa ndi Food and Drug Administration (FDA).

Kuphatikiza mankhwala

Mu Meyi 2019, a FDA adavomereza venetoclax (Venclexta) kuphatikiza ndi obinutuzumab (Gazyva) kuchitira anthu omwe anali ndi CLL omwe sanalandire chithandizo ngati mankhwala a chemotherapy.

Mu Ogasiti 2019, ofufuza adafalitsa zotsatira kuchokera ku mayeso achipatala a Phase III akuwonetsa kuti kuphatikiza kwa rituximab ndi ibrutinib (Imbruvica) kumapangitsa kuti anthu azikhala opanda matenda kwanthawi yayitali kuposa momwe angathandizire pakadali pano.

Kuphatikizana kumeneku kumapangitsa kuti anthu athe kuchita popanda chemotherapy mtsogolo. Mankhwala osagwiritsa ntchito chemotherapy ndiofunikira kwa iwo omwe sangalole zovuta zina zokhudzana ndi chemotherapy.

Chithandizo cha CAR T-cell

Chimodzi mwazinthu zabwino kwambiri zamtsogolo za chithandizo cha CLL ndi chithandizo cha CAR T-cell. CAR T, yomwe imayimira chimeric antigen receptor T-cell therapy, imagwiritsa ntchito maselo amthupi amunthu kulimbana ndi khansa.

Njirayi imaphatikizapo kutulutsa ndikusintha ma cell amthupi a munthu kuti azindikire ndikuwononga ma cell a khansa. Maselo amabwezeretsedwanso m'thupi kuti achulukane ndikulimbana ndi khansa.

Mankhwala a CAR T-cell akulonjeza, koma amakhala ndi zoopsa. Vuto limodzi ndi vuto lotchedwa cytokine release syndrome. Uku ndi kuyankha kotupa komwe kumayambitsidwa ndi ma CAR T-cell omwe amalowetsedwa. Anthu ena amatha kukumana ndi zovuta zomwe zitha kubweretsa imfa ngati sizichiritsidwa mwachangu.

Mankhwala ena omwe amafufuzidwa

Mankhwala ena omwe akuwunikidwa pano pakuyesedwa kwa CLL ndi awa:

• Zanubrutinib (BGB-3111)
• entospletinib (GS-9973)
• tirabrutinib (ONO-4059 kapena GS-4059)
• umbralisib (TGR-1202)
• cirmtuzumab (UC-961)
• ublituximab (TG-1101)
• pembrolizumab (Keytruda)
• nivolumab (Opdivo)

Mayeso azachipatala akamalizidwa, ena mwa mankhwalawa amatha kuvomerezedwa kuti athetse CLL. Lankhulani ndi dokotala wanu za kulowa nawo mayeso azachipatala, makamaka ngati njira zamankhwala pano sizikukuthandizani.

Mayesero azachipatala amawunika momwe mankhwala atsopano amathandizira komanso kuphatikiza kwa mankhwala omwe avomerezedwa kale. Mankhwala atsopanowa atha kukuthandizani kuposa omwe akupezeka pano. Pakadali pano pali mayeso azachipatala omwe akuchitika ku CLL.

Kutenga

Anthu ambiri omwe amapezeka kuti ali ndi CLL sadzafunika kuyamba kumwa mankhwala nthawi yomweyo. Matendawa akangoyamba kukula, muli ndi njira zambiri zamankhwala zomwe mungapeze. Palinso mayesero osiyanasiyana azachipatala omwe mungasankhe omwe akufufuza njira zatsopano zamankhwala ndi mitundu yothandizira.