An ka hoʻololi ʻana i ke ʻano o ke ʻano o ke ʻano allogeneic He lapaʻau koʻikoʻi kahi e loaʻa ai iā ʻoe ke hoʻololi ʻana i nā pūnaewele kumu o ka mea hāʻawi (kekahi ʻē aʻe). He ʻokoʻa kēia i ka hoʻihoʻi ʻana o ka mea maʻi i kā lākou mau sela ponoʻī, i kapa ʻia he ka hoʻololi ʻana i ke ʻano o ke kino. Kūkākūkā ʻia kēia ma kekahi ʻaoʻao ʻē aʻe.
ʻO ka manaʻo nui o nā hoʻololi ʻana o nā cell stem allogeneic?
ʻO Dr Amit Khot, Hematologist & kauka hoʻololi i ka iwi iwi
ʻO Peter MacCallum Cancer Center & Royal Melbourne Hospital
Ke hoʻohana nei ka hoʻololi ʻana i nā pūnaʻi pūlima Allogeneic i nā pūnaewele kumu i hōʻiliʻili ʻia mai kahi mea hāʻawi (kekahi mea ʻē aʻe) e pani i kāu mau pūnaewele ponoʻī. Hana ʻia kēia no ka mālama ʻana i ka Lymphoma kū ʻole (ʻaʻole pane i ka lāʻau lapaʻau) a i ʻole ka hoʻi hou ʻana (lymphoma e hoʻi mau ana. ʻAʻole pono ka hapa nui o ka poʻe me lymphoma i kahi transplant cell stem. iho) hoʻololi.
ʻO Lymphoma kahi maʻi kanesa o nā lymphocytes. ʻO nā Lymphocytes kekahi ʻano o ke koko keʻokeʻo keʻokeʻo e ulu ana mai nā pūnaewele kumu. ʻO ka pahuhopu o chemotherapy ʻo ia ka hoʻopau ʻana i nā pūnaewele lymphoma a me nā pūnaewele a pau i hiki ke ulu aʻe i lymphoma. Ke hoʻopau ʻia nā mea ʻino, hiki ke ulu hou nā cell hou i manaʻo ʻia ʻaʻole he maʻi kanesa.
I ka hihia o ka poʻe i hoʻi hou a i ʻole lymphoma refractory, ʻaʻole hana kēia - e ulu mau ana ka lymphoma ma muli o ka mālama ʻana. No laila, ʻo ka hoʻopau ʻana i nā pūnaewele puʻupuʻu me ka nui loa o ka chemotherapy, a laila ke hoʻololi ʻana i nā pūnaewele kumu o kēlā kanaka me ka mea ʻē aʻe, hiki ke loaʻa i kahi ʻōnaehana pale hou kahi e lawe ai nā pūnaewele mea hāʻawi i ke kuleana o ka hana ʻana i nā pūnana koko i lilo ʻole i lymphoma.
ʻO ka pahuhopu o ka hoʻololi ʻana i ke ʻano o ke kino
Aia kekahi mau kumu e pono ai i ka poʻe maʻi lymphoma ke hoʻololi i ke ʻano o ke ʻano pū me:
- No ka mālama 'ana i nā po'e ma'i lymphoma i ke kala 'ana, akā 'a'ole nui ka 'pilikia' o ka ho'i 'ana mai o ka lymphoma
- Ua hoʻi hou mai ka lymphoma ma hope o ka hoʻomaʻamaʻa mua ʻana i ka laina mua, no laila ua hoʻohana ʻia ka chemotherapy ikaika (ikaika) e hoʻihoʻi iā lākou i ke kala ʻana (ʻaʻohe maʻi ʻike ʻia)
- He pale ka lymphoma (ʻaʻole i pane piha) i ka lāʻau lapaʻau mua me ka manaʻo e loaʻa kahi kala
Hiki ke hā'awi 'ia nā hana 'elua i ka ho'ololi 'ana o ke stem cell allogeneic
- ʻO ka nui loa o ka lāʻau lapaʻau e hoʻopau i ka lymphoma a ʻo nā pūnaewele hāʻawi hou e hāʻawi i kahi ala e hoʻōla ai ka ʻōnaehana pale, e hōʻemi ana i ka manawa i pau ʻole ai ka ʻōnaehana pale. Lawe nā pūnaewele hāʻawi hou i ka hana o nā ʻōnaehana pale a me ka hana ʻana i nā ʻāpana koko olakino, e like me nā lymphocytes. Hoʻololi nā pūnaewele kumu hāʻawi i nā pūnaewele kino ʻole o ka mea maʻi.
- Hoʻopili i ka hopena lymphoma. ʻO kēia ka manawa e ʻike ai nā pūnaewele kumu hāʻawi (i kapa ʻia ʻo ka graft) i ke koena lymphoma cell a hoʻouka iā lākou, e luku ana i ka lymphoma. He hopena maikaʻi kēia kahi e kōkua ai nā pūnaewele hāʻawi i ka mālama ʻana i ka lymphoma. He mea nui ia e hoʻomaopopo ʻaʻole hiki ke hana like kēia ʻano hoʻololi i ka hopena lymphoma. Hiki i ka lymphoma ke kū'ē i nā pūnaewele kumu hāʻawi, a i ʻole hiki i ke kino o ka mea loaʻa (i kapa ʻia ʻo ka host) ke kaua kūʻē i nā cell hāʻawi (i kapa ʻia ka graft) graft versus host disease (kahi hoʻopiʻi o ka hoʻololi allogeneic).
ʻElima mau ʻanuʻu ke kaʻina hana o ka hoʻololi ʻana i ke ʻano allogeneic stem cell transplant
ʻO Dr Amit Khot, Hematologist & kauka hoʻololi i ka iwi iwi
ʻO Peter MacCallum Cancer Center & Royal Melbourne Hospital
- e hoomakaukau ai: aia kēia me nā hoʻokolohua koko e hoʻoholo ai i ke ʻano o nā cell āu e makemake ai. I kekahi manawa pono e loaʻa i nā kānaka ka chemotherapy 'salvage' e ho'āʻo a hōʻemi i ka lymphoma ma mua o ka hoʻololi ʻana.
- ʻOhi pūnaʻi kumu: ʻO kēia ke kaʻina o ka ʻohi ʻana i nā pūnaewele kumu, no ka mea, ʻo ka allogenic transplant mai ka mea hāʻawi, pono ka hui lapaʻau e ʻimi i kahi pāʻani no ka transplant.
- Lapaʻau hoʻoluʻu: ʻO kēia ka chemotherapy, target therapy a me ka immunotherapy i lawelawe ʻia i nā kau kiʻekiʻe loa e hoʻopau i nā lymphoma āpau
- Hoʻohui hou ʻia o nā pūnana pū: i ka manawa i lawelawe ʻia ai nā lāʻau lapaʻau kiʻekiʻe, mālama ʻia nā pūnaewele kumu i hōʻiliʻili mua ʻia mai ka mea hāʻawi.
- Hoʻopili ʻia: ʻO kēia ke kaʻina hana e noho ai nā pūnaewele kumu hāʻawi i loko o ke kino a lawe i ka hana o ka ʻōnaehana pale.
Hoʻomākaukau no ka lāʻau lapaʻau
He nui ka hoʻomākaukau e pono ai i ke alakaʻi ʻana i kahi transplant cell stem. He ʻokoʻa kēlā me kēia transplant a pono e hoʻonohonoho ka hui transplant i nā mea āpau no ka mea maʻi. ʻO kekahi o nā hoʻomākaukau e manaʻo ʻia e hiki ke komo:
ʻO ka hoʻokomo ʻana i kahi laina waena
Inā ʻaʻohe laina waena o ka mea maʻi, a laila e hoʻokomo ʻia kekahi ma mua o ka hoʻololi ʻana. Hiki i ka laina waena ke lilo i PICC (peripherally inserted central catheter). He CVL paha ia (central venous line). Na ke kauka e hoʻoholo i ka laina kikowaena kūpono no ka mea maʻi.
Hāʻawi ka laina kikowaena i kahi ala e loaʻa ai nā lāʻau lapaʻau like ʻole i ka manawa like. Pono ka poʻe maʻi i nā lāʻau lapaʻau like ʻole a me nā hoʻāʻo koko i ka wā o ka hoʻololi ʻana a me kahi laina waena e kōkua i nā kahu hānai e hoʻokele maikaʻi i ka mālama ʻana o ka mea maʻi.
Chemotherapy
Hoʻohana mau ʻia ka chemotherapy kiʻekiʻe ma ke ʻano he ʻāpana o ke kaʻina hana hoʻololi. Kāhea ʻia ka chemotherapy kiʻekiʻe lāʻau hoʻonaʻauao. Ma waho aʻe o ka chemotherapy kiʻekiʻe, pono kekahi mau maʻi e hoʻopakele i ka chemotherapy. ʻO ka Salvage therapy ka wā e paʻakikī ai ka lymphoma a pono e hoʻemi ʻia ma mua o ke koena o ke kaʻina hoʻololi. ʻO ka inoa hoʻopakele mai ka ho'āʻo ʻana e hoʻopakele i ke kino mai ka lymphoma.
Ka neʻe ʻana no ka mālama ʻana
ʻO kekahi mau halemai i loko o Australia wale nō e hiki ke hoʻokō i ka hoʻololi ʻana o nā cell stem allogeneic. Ma muli o kēia, pono paha e hoʻoneʻe i ko lākou home, i kahi kokoke i ka haukapila. Loaʻa i ka hapa nui o nā halemai hoʻololi i kahi noho hoʻomanawanui e hiki ai i ka mea maʻi a me ke kahu mālama ke noho.
Mālama i ka momona
ʻO ka hoʻololi ʻana o ka stem cell e hopena i ka hiki o ka mea maʻi ke loaʻa keiki. He mea nui e kūkākūkā ʻia nā koho i loaʻa no ka mālama ʻana i ka momona.
ʻLelo aʻoaʻo kūpono
ʻO ka loaʻa ʻana o ka hoʻololi ʻana i ke ʻano o ka pūnaewele e pili ana i kahi noho lōʻihi i ka haukapila. He mea kōkua paha ke kāʻei ʻana i kekahi o kēia mau mea:
- ʻElua mau lole palupalu a ʻoluʻolu a i ʻole nā pajamas a me ka nui o nā lole lalo.
- Pahu niho (paʻalu), toothpaste, kopa, moisturizer mālie, deodorant mālie
- ʻO kou uluna ponoʻī (holoi wela i kou pahu uluna a me nā pākeʻe pilikino/hoʻolei i nā moena ma mua o ke komo ʻana i ka haukapila - holoi wela iā lākou i mea e hōʻemi ai i ka maʻi bacteria no ka mea e nāwaliwali loa kou ʻōnaehana pale).
- ʻO nā kāmaʻa a i ʻole nā kāmaʻa ʻoluʻolu a me ka nui o nā pūkini
- Nā mea pilikino e hoʻomālamalama i kou lumi o ka haukapila (he kiʻi o kāu poʻe aloha)
- Nā mea leʻaleʻa e like me nā puke, nā makasina, nā huaʻōlelo, iPad/laptop/papa. Hiki i ka haukapila ke hoʻoluhi loa inā ʻaʻohe āu mea e hana ai.
- ʻO kahi kalena no ka mālama ʻana i ka lā, hiki i ke komo ʻana i ka haukapila lōʻihi ke hoʻoheheʻe i nā lā a pau.
HLA a me ka kikokiko kikokiko
I ka loaʻa ʻana o kahi hoʻololi ʻana o ke ʻano allogeneic (donor), hoʻonohonoho ka mea hoʻoponopono hoʻololi i kahi ʻimi no ka hāʻawi ʻana i kahi mea hāʻawi pū. Loaʻa paha ka holomua o ka hoʻololi ʻana i ke ʻano allogeneic stem cell inā pili pono nā pūnaewele o ka mea hāʻawi i ka mea maʻi. No ka nānā ʻana i kēia, e hana ʻia ka hoʻāʻo koko i ka mea maʻi kikokiko kikokiko nana i na polokina like ole ma ka ili o na keena i kapaia kanaka leukocyte antigens (HLA).
Hana nā pūnaewele o kēlā me kēia kanaka i nā protein HLA e kōkua i ka ʻōnaehana immune e ʻike i nā cell i loko o ke kino a ʻike i nā sela ʻaʻole ia.
Nui nā ʻano like ʻole o ka HLA a ke hoʻāʻo nei ka hui lapaʻau e ʻimi i kahi mea hāʻawi nona nā ʻano HLA e like me ka hiki.
Inā hiki, e hoʻāʻo pū lākou e hōʻoia i ka mea maʻi a me ka mea hāʻawi i nā maʻi like ʻole, ʻoiai ʻaʻole nui kēia ma mua o ka HLA-matching.
Loaʻa i nā kaikunāne a i ʻole nā kaikuahine nā protein HLA e like me ka mea maʻi. Ma kahi o 1 i loko o 3 kanaka he kaikunāne a he kaikuahine maikaʻi. Inā ʻaʻohe kaikunāne a mau kaikuahine paha ka mea maʻi, a inā ʻaʻole maikaʻi lākou, e ʻimi ka hui lapaʻau i kahi mea hāʻawi manawaleʻa nona ke ʻano HLA i kūpono i nā mea maʻi e like me ka hiki. Ua ʻike ʻia kēia ma ke ʻano he mea hāʻawi like ʻole (MUD) a ua hoʻopaʻa inoa ʻia nā miliona o nā mea manawaleʻa me nā papa inoa pūnaewele kūloko a me ka honua.
Inā ʻaʻole ʻike ʻia kahi mea hāʻawi pili pili ʻole (MUD) no ka mea maʻi, hiki paha ke hoʻohana i nā kumuwaiwai ʻē aʻe o nā pūnaewele pū. Aia kēia mau mea:
- He hoahānau nona ka hapalua o ka HLA like me kāu: ʻike ʻia kēia he mea hāʻawi 'haploidentical'
- ʻO ke koko umbilical cord mai kahi hāʻawi pili ʻole: ʻaʻole pono e pili like ke koko kaula umbilical me kāu ʻano HLA e like me nā kumu ʻē aʻe o nā pūnaewele kumu. Hiki ke hoʻohana ʻia no nā keiki ma mua o nā pākeke no ka mea ʻoi aku ka liʻiliʻi o nā pūnaewele ma mua o nā kumu ʻē aʻe. Loaʻa nā papa inoa o ke koko umbilical cord i mālama ʻia.
ʻOhi ʻana o nā pūnaʻi kumu
ʻElua mau ala e hiki ai i ka mea hāʻawi ke hāʻawi i nā pūnana pū.
- ʻO ka ʻohi ʻana o ke kōkoʻokoʻa pili
- ʻO ka hāʻawi ʻia ʻana o nā pūnaʻi koko koko iwi
ʻO ka hāʻawi ʻana i nā pūnaʻi koko pili
ʻOhi ʻia nā pūnaewele puʻupuʻu mai ke kahe koko ʻokoʻa. Ma ke alakaʻi ʻana i ka hōʻiliʻili ʻana o nā cell stem peripheral, loaʻa ka hapa nui o nā kānaka i nā injections o ka ulu ulu. Hoʻoulu ʻia nā kumu ulu i ka hana ʻana o nā cell stem. Kōkua kēia i ka neʻe ʻana o nā pūnaewele mai ka iwi iwi, i loko o ke kahe koko, mākaukau no ka ʻohi ʻana.
Hana ʻia ka hōʻiliʻili ma ka hoʻokaʻawale ʻana i nā cell stem mai ke koena o ke koko a hoʻohana ke kaʻina hana i kahi mīkini apheresis. Hiki i ka mīkini apheresis ke hoʻokaʻawale i nā ʻāpana like ʻole o ke koko a hiki ke hoʻokaʻawale i nā pūnaewele kumu. Ke hele nei ke koko ma ka pae o ka hōʻiliʻili cell, hele hou ia i loko o ke kino. He mau hola kēia hana (ma kahi o 2 - 4 mau hola). Hiki i ka mea hāʻawi ke hoʻi i ka home ma hope o ke kaʻina hana, akā naʻe, pono e hoʻi i ka lā aʻe inā ʻaʻole lawa nā cell i hōʻiliʻili ʻia.
ʻOi aku ka liʻiliʻi o ka Apheresis ma mua o ka hōʻiliʻili ʻana o ka iwi iwi a ʻo ia ke kumu i makemake nui ʻia ai ka hōʻiliʻili pūlima.
Ma nā mea hoʻololi allogeneic (donor), hoʻokō ka mea hāʻawi i ka apheresis no ka mea i loaʻa a lawe ʻia kēia hōʻiliʻili i kahi kokoke i ka lā o ka hoʻololi ʻana. No ka mea, e hāʻawi hou ʻia kēia mau pūnaewele i ka mea i loaʻa i ka lā o ka transplant.
ʻO ka hāʻawi ʻia ʻana o nā pūnaʻi koko koko
ʻO ke ala maʻamau o ka hōʻiliʻili ʻana i nā pūnaewele kumu he ʻohi iwi iwi. ʻO kēia kahi kahi e hoʻihoʻi ʻia ai nā pūnaewele mai ka iwi iwi ma lalo o ka anesthesia āpau. Hoʻokomo nā kauka i ka nila i loko o ka iwi ma ka ʻāpana pelvic, i kapa ʻia ʻo ka iliac crest. Hoʻokuʻu ʻia ka ʻōpū o ka iwi mai ke pelvis, ma o ka nila, a laila kānana ʻia kēia iwi iwi a mālama ʻia a hiki i ka lā o ka hoʻololi ʻana.
Koko kaula ʻO ka hāʻawi ʻana mai ka panakō pili aupuni kahi i hāʻawi ʻia a mālama ʻia kahi hāʻawi o nā pūnaewele kumu mai ke koko i waiho ʻia ma ke kaula a me ka placenta ma hope o ka hānau ʻana.
Pehea ka hana apheresis
Ka hana ʻana/mālama ʻana i nā pūnaewele a i ʻole ka iwi iwi
ʻO nā pūnaewele kumu i hōʻiliʻili ʻia no ka transplant allogeneic (donor), e hōʻiliʻili koke ʻia ma mua o ka hoʻohana ʻana a ʻaʻole mālama ʻia no kekahi manawa lōʻihi.
ʻO nā pūnaewele kumu i hōʻiliʻili ʻia no ka transplant autologous (self), mālama ʻia a mālama ʻia i loko o ka paʻukū a hiki i ka mākaukau no ka hoʻohana.
Ka hoʻolaha
Hāʻawi mua ʻia nā maʻi e hoʻololi ana i ka lāʻau lapaʻau i kapa ʻia ʻo ka hoʻomaʻamaʻa ʻana. ʻO kēia ka lāʻau lapaʻau kiʻekiʻe i mālama ʻia i nā lā ma mua o ka hoʻokomo ʻia ʻana o nā pūnaewele kumu. Hiki ke ho'okomo i ka lā'au lapa'au i ka chemotherapy a i kekahi manawa ka lā'au lapa'au. ʻO nā pahuhopu ʻelua o ka conditioning therapy:
- E pepehi i ka lymphoma e like me ka hiki
- E ho'ēmi i ka heluna kanaka pūnaʻi
Nui nā hui like ʻole o ka chemotherapy, radiation therapy a me ka immunotherapy hiki ke hoʻohana ʻia i nā regimen conditioning. Aia nā ʻano like ʻole o ka hoʻomaʻamaʻa ʻana, ʻo ia hoʻi:
- ʻO ka hoʻomaʻamaʻa myeloablative piha
- ʻAʻole myeloablative conditioning
- Hoʻemi ʻia ka hoʻoikaika kino
I loko o nā papa hana a pau, ʻoi aku ka ikaika o ka mālama ʻana a ma muli o ka hopena, nui nā cell olakino e make pū me ka lymphoma. ʻO ke koho ʻana o ka regimen e hilinaʻi ʻia ma ke ʻano o ka lymphoma, ka mōʻaukala lapaʻau a me nā mea ʻē aʻe e like me ka makahiki, ke olakino a me ke olakino. E kūkākūkā ka hui lapaʻau me ka mea maʻi i ke ʻano o ka hoʻomaʻamaʻa ʻana i kūpono no ka mea maʻi.
Ma kahi hoʻololi allogeneic, hiki ke hoʻokomo ʻia nā mea maʻi i ka haukapila ma mua o 14 mau lā ma mua o ka hoʻololi ʻana. He ʻokoʻa kēlā me kēia hihia maʻi a na kāu kauka e haʻi iā ʻoe i ka wā e ʻae ʻia ai ʻoe. Noho ka poʻe maʻi i ka haukapila ma nā wahi āpau mai 3 - 6 mau pule ma hope o ka hoʻololi ʻana. He alakaʻi kēia; ʻokoʻa kēlā me kēia hoʻololi ʻana, a makemake kekahi poʻe i ka mālama olakino ʻoi aku ma mua o 6 pule.
Inā loaʻa iā ʻoe kahi hoʻololi ʻana o ka cell stem allogeneic me ka hoʻohana ʻana i nā cell stem mai kahi mea hāʻawi like ʻole a i ʻole like ʻole, pono paha ʻoe i ka mālama ʻana i ka ʻoi aku ka ikaika.
Loaʻa paha iā ʻoe ka lāʻau hoʻomaʻamaʻa ʻokoʻa inā loaʻa iā ʻoe kahi hoʻololi allogeneic me ka hoʻohana ʻana i nā pūnaewele mai ke koko umbilical cord a i ʻole mai ka hapalua like.
Hiki iā ʻoe ke komo i ka ʻike kikoʻī e pili ana i nā regimens conditioning ma ka Eviq pūnaewele.
Hoʻopili hou i nā pūnaewele kumu
Ma hope o ka pau ʻana o ka hoʻomaʻamaʻa ʻana i ka chemotherapy, hoʻohui hou ʻia nā pūnaʻi stem. Hoʻomaka mālie kēia mau pūnaewele kumu e hoʻohua i nā pūnaʻi koko olakino hou. ʻO ka hopena, e hoʻopuka lākou i nā pūnaewele olakino e hoʻopiha hou i ka iwi iwi holoʻokoʻa, e hoʻopiha i nā koko a me nā cell immune.
He hana maʻalahi ka hoʻihoʻi ʻana i nā pūnana pū. Ua like ia me ke kahe koko. Hāʻawi ʻia nā cell ma o kahi laina i ka laina waena. ʻO ka lā i hoʻohui hou ʻia ai nā pūnaewele i kapa ʻia ʻo "Day Zero".
Me kekahi kaʻina hana lapaʻau, aia ka pilikia o ka loaʻa ʻana o ka hopena i ka infusion cell stem. No ka hapanui o ka poʻe ʻaʻohe pane, akā ʻike paha nā poʻe ʻē aʻe:
- Manaʻo maʻi a maʻi paha
- ʻO ka ʻono ʻino a i ʻole ke ʻano wela o kou waha
- Ke kaheʻie kiʻekiʻe
- Ka hopena hoʻowali
- Hoʻoponopono
I loko o ka hoʻololi ʻana o nā pūnaʻi allogeneic, ʻoiai e paʻa ana kēia mau pūnaewele i hāʻawi ʻia (a i ʻole engraft) i ka mea loaʻa (maʻi). Hoʻomaka lākou e hana ma ke ʻano he ʻāpana o ka ʻōnaehana pale a hiki ke hoʻouka i nā pūnaewele lymphoma. Ua kapa ʻia kēia ka hopena o ka graft-versus lymphoma.
I kekahi mau hihia, ma hope o ka hoʻololi ʻana i ka allogeneic, hoʻouka pū nā mea hāʻawi i nā sela olakino o ka mea maʻi. Kapa ʻia kēia ʻO ka maʻi ʻo graft-versus-host (GVHD).
ʻO ka hoʻopili ʻana i kāu mau pūnaewele kumu
ʻO ka engraftment ka wā e hoʻomaka mālie ai nā pūnaewele kumu hou ma ke ʻano he pūnaeau kumu mua. Hana ʻia kēia ma kahi o 2 - 3 pule ma hope o ka hoʻokomo ʻia ʻana o nā pūnaewele kumu akā hiki ke lōʻihi aku, ʻoi aku ka nui inā loaʻa mai nā pūnaewele hou mai ke koko umbilical cord.
I ka wā e hoʻopaʻa ʻia ai nā pūnaʻi kumu hou, aia ʻoe i kahi pilikia nui o ka loaʻa ʻana o kahi maʻi. Pono ka poʻe e noho i ka haukapila no kēia manawa, no ka mea hiki ke maʻi a pono e loaʻa koke ka lāʻau lapaʻau.
ʻOiai ʻoe e kali nei no ka hoʻomaikaʻi ʻana o kāu helu koko, loaʻa paha iā ʻoe kekahi o kēia mau lāʻau lapaʻau e kākoʻo ai i kou ola hou ʻana:
- Hoʻokahe koko – no ka helu ʻulaʻula haʻahaʻa (anemia)
- ʻO ka hoʻoili ʻana i ka platelet - no nā pae platelet haʻahaʻa (thrombocytopenia)
- Antibiotic - no nā maʻi bacteria
- ʻO ka lāʻau antiviral - no nā maʻi maʻi
- ʻO ka lāʻau anti-fungal - no nā maʻi fungal
ʻO ka maʻi hoʻopili
Ma hope o ka loaʻa ʻana o nā pūnaewele hou, hoʻomohala kekahi poʻe i kēia mau hōʻailona ma hope o 2-3 mau pule, ma kahi o ka manawa o ka hoʻopaʻa ʻia ʻana o ke kelepona:
- ʻO ke kuni: ka wela kiʻekiʻe o 38 degere a i ʻole
- He ʻulaʻula
- Kōkua
- Hoʻomaha ka wai
Kapa ʻia kēia ʻo 'engraftment syndrome'. ʻOi aku ka maʻamau ma hope o ka hoʻololi ʻana i nā pūnaʻi pūʻokoʻa (autologous) ma mua o ka mea hāʻawi (allogeneic) stem cell transplant.
He hopena maʻamau ia o ka hoʻololi ʻana a mālama ʻia me nā steroid. Hiki ke hoʻokumu ʻia kēia mau hōʻailona e nā kumu ʻē aʻe, me ka chemotherapy, a ʻaʻole paha he hōʻailona o ka maʻi engraftment.
ʻO kekahi o nā protocols maʻamau o ka haukapila i ka wā o kahi transplant e komo pū:
- Noho maʻamau ʻoe ma ke keʻena haukapila ma kāu iho no ka lōʻihi o kou noho ʻana
- Hoʻomaʻemaʻe mau ʻia ka lumi o ka haukapila a hoʻololi ʻia nā pale a me nā uhi uluna i kēlā me kēia lā
- ʻAʻole hiki iā ʻoe ke loaʻa nā mea kanu ola a pua paha i loko o kou lumi
- Pono nā limahana o ka haukapila a me nā malihini e holoi i ko lākou mau lima ma mua o ke komo ʻana i kou lumi
- I kekahi manawa pono paha nā malihini a me nā limahana o ka haukapila e ʻaʻahu i nā mīkina lima, nā ʻaʻahu a i ʻole nā pale, a me nā pale maka ke kipa aku iā ʻoe.
ʻAʻole pono nā kānaka e kipa iā ʻoe inā ʻaʻole maikaʻi lākou - ʻAʻole ʻae ʻia nā keiki ma lalo o kekahi mau makahiki e kipa - ʻoiai ʻae kekahi mau haukapila iā lākou inā maikaʻi nā keiki
Ke hoʻi ka helu o kou koko a lawa ka maʻi, hiki iā lākou ke hoʻi i ka home. Ma hope o kēia manawa, e hahai pono ʻia lākou e ka hui lapaʻau.
ʻO ka hoʻopiʻi ʻana mai ka hoʻololi ʻana i ke ʻano o ke kino
ʻO ka maʻi maʻi hoʻokipa (GvHD)
ʻO ka maʻi ʻo Graft-versus-host (GvHD) kahi hoʻopiʻi maʻamau o kahi transplant cell stem allogeneic. Hiki ke hana i ka wā:
- ʻO nā pūnaewele T hāʻawi (i kapa ʻia ʻo ka 'graft') ʻike i nā antigens ma nā cell ʻē aʻe i loko o ke kino o ka mea loaʻa (i kapa ʻia ʻo ka 'host') ma ke ʻano he haole.
- Ma hope o ka ʻike ʻana i kēia mau antigens, a laila hoʻouka ka mea hāʻawi T-cell i nā pūnaewele o kā lākou pūʻali hou.
Hiki ke hoʻohana ʻia kēia hopena i ka wā e hoʻouka ai ka mea hāʻawi T-cell hou i nā keena lymphoma i koe (i kapa ʻia ʻo ka graft versus lymphoma effect). ʻO ka mea pōʻino, hiki i nā mea hāʻawi T-cell ke hoʻouka i nā ʻiʻo olakino. Hiki i kēia ke hana i nā hopena koʻikoʻi.
ʻO ka hapa nui o ka manawa GvHD ke kumu o nā hōʻailona maʻalahi a me ka haʻahaʻa, akā i kekahi manawa, hiki ke koʻikoʻi a hiki ke hoʻoweliweli i ke ola. Ma mua a ma hope o ka hoʻololi ʻana, hāʻawi ʻia nā mea maʻi e hōʻemi i ka pilikia o ka hoʻomohala ʻana iā GvHD. Ke nānā pono nei ka hui transplant i ka mea maʻi no nā hōʻailona o GvHD i hiki iā lākou ke mālama iā ia i ka wā hiki, inā e ulu ana.
Hoʻonohonoho ʻia ʻo GvHD ma ke ʻano he 'acute' a i ʻole 'chronic' ma muli o nā hōʻailona a me nā hōʻailona.
Pilikia o ka ma'i
Ma hope o ka hoʻololi ʻana i ke kelepona, ʻo ka nui o ka chemotherapy e hoʻopau i ka nui o nā keʻokeʻo keʻokeʻo, me kahi keʻokeʻo keʻokeʻo i kapa ʻia he neutrophils. ʻO ka pae haʻahaʻa o nā neutrophils i kapa ʻia ʻo neutropenia. ʻO ka neutropenia lōʻihi e kau i kekahi i kahi kūlana kiʻekiʻe loa e hoʻomohala i kahi maʻi. Hiki ke mālama ʻia nā maʻi maʻi, akā naʻe inā ʻaʻole i loaʻa koke a mālama koke ʻia hiki ke lilo i mea weliweli i ke ola.
ʻOiai i loko o ka haukapila, ma hope koke o ka hoʻololi ʻana i ka stem cell, e mālama ka hui lapaʻau i ka pale ʻana i ka ulu ʻana o nā maʻi a me ka nānā pono ʻana i nā hōʻailona o ka maʻi. ʻOiai ua mālama ʻia ka nui o ka mālama ʻana no ka hōʻemi ʻana i ka pilikia o ka loaʻa ʻana o kahi maʻi, ʻo ka hapa nui o nā maʻi i loaʻa ka allogeneic stem cell transplant e loaʻa i kahi maʻi.
I nā pule mua ma hope o ka hoʻololi ʻana, ʻoi aku ka nui o ka poʻe maʻi i ka hoʻomohala ʻana i kahi maʻi bacterial. ʻO ia mau maʻi e pili ana, nā maʻi kahe koko, ka maʻi pneumonia, nā maʻi ʻōnaehana digestive a i ʻole nā maʻi ʻili.
I kēia mau mahina e hiki mai ana, ʻoi aku ka pilikia o ka poʻe maʻi i ka hoʻomohala ʻana i nā maʻi viral a ʻo ia paha nā maʻi e moe moe ana i loko o ke kino ma mua o ka hoʻololi ʻana a hiki ke ʻā aʻe ke haʻahaʻa ka ʻōnaehana pale. ʻAʻole lākou e hana mau i nā hōʻailona. E hana ʻia nā hoʻāʻo koko maʻamau ma hope o ka hoʻololi ʻana i mea e ʻike koke ʻia ai kahi maʻi maʻi maʻi i kapa ʻia ʻo cytomegalovirus (CMV). Inā hōʻike ʻia kahi hōʻike koko he CMV - ʻoiai inā ʻaʻohe hōʻailona - e mālama ka mea maʻi me nā lāʻau antiviral. ʻOi aku ma mua o hoʻokahi papa o ka lāʻau e pono ai a hiki i kēia lāʻau ke hoʻolōʻihi i ka noho ʻana i ka haukapila.
Hoʻomaka ka piʻi ʻana o ke koko ma waena o 2 a i 4 mau pule ma hope o ka hoʻololi ʻana i ke ʻano o nā pūnaʻi allogeneic stem cell. Eia nō naʻe, hiki ke lawe i nā mahina he nui, a i ʻole mau makahiki paha, no ka hoʻōla piha ʻana o ka ʻōnaehana pale.
Ke hoʻokuʻu ʻia mai ka haukapila, pono e ʻōlelo ka hui lapaʻau i nā hōʻailona o ka maʻi e nānā aku ai a me ka mea e hoʻopili ai inā loaʻa kahi maʻi a i ʻole kekahi mea e hopohopo ai ka mea maʻi.
Nā hopena ʻaoʻao o ka chemotherapy kiʻekiʻe loa
Loaʻa paha i nā maʻi nā hopena ʻaoʻao mai ka lāʻau anti-cancer kiʻekiʻe. He mea maʻamau paha nā hopena ʻaoʻao aʻe a aia ka ʻike hou aʻe ma ka aoao waiwai pauku
- Mucositis waha (ʻeha waha)
- Anemia (ka helu ʻulaʻula haʻahaʻa)
- Thrombocytopenia (ka helu platelet haʻahaʻa)
- ʻO ka naʻi a me ka luaʻi
- ʻO nā pilikia o ka ʻōpū ʻai (ka maʻi paʻa a i ʻole ka constipation)
ʻAʻole hāʻule
Hiki ke hoʻopau ʻia ke kumu ʻole inā ʻaʻole e noho nā pūnaewele kumu i hoʻololi ʻia i loko o ka iwi iwi a hana i nā kiʻi koko hou. 'O ia ho'i, 'a'ole ho'i hou ka helu koko, a i 'ole e ho'omaka ana e ho'ōla a iho i lalo.
He mea koʻikoʻi ka hāʻule ʻana o ka Graft akā he mea kakaʻikahi ma hope o ka hoʻololi ʻana o ke ʻano allogeneic stem cell, ʻoi aku ka maikaʻi inā pili maikaʻi ka mea hāʻawi.
E nānā pono ka hui lapaʻau i nā helu koko a inā hoʻomaka ka hāʻule ʻana o ka pūlima hou, hiki ke mālama mua ʻia ka mea maʻi me nā hormones growth factor. Hiki i kēia mau mea ke hoʻoikaika i nā pūnaewele i loko o ka iwi iwi e hana hou aku.
Inā ʻaʻole i hoʻopaʻa ʻia ka mea hāʻawi i nā pūnaewele kumu, pono paha i ka mea maʻi ke hoʻololi hou i ka lua. Hiki ke hoʻololi ʻia kēia hoʻololi ʻelua mai ka mea hāʻawi pūlima like a i ʻole kekahi mea ʻē aʻe.
Nā hopena lohi
ʻO nā hopena hope loa nā pilikia olakino e ulu ana i mau mahina a i ʻole mau makahiki ma hope o ka mālama ʻana i ka lymphoma. ʻO ka hapa nui o nā kikowaena transplant i hoʻolaʻa i nā lawelawe hopena hope e hāʻawi ana i nā polokalamu screening e ʻike i nā hopena hope i ka wā hiki. Hāʻawi kēia i ka mea maʻi i ka manawa maikaʻi loa e mālama maikaʻi ʻia inā hoʻomohala lākou i nā hopena hope loa.
Hiki paha i nā maʻi ke hoʻomohala i ka Post-Transplant Lymphoproliferative Disorder (PTLD) - nā lymphomas hiki ke ulu i loko o ka poʻe e lawe ana i nā lāʻau immunosuppressant ma hope o ka hoʻololi ʻana. Eia nō naʻe, he kakaikahi ka PTLD. ʻO ka hapa nui o nā maʻi i loaʻa i nā transplants ʻaʻole i hoʻomohala i ka PTLD.
Malama hahai
Ma hope o ka hoʻololi ʻana i ke kelepona, e loaʻa nā manawa maʻamau (i kēlā me kēia pule) me ke kauka. E hoʻomau ʻia ka hahai ʻana no nā mahina a me nā makahiki ma hope o ka mālama ʻana, akā e emi a emi iki ka manawa i ka hala ʻana o ka manawa. I ka hopena, hiki i nā kauka transplant ke hāʻawi i ka mālama ʻana, i nā maʻi GP.
Ma kahi o 3 mahina ma hope o ka hoʻololi ʻana, a Pākuʻi PET, C scan A / / iwi iwi aspirate (BMA) hiki ke hoʻonohonoho ʻia e loiloi i ke ʻano o ka hoʻihoʻi ʻana.
He mea maʻamau ka hoʻi ʻana i ka haukapila no ka mālama ʻana i nā pule a me nā mahina ma hope o ka hoʻololi ʻana akā ke hele nei ka manawa, e emi ana ka pilikia o nā pilikia koʻikoʻi.
Loaʻa paha i nā maʻi nā hopena ʻaoʻao mai ka lāʻau lapaʻau kiʻekiʻe a manaʻo paha ka maikaʻi ʻole a luhi loa. Eia nō naʻe, ma kahi o hoʻokahi makahiki e hoʻihoʻi ʻia mai kahi transplant cell stem.
Pono ka hui lapaʻau e aʻo i nā kumu ʻē aʻe e noʻonoʻo ai i ka wā hoʻōla. Loaʻa iā Lymphoma Australia kahi ʻaoʻao Facebook pilikino pūnaewele, ʻo Lymphoma Down Under kahi e hiki ai iā ʻoe ke nīnau i nā nīnau a loaʻa ke kākoʻo mai nā poʻe ʻē aʻe i loaʻa i ka lymphoma a i ʻole ka hoʻololi ʻana i ke kelepona.
He aha ka hopena ma hope o ka hoʻololi ʻana i ke kelepona?
Hoʻopau i ka mālama ʻana hiki ke lilo i manawa paʻakikī no nā maʻi he nui, ʻoiai lākou e hoʻihoʻi hou i ke ola ma hope o ka hoʻololi ʻana. Hiki ke pili kekahi o nā pilikia maʻamau i:
- Helu
- ʻO ke ʻano noʻonoʻo
- Ola kino
- 'ana ma
- Hana, aʻo a me nā hana pilikanaka
ʻIke hou aku
Ua ʻike ʻia ʻo Steve me ka mantel cell lymphoma i ka makahiki 2010. Ua ola ʻo Steve i ka autologous a me ka allogeneic stem cell transplant. ʻO kēia ka moʻolelo a Steve.
ʻO Dr Nada Hamad, Hematologist & kauka hoʻololi i ka iwi iwi
Halemai o St Vincent, Sydney
ʻO Dr Amit Khot, Hematologist & kauka hoʻololi i ka iwi iwi
ʻO Peter MacCallum Cancer Center & Royal Melbourne Hospital
ʻO Dr Amit Khot, Hematologist & kauka hoʻololi i ka iwi iwi
ʻO Peter MacCallum Cancer Center & Royal Melbourne Hospital
ʻO Dr Amit Khot, Hematologist & kauka hoʻololi i ka iwi iwi
ʻO Peter MacCallum Cancer Center & Royal Melbourne Hospital
ʻO Dr Amit Khot, Hematologist & kauka hoʻololi i ka iwi iwi
ʻO Peter MacCallum Cancer Center & Royal Melbourne Hospital
