Acute Myeloid Leukemia (AML): ndi chiyani, zizindikiro ndi chithandizo

Zamkati

• Zizindikiro zazikulu
• Kuzindikira ndi kugawa
• Momwe mankhwalawa amachitikira
• 1. Chemotherapy
• 2. Radiotherapy
• 3. Kuika mafuta m'mafupa
• 4. Chithandizo cha chandamale ndi chitetezo chamthupi
• 5. Mankhwala amtundu wa Car T-Cell

Acute myeloid leukemia, yemwenso amadziwika kuti AML, ndi mtundu wa khansa yomwe imakhudza ma cell amwazi ndipo imayamba m'mafupa, omwe ndi omwe amachititsa kupanga maselo amwazi. Khansara yamtunduwu imakhala ndi mwayi waukulu wochiritsidwa ikapezeka koyambirira, pomwe kulibe chifuwa chachikulu ndipo imayambitsa zizindikilo monga kuonda ndi kutupa kwa malirime ndi mimba, mwachitsanzo.

Khansa ya m'magazi ya myeloid imakula mofulumira kwambiri ndipo imatha kuchitika kwa anthu azaka zonse, komabe imachitika pafupipafupi kwa akulu, chifukwa ma cell a khansa amadziphatika m'mafupa ndipo amatulutsidwa m'magazi, momwe amatumizidwa ku ziwalo zina, monga chiwindi , ndulu kapena dongosolo lamanjenje, komwe amapitilizabe kukula ndikukula.

Chithandizo cha khansa yayikulu ya myeloid chitha kuchitidwa kuchipatala cha khansa ndipo chimakhala chachikulu kwambiri m'miyezi iwiri yoyambirira, ndipo osachepera chaka chimodzi chithandizochi chikuyenera kuchiritsidwa.

Zizindikiro zazikulu

Zizindikiro zofala kwambiri za khansa ya m'magazi ndi:

• Kuchepa kwa magazi, komwe kumadziwika ndi kuchepa kwa hemoglobin;
• Kumva kufooka ndi kufooka kwakukulu;
• Pallor ndi mutu womwe umayamba chifukwa cha kuchepa kwa magazi;
• Kutuluka magazi pafupipafupi komwe kumadziwika ndikutuluka kosavuta kwammphuno komanso kuchuluka kwa msambo;
• Kupezeka kwa mikwingwirima ikuluikulu ngakhale atagwidwa pang'ono;
• Kutaya njala ndi kuwonda popanda chifukwa chomveka;
• Kutupa ndi zilonda zowawa, makamaka m'khosi ndi kubuula;
• Pafupipafupi matenda;
• Kupweteka kwa mafupa ndi mafupa;
• Malungo;
• Kupuma pang'ono ndi chifuwa;
• Kutuluka thukuta usiku, komwe kumakunyowetsani zovala zanu;
• Kupweteka m'mimba komwe kumachitika chifukwa cha kutupa kwa chiwindi ndi ndulu.

Khansa yamagazi yamtundu wamtundu wamtundu wamtundu wa khansa yamagazi yomwe imakhudza kwambiri achikulire ndipo matendawa amatha kupangidwa atayezetsa magazi, kuphulika kwa lumbar ndi mafupa.

Kuzindikira ndi kugawa

Kupezeka kwa matenda a khansa ya myeloid kumatengera zizindikilo zomwe zimaperekedwa ndi munthuyo komanso zotsatira za mayeso, monga kuwerengetsa magazi, kusanthula m'mafupa ndi mayeso am'magazi ndi ma immunohistochemical. Kudzera kuwerengera kwa magazi, ndizotheka kuwona kuchepa kwa kuchuluka kwa maselo oyera amwazi, kupezeka kwa kufalitsa maselo oyera am'magazi oyera komanso kuchuluka kwama cell ofiira ndi ma platelets. Kuti mutsimikizire matendawa, ndikofunikira kuti myelogram ichitidwe, momwe amapangidwira kupyoza ndi kusonkhanitsa kwa mtundu wa mafupa, womwe umawunikidwa mu labotale. Mvetsetsani momwe myelogram imapangidwira.

Kuti tizindikire mtundu wa leukemia wa pachimake, ndikofunikira kuti mayeso am'magazi ndi ma immunohistochemical ayesedwe kuti azindikire mawonekedwe am'magazi omwe amapezeka m'magazi omwe amadziwika ndi matendawa, izi ndizofunikira kudziwa kufalikira kwa matendawa komanso dokotala kuti afotokoze chithandizo choyenera kwambiri.

Mtundu wa AML utadziwika, adotolo amatha kudziwa zamankhwalawa ndikupeza mwayi wochiritsidwa. AML imatha kugawidwa m'magulu ena, omwe ndi:

Momwe mankhwalawa amachitikira

Chithandizo cha acute myeloid leukemia (AML) chikuyenera kuwonetsedwa ndi oncologist kapena hematologist ndipo chitha kuchitidwa kudzera munjira zingapo, monga chemotherapy, mankhwala kapena kupatsira m'mafupa:

1. Chemotherapy

Chithandizo cha leukemia ya myeloid yoyambira chimayamba ndi mtundu wa chemotherapy yotchedwa induction, yomwe cholinga chake ndi kukhululuka kwa khansa, izi zikutanthauza kuti muchepetse maselo omwe ali ndi matenda mpaka asapezeke pakuyesa magazi kapena mu myelogram, komwe ndiko kuyesa magazi omwe asonkhanitsidwa molunjika kuchokera m'mafupa.

Mankhwalawa amawonetsedwa ndi a hematologist, amachitika kuchipatala cha odwala kuchipatala ndipo amachitika pogwiritsa ntchito mankhwala molunjika mumtsempha, kudzera mu catheter yoyikidwa kumanja kwa chifuwa chotchedwa port-a-cath kapena polowa mumtsuko wa mkono.

Nthawi zambiri matenda a khansa ya myeloid, adokotala amalimbikitsa kuti munthuyo alandire mankhwala osiyanasiyana, otchedwa protocols, omwe makamaka amagwiritsa ntchito mankhwala monga cytarabine ndi idarubicin, mwachitsanzo. Mapulogalamuwa amachitika pang'onopang'ono, ndi masiku a chithandizo champhamvu komanso masiku ochepa opuma, omwe amalola kuti thupi la munthuyo lipezenso bwino, ndipo kuchuluka kwa nthawi zoti zichitike kumadalira kuuma kwa AML.

Ena mwa mankhwala odziwika kwambiri ochiza mtundu wa leukemia ndi awa:

Dokotala angalimbikitsenso kugwiritsa ntchito corticosteroids, monga prednisone kapena dexamethasone, ngati gawo la njira yothandizira odwala matenda a khansa ya myeloid. Kafukufuku wina akupangidwa kotero kuti mankhwala atsopano monga capecitabine, lomustine ndi guadecitabine amagwiritsidwanso ntchito kuchiza matendawa.

Kuphatikiza apo, atachotsa matendawa ndi chemotherapy, adotolo amatha kuwonetsa mitundu yatsopano yamankhwala, yotchedwa kuphatikiza, yomwe imathandizira kuonetsetsa kuti maselo a khansa achotsedwa mthupi lonse. Kuphatikizaku kumatha kuchitika kudzera mu chemotherapy yayikulu komanso kupatsira mafuta m'mafupa.

Chithandizo cha khansa yayikulu ya myeloid ndi chemotherapy imachepetsa kuchuluka kwa maselo oyera m'magazi, omwe ndi chitetezo chamthupi, ndipo munthuyo amakhala ndi chitetezo chochepa, zomwe zimawapangitsa kuti atenge matenda. Chifukwa chake, nthawi zina, munthuyo amafunika kupita naye kuchipatala akamalandira chithandizo ndipo amafunika kugwiritsa ntchito maantibayotiki, ma antivirals ndi ma antifungals popewa matenda kuti angabuke. Ndipo komabe, ndizofala kuti zizindikilo zina ziwonekere, monga kutaya tsitsi, kutupa kwa thupi ndi khungu lokhala ndi mawanga. Phunzirani za zovuta zina za chemotherapy.

2. Radiotherapy

Radiotherapy ndi mtundu wa chithandizo chomwe chimagwiritsa ntchito makina omwe amatulutsa ma radiation m'thupi kupha ma cell a khansa, komabe, mankhwalawa sagwiritsidwa ntchito kwambiri kwa myeloid leukemia ndipo imagwiritsidwa ntchito ngati matenda afalikira ku ziwalo zina, monga ubongo ndi testis, zoti zizigwiritsidwa ntchito musanafike kupatsirana kwa mafupa kapena kuti muchepetse ululu m'fupa lomwe lagwidwa ndi leukemia.

Asanayambe magawo a radiotherapy, adotolo amapanga mapulani, amawunika zithunzi za tomography yolembedwera kuti malo enieni omwe radiation iyenera kufikira m'thupi afotokozeredwe kenako, zolemba zimapangidwa pakhungu, ndi cholembera chapadera, kuwonetsa malo oyenera pamakina a radiotherapy ndikuti magawo onse azikhala nthawi zonse pamalo oonekera.

Monga chemotherapy, mankhwala amtunduwu amathanso kuyambitsa zovuta zina, monga kutopa, kusowa njala, nseru, zilonda zapakhosi komanso khungu limasintha mofanana ndi kutentha kwa dzuwa. Phunzirani zambiri za chisamaliro chomwe chiyenera kutengedwa nthawi ya radiotherapy.

3. Kuika mafuta m'mafupa

Kuika mafuta m'mafupa ndi mtundu wamagazi wopangidwa kuchokera ku maselo am'magazi am'magazi omwe amatengedwa mwachindunji kuchokera m'mafupa a woperekayo, mwina kudzera pakuchita opaleshoni ya magazi m'chiuno kapena kudzera mu apheresis, womwe ndi makina omwe amalekanitsa maselo am'magazi kudzera mu catheter mumtsempha.

Kuika kotereku kumachitika pambuyo poti mankhwala a chemotherapy kapena ma radiotherapy achita kwambiri pokhapokha ma cell a khansa asanakumanidwe pamayeso. Pali mitundu ingapo yama transplants, monga autologous ndi allogeneic, ndipo chisonyezero chimapangidwa ndi hematologist malinga ndi zomwe zimayambitsa matenda a khansa ya myeloid. Onani zambiri za momwe kusintha kwa mafupa kumachitikira ndi mitundu yosiyanasiyana.

4. Chithandizo cha chandamale ndi chitetezo chamthupi

Njira zochiritsira ndi mtundu wa chithandizo chomwe chimagwiritsa ntchito mankhwala omwe amayambitsa ma cell omwe amadwala khansa ya m'magazi ndimasinthidwe ena amtundu, zomwe zimayambitsa zovuta zochepa kuposa chemotherapy. Ena mwa mankhwala omwe amagwiritsidwa ntchito ndi awa:

• Zoletsa za FLT3: zikuwonetsedwa kwa anthu omwe ali ndi khansa yayikulu ya myeloid ndi kusintha kwa jiniZamgululi ndipo ena mwa mankhwalawa ndi midostaurin ndi gilteritinib, omwe sanalandiridwebe ku Brazil;
• HDI zoletsa: analimbikitsa dokotala kuti agwiritse ntchito kwa anthu omwe ali ndi khansa ya m'magazi ndi kusintha kwa majiniIDH1 kapenaIDH2, zomwe zimapewa kukhwima koyenera kwa maselo amwazi. Ma HDI inhibitors, monga enasidenib ndi ivosidenib, amatha kuthandiza ma cell a leukemia okhwima kukhala maselo abwinobwino amwazi.

Kuphatikiza apo, mankhwala ena omwe amagwiritsa ntchito majini ena amagwiritsidwanso ntchito ngati zoletsa za jini la BCL-2, monga venetoclax, mwachitsanzo. Komabe, njira zina zamakono zothandizira chitetezo cha mthupi kuthana ndi maselo a leukemia, omwe amadziwika kuti immunotherapy, nawonso amalimbikitsidwa kwambiri ndi akatswiri a magazi.

Ma antibodies a monoclonal ndi mankhwala a immunotherapy omwe amapangidwa ngati mapuloteni a chitetezo cha mthupi omwe amadziphatika kukhoma lamaselo a AML kenako kuwawononga. Mankhwala a gemtuzumab ndi mankhwala amtunduwu omwe amalimbikitsidwa ndi madokotala kuti athetse khansa ya m'magazi.

5. Mankhwala amtundu wa Car T-Cell

Mankhwala a Gene omwe amagwiritsa ntchito njira ya Car T-Cell ndi njira yothandizira anthu omwe ali ndi leukemia yovuta kwambiri yomwe imachotsa maselo amthupi, otchedwa T cell, mthupi la munthu kenako ndikuwatumiza ku labotale. Mu labotale, maselowa amasinthidwa ndipo zinthu zomwe zimatchedwa CAR zimayambitsidwa kuti zitha kuwononga ma cell a khansa.

Atalandira chithandizo mu labotale, ma T cell amalowetsedwa m'malo mwa munthu yemwe ali ndi leukemia kuti, atasinthidwa, awononge maselo omwe ali ndi khansa. Chithandizo chamtunduwu chikuwerengedwabe ndipo sapezeka ndi SUS. Onani zambiri za momwe mankhwala a Car T-Cell amachitikira ndi zomwe zingachiritsidwe.

Onaninso kanema wamomwe mungachepetsere zovuta zamankhwala am'mimba: