He aha ka lymphoma kiʻekiʻe?
ʻO nā lymphoma kiʻekiʻe he lymphomas e ulu a laha wikiwiki i kou kino. Ma muli o ka ulu wikiwiki ʻana o nā pūnaewele lymphoma, ʻaʻole hiki iā lākou ke hoʻomohala a hana paha e like me ka mea e pono ai, no laila ke ʻano ʻokoʻa loa lākou mai kāu mau pūnaʻi B olakino maʻamau.
ʻO nā lymphoma kiʻekiʻe e hiki ke loaʻa i ʻelua a ʻekolu paha mau hoʻoponopono hou ʻana a i ʻole ka ʻōlelo pālua ʻo Diffuse Large B-cell Lymphoma (DLBCL) a me nā lymphoma B-cell kiʻekiʻe. No ka ʻike e pili ana i kēia mau subtypes, e kaomi i nā loulou ma lalo nei.
Ka hoʻomaopopo ʻana i kāu genetics lymphoma
Hana ʻia nā hoʻokolohua cytogenetic e nānā i nā ʻano like ʻole e pili ana i kāu maʻi. No ka ʻike hou aku e pili ana i kēia, e ʻoluʻolu e ʻike i kā mākou ʻāpana no ka hoʻomaopopo ʻana i kāu genetics lymphoma ma lalo o kēia ʻaoʻao. ʻO nā hoʻokolohua i hoʻohana ʻia no ka nānā ʻana i nā hoʻololi genetic i kapa ʻia nā hoʻokolohua cytogenetic. Ke nānā nei kēia mau hoʻāʻo e ʻike inā ua loli ʻoe i nā chromosomes a me nā genes.
Loaʻa iā mākou he 23 mau chromosomes, a ua helu ʻia lākou e like me ko lākou nui. Inā loaʻa iā ʻoe ka DHL a i ʻole THL, ua hoʻonohonoho hou ʻia nā genes (MYC a me BCL genes) ma kāu chromosomes.
He aha nā genes a me nā chromosomes
ʻO kēlā me kēia pūnaewele e hoʻokumu i ko mākou kino he nucleus, a i loko o ka nucleus he 23 mau chromosomes. Hana ʻia kēlā me kēia chromosome mai nā kaula lōʻihi o DNA (deoxyribonucleic acid) i loko o kā mākou mau genes. Hāʻawi kā mākou mau genes i ke code e pono ai e hana i nā cell a me nā protein āpau i loko o ko mākou kino, a haʻi iā lākou pehea e nānā ai a hana paha.
Ka ʻike nui o ka lymphoma pālua (DHL) a me ka lymphoma triple hit (THL).
ʻO nā lymphoma pālua (DHL) a me triple hit (THL) lymphoma ke loaʻa iā ʻoe kahi lymphoma kiʻekiʻe a me ka hoʻololi ʻana i kāu ʻelua (pālua) a i ʻole ʻekolu (hit triple) o kāu mau genes. Ua kapa ʻia ka hoʻololi ʻana i kēia mau genes he hoʻonohonoho hou a hiki ke hoʻonui i kou manawa e loaʻa ai ka lymphoma a paʻakikī i ka mālama ʻana i kekahi mau hihia.
Ua ʻoi aku ka maikaʻi o ka hahau ʻekolu ma mua o ka lymphoma pālua?
Ma triple hit lymphoma he hoʻololi hou kāu i kāu mau genes MYC a me BCL2, akā e hoʻololi hou ʻia nō hoʻi ʻoe ma kekahi ʻano i kapa ʻia ʻo BCL6.
Ua manaʻo ʻia ma mua, ʻoi aku ka ʻino o ka loaʻa ʻana o ka lymphoma triple ma mua o ka loaʻa ʻana o ka lymphoma pālua, a ʻoi aku ka paʻakikī a ʻoi aku ka paʻakikī o ka mālama ʻana.
Eia naʻe, me ka noiʻi hou aʻe ua ʻike mākou ʻaʻole ia ka hihia. ʻO ka ʻoiaʻiʻo, ke manaʻo nei ka World Health Organization (WHO) ʻaʻole e manaʻo hou ʻia ka lymphoma triple hit ma ke ʻano he noʻonoʻo ʻokoʻa, a mālama ʻia e like me ka mālama ʻana i ka lymphoma lua.
Ua like anei nā lymphoma pā pālua?
ʻO ka manaʻo nui o ka lymphoma hōʻike pālua (DEL)
ʻO ka lymphoma hōʻike pālua ʻo ia ka loaʻa ʻana o nā protein MYC a me BCL ʻē aʻe ma kāu mau keena lymphoma, akā naʻe, ʻaʻohe āu hoʻonohonoho hou i kāu mau genes.
Hiki i kēia mau protein ke ho'ōki i ka luku ʻia ʻana o nā maʻi maʻi a hiki i ka ulu ʻana o ka lymphoma.
ʻOi aku ka paʻakikī o ka mālama ʻana i kekahi mau lymphoma expressor pālua, akā pili kēia i nā kumu ʻē aʻe e like me ka loaʻa ʻana o nā hoʻololi genetic ʻē aʻe a i ʻole nā protein ʻē aʻe ma kāu mau pūnaewele lymphoma.
Hoʻonohonoho hou a me ka ʻōlelo protein ma Double & Triple Hit, a me Double Expressor Lymphomas | ||||
| MYC Hoʻoponopono | BCL2 Hoʻonohonoho hou | BCL6 Hoʻonohonoho hou | ʻO ka overexpression o nā protein MYC a me BCL |
Paʻi pālua | ʻAE | ʻAE | ʻAʻole | ʻO ka maʻamau, akā ʻaʻole i nā manawa a pau |
Pāʻakolu | ʻAE | ʻAE | ʻAE | ʻO ka maʻamau, akā ʻaʻole i nā manawa a pau |
Mea hoʻolaha pālua | ʻAʻole | ʻAʻole | ʻAʻole | ʻAE |
E noi i kāu kauka e wehewehe iā ʻoe i nā loli hoʻokahi a pehea ka hopena o kēia mau mea i kāu lapaʻau.
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Proto-oncogenes a me Oncogenes
ʻO MYC a me BCL nā proto-oncogenes. Ke hoʻololi hou ʻoe i kēia mau genes, hiki iā lākou ke lilo i oncogenes. Kaomi ma nā pahu pahu e aʻo i ke ʻano o nā proto-oncogenes a me nā oncogenes.
Proto-oncogenes
Proto-oncogenes
Inā hoʻololi ʻia kahi proto-oncogene a i ʻole hoʻonohonoho hou ʻia hiki ke lilo i oncogenes.
ʻO Oncogenes
oncogene
He aha ka MYC a me BCL Genes & Proteins?
MYC Gene & Protein
Hāʻawi ka MYC gene i ka ʻike no ka MYC protein e hana ʻia a hana pono. Kōkua ka protein MYC e ulu a pale i ka make. He maikaʻi kēia inā loaʻa iā ʻoe nā cell olakino e hana pono ana. Eia nō naʻe, ke hoʻololi hou ʻia ka gene MYC, a i ʻole ʻoi aku ka nui o ka protein MYC, hiki ke ulu a ulu pū kekahi mau mea maʻi kanesa.
ʻO ka hoʻonohonoho hou ʻana o MYC gene, a i ʻole ka nui o ka protein MYC e hoʻōki i ka make ʻana o nā maʻi maʻi a hiki iā lākou ke hoʻomau i ka ulu ʻana a me ka hana ʻana i nā maʻi kanesa hou.
Nā Genes a me nā Protein BCL
ʻO BCL ke kū nei B-cell lymphoma - Aia kekahi mau ʻano subtypes o nā genes BCL a me nā protein. ʻOi aku ka kikoʻī o ka BCL ma mua o ka MYC no ka mea i kuhikuhi ʻia i ka hoʻomohala ʻana, ka hana a me ke ola ʻana o nā lymphocytes B-cell.
Ke hana maikaʻi nei ʻo BCL2 a me BCL6 e like me ka mea e pono ai, mālama lākou i ke koena maikaʻi o ke olakino B-cell lymphocytes.
ʻO ka loaʻa ʻana o ka hoʻoponopono hou ʻana i kāu moʻo BCL2 ke manaʻo ʻia he ʻoi aku ka ʻoi aku o ka lymphoma koʻikoʻi, a ʻoi aku ka nui o ka manawa e hoʻi hou ai ma mua o ka hoʻoponopono hou ʻana i kāu gene BCL 6.
BCL2
Hāʻawi ka gene BCL2 i ka ʻike no ka protein BCL2 e hana ʻia.
Ke hoʻololi hou ʻia ka gene BCL2, a i ʻole ka overexpression o nā protein BCL2, hoʻomau nā lymphocytes B-cell i ka ulu a hoʻonui. Inā ulu wikiwiki nā lymphocytes B-cell ʻaʻole hiki iā lākou ke hoʻomohala maikaʻi a i ʻole, inā loaʻa iā lākou nā loli maʻi kanesa, hiki iā lākou ke hopena i ka lymphoma ke hoʻomau nei lākou i nā lymphocytes B-cell cancerous.
BCL6
Hāʻawi ka gene BCL6 i ka ʻike no ka protein BCL6 e hana ʻia.
Ke hoʻonohonoho hou ʻia a hoʻololi ʻia paha, hiki i ka BCL6 ke hoʻopilikia i ke ʻano o ka hana ʻana o nā genes suppressor tumor. ʻO nā genes suppressor tumor ka mea kūikawā e ʻike a luku i nā maʻi kanesa.
Hiki i ka BCL6 ke pale i nā genes suppressor tumor mai ka hiki ke ʻike a luku i nā pūnaeau maʻi maʻi. Hiki ke pale aku follicular helper T-cell lymphocytes mai ka hooulu ana. Pono kēia mau pūnaewele T no ke kōkua ʻana i nā pūnaʻi B e hana maikaʻi i ke kaua ʻana i ka maʻi kanesa.
Ke hoʻāʻo ʻana no Double / Triple Hit a me Double Expressor
Inā loaʻa iā ʻoe kahi lymphoma kiʻekiʻe, makemake paha kāu kauka e hoʻāʻo hou i kāu biopsies e ʻike ai inā loaʻa iā ʻoe kekahi mau hoʻololi genetic a i ʻole nā protein hōʻike pālua. Kāhea ʻia ka hoʻāʻo Flourescence In Situ Hybridization (FISH) a nānā i nā hōʻailona genetic like ʻole, e like me MYC a me BCL ma kāu mau laʻana biopsy.
ʻAʻole i uhi ʻia ka hoʻāʻo FISH e ka papahana pōmaikaʻi Medicare, akā i kekahi mau hihia hiki ke uhi ʻia ma ke ʻano he ʻāpana o kāu hana diagnostic. Eia nō naʻe, hiki ke hoʻopau wale ʻia ma kekahi mau kikowaena ma waena o Australia, no laila, i kekahi mau hihia, ʻaʻohe kumu kūʻai no ʻoe e hana ai. Hiki ke ʻokoʻa ke kumukūʻai ma muli o kahi āu e hana ai.
He mea nui e ʻike ʻaʻole hiki ke hoʻololi ʻia nā hopena i ka lāʻau lapaʻau āu e hāʻawi ʻia ai, a aia kekahi mau mea hana "prognostic indicator" hiki ke hoʻohana ʻia ma kahi o ka hoʻāʻo FISH. Hiki i kāu kauka ke hoʻohana i kēia mau hoʻokolohua ʻē aʻe e nānā i ka maikaʻi o kāu pane ʻana i ka lāʻau lapaʻau. ʻO kēia nā mea hana i ʻike ʻia ma ke ao holoʻokoʻa i hoʻāʻo ʻia a hoʻāʻo ʻia he hōʻailona maikaʻi o kāu pane ʻana i ka lāʻau lapaʻau.
'O ka manawa pinepine, 'a'ole e loli kou lapa'au 'ana inā he DHL/THL 'oe a i 'ole ka lymphoma hō'ike lua, akā i kekahi mau hihia, hiki paha. Inā loli ka lāʻau inā loaʻa iā ʻoe kēia mau ʻokoʻa, a laila hiki iā ʻoe ke noʻonoʻo e hana i ka hoʻāʻo.
Lapaʻau no DHL, THL a me DEL
ʻO ka mālama pinepine ʻana no DHL, THL a me DEL he mau lapaʻau like ia i hāʻawi ʻia ma High-grade B-cell Lymphoma a me Diffuse Large B-cell Lymphoma. I kekahi mau hihia, hiki i kāu kauka haematologist ke koho i kahi ʻano lapaʻau koʻikoʻi nou. Eia nō naʻe, ʻaʻohe mau hoʻokolohua lapaʻau nui e hāʻawi i nā hōʻike e ʻoi aku ka maikaʻi o ka hoʻomaʻamaʻa koʻikoʻi iā ʻoe.
ʻO kāu koho ʻana i ka lāʻau lapaʻau he hoʻoholo me kāu haematologist a oncologist ke loaʻa iā lākou nā ʻike a pau e pili ana i kāu lymphoma, a ua kūkākūkā i nā pono a me nā pilikia o kēlā me kēia lapaʻau iā ʻoe, a me kou manawa e ola ai a hoʻi hou.
No ka ʻike hou aku e pili ana i ka mālama ʻana, e ʻoluʻolu e ʻike i nā loulou ma lalo nei
hōʻuluʻulu manaʻo
- Loaʻa ka Double Hit (DHL), Triple hit (THL) a me Double expressor (DEL) i ka poʻe me nā lymphoma kiʻekiʻe e like me Diffuse Large B-cell Lymphoma a me High-grade B-cell Lymphoma.
- ʻO nā lymphoma pālua a me triple hit e pili ana i nā hoʻololi genetic i kapa ʻia nā hoʻonohonoho hou i hana ʻia ma nā genes MYC a me BCL.
- ʻO ka lymphoma hōʻike pālua ʻo ia hoʻi, aia kahi ʻōlelo ʻoi aku (nui loa) o nā protein MYC a me BCL, akā ʻaʻohe hoʻonohonoho hou.
- Loaʻa nā manaʻo like ʻole o ka lymphoma triple hit me kahi lymphoma pā pālua me ka MYC gene a me BCL2 hoʻonohonoho hou.
- Hiki i kēia mau ʻokoʻa i kāu lymphoma ke hoʻoikaika a paʻakikī hoʻi e mālama ma mua o nā ʻano subtypes o DLBCL a me nā lymphoma B-cell kiʻekiʻe.
- Loaʻa iā ʻoe kahi kūlana kiʻekiʻe o ka hoʻi hou ʻana me ʻoe he hoʻololi DHL, THL a i ʻole DEL i kāu lymphoma.
- Ua like paha ka mālama ʻana o DHL, THL a me DEL me ka poʻe me nā ʻano subtype ʻē aʻe o DLBCL a me High-grade B-cell lymphoma.
- Hiki ke pipiʻi ka hoʻāʻo ʻana no DHL, THL a me DEL no ka mea ʻaʻole i uhi ʻia e ka papahana pōmaikaʻi Medicare, no laila pono ʻoe e uku iā ʻoe iho.
- E kamaʻilio me kāu kauka e pili ana i kāu mau ʻano like ʻole a me ke ʻano o kēia mau mea iā ʻoe.
- ʻAʻole ʻoe wale nō, inā makemake ʻoe e kamaʻilio e pili ana i kāu lymphoma a me nā koho, e kāhea i kā mākou Lymphoma Care Nurses. Kaomi ma ka pihi Hoʻokaʻaʻike iā mākou ma lalo o ka pale no nā kikoʻī.
