ʻO nā lymphocytes B-cell i ka Diffuse Large B-cell Lymphoma (DLBCL)
No ka hoʻomaopopo ʻana i ka DLBCL pono ʻoe e ʻike iki e pili ana i kāu lymphocytes B-Cell.
ʻO nā lymphocytes pūnaewele B:
- He ʻano o ke koko keʻokeʻo
- E hakakā i ka maʻi a me nā maʻi e mālama pono iā ʻoe.
- E hoʻomanaʻo i nā maʻi i loaʻa iā ʻoe i ka wā ma mua, no laila inā loaʻa hou iā ʻoe ka maʻi like, hiki i ka ʻōnaehana pale o kou kino ke hakakā me ka ʻoi aku ka maikaʻi a me ka wikiwiki.
- Hana ʻia i loko o kou iwi iwi (ʻo ka ʻāpana spongy i waenakonu o kou mau iwi), akā e noho mau i loko o kou ʻōpū a me kou mau lymph nodes. Noho kekahi i kou thymus a me ke koko pū kekahi.
- Hiki ke hele ma kāu ʻōnaehana lymphatic, i kekahi ʻāpana o kou kino e hakakā ai i ka maʻi a i ʻole ka maʻi.
Hoʻokumu ʻo DLBCL i ka wā e lilo ai kekahi o kāu mau pūnaʻi B i ka maʻi kanesa. Ulu lākou me ka ʻole ka mālama ʻia, ʻano ʻino, a ʻaʻole make i ka wā e pono ai.
Ke loaʻa iā ʻoe ka DLBCL i kāu lymphocytes B-cell cancerous:
- ʻAʻole e hana maikaʻi e hakakā i nā maʻi a me nā maʻi.
- Hiki ke lilo i ʻoi aku ka nui ma mua o ka pono a hiki ke nānā ʻokoʻa i kāu mau pūnaewele B olakino.
- Hiki ke ulu a ulu ka lymphoma ma kekahi wahi o kou kino.
- Hoʻolaha ʻia (diffuse) ma mua o ka hui pū ʻana.
ʻOiai ʻo DLBCL ka mea maʻamau he lymphoma e ulu wikiwiki ana (aggressive), hiki ke ho'ōla 'ia nā kānaka he nui me DLBCL me ka lapaʻau ʻana, ʻoiai inā ʻike ʻia ʻoe me kahi pae kiʻekiʻe. He ʻokoʻa loa ka pae kiʻekiʻe o ka lymphoma i nā pae kiʻekiʻe o nā maʻi maʻi ʻē aʻe ʻaʻole hiki ke hoʻōla ʻia.
Nā kumu o ka Diffuse Large B-cell Lymphoma (DLBCL)
ʻAʻole mākou ʻike i ke kumu o ka DLBCL, akā manaʻo ʻia nā ʻano pilikia like ʻole e hoʻonui i kou pilikia o ka hoʻomohala ʻana. ʻO kekahi, nā kumu pilikia no DLBCL e manaʻo ʻia e hoʻokomo i kēia mau mea inā ʻoe:
- Loaʻa kahi maʻi e pili ana i kāu ʻōnaehana pale e like me ka maʻi maʻi immunodeficiency kanaka (HIV).
- Ke lawe nei i nā lāʻau e hoʻopau i kou ʻōnaehana pale, e like me nā lāʻau i lawe ʻia ma hope o ka hoʻololi ʻana o ke kino.
- Loaʻa kahi lālā o ka ʻohana me ka lymphoma.
- Loaʻa i ka maʻi hepa C - he maʻi maʻi e pili ana i kou ake.
- Ua kaumaha ma ke ʻano he kamaliʻi.
*He mea nui e hoʻomaopopo, ʻaʻole hiki i nā poʻe a pau i loaʻa kēia mau mea pilikia ke hoʻomohala i ka DLBCL, a hiki i kekahi poʻe me kēlā mau kumu pilikia ke hoʻomohala i ka DLBCL.
No ka ʻike nui o DLBCL i hōʻike ʻia e ka haematologist Michael Dickinson e ʻoluʻolu e nānā i ke wikiō ma lalo nei.
Nā hōʻailona o ka Diffuse Large B-cell Lymphoma (DLBCL)
ʻO ka hōʻailona mua a i ʻole ka hōʻailona o DLBCL e loaʻa iā ʻoe he puʻupuʻu, a i ʻole kekahi mau puʻupuʻu e ulu mau ana. Hiki paha iā ʻoe ke ʻike a ʻike paha iā lākou ma kou ʻāʻī, ka ʻāʻī a i ʻole ka ʻāʻī. ʻO kēia mau puʻupuʻu he lymph nodes (glands) i hoʻonui ʻia, ua pehu ʻia ma muli o ka nui ʻana o nā pūnaʻi B maʻi maʻi e ulu ana i loko o lākou.
Hoʻomaka pinepine lākou ma kahi ʻāpana o kou kino, a laila laha i kāu ʻōnaehana lymphatic a i nā wahi ʻē aʻe o kou kino e like me kāu:
- ʻāpala
- kāu thyma
- ka umauma
- ate
- iwi
- ka iwi o ka iwi
- ʻōnaehana ʻōnaehana waena (CNS)
- nā kino ʻē aʻe
Nā ʻano o kāu ʻōnaehana lymphatic - Spleen and thymus
ʻO kou ʻōpū he ʻōkana e kānana i kou koko a mālama i ke olakino. He okana nō hoʻi ia o kāu ʻōnaehana lymphatic kahi e noho ai kāu lymphocytes B-cell a hana i nā antibodies e hakakā i ka maʻi. Aia ia ma ka ʻaoʻao hema o kou ʻōpū luna ma lalo o kou māmā a kokoke i kou ʻōpū (opu).
Ke nui loa kou ʻāʻī, hiki iā ia ke hoʻoikaika i kou ʻōpū a māʻona ʻoe, ʻoiai inā ʻaʻole ʻoe i ʻai nui.
ʻO kou thymus kekahi ʻāpana o kāu ʻōnaehana lymphatic. He ʻano pepeke ia e noho ana ma hope pono o kou iwi umauma ma mua o kou umauma. Ke ola nei kekahi mau pūnaʻi B a hele i loko o kou thymus.
Ma muli o kahi e ulu ai ʻo DLBCL, loaʻa paha iā ʻoe nā hōʻailona like ʻole e like me ka mea i helu ʻia ma lalo nei.
ʻO nā hōʻailona o DLBCL (Paʻakau mua)
Wahi i pili | Ōuli |
Gut - me kou ʻōpū a me kou ʻōpū | Nausea me ka luaʻi ʻole a me ka luaʻi ʻole (ka maʻi i loko o kou ʻōpū a i ʻole ka luaʻi ʻana). ʻO ka maʻi maʻi a i ʻole ka paʻa ʻana (ka wai a i ʻole ka poʻe paʻakikī). Koko ke hele i ka lua. Manaʻo piha inā ʻaʻole ʻoe i ʻai nui. |
Pūnaehana nūnū waena (CNS) - me kou lolo a me ke kuamoʻo | Hoʻololi huikau a hoʻomanaʻo paha. Hoʻololi pilikino. Nā mākana. Nawaliwali, numbness, kuni a i ʻole nā kui a me nā nila ma kou mau lima a me kou mau wāwae. |
umauma | ʻO ka manawa pōkole ʻO kaʻeha hope He ʻūhā maloʻo |
ʻŌiwi iwi | ʻO nā helu koko haʻahaʻa e pili ana i nā ʻulaʻula, nā keʻokeʻo a me nā platelet e hopena i: o Pokole hanu. o ʻO nā maʻi maʻi e hoʻi mai ana a paʻakikī paha ke hoʻopau ʻia. o Ke koko ʻokoʻa a ʻeha paha. |
Skin | ʻulaʻula a poni paha ke nānā aku. ʻO nā puʻupuʻu a me nā puʻupuʻu ma kou ʻili he ʻili a ʻulaʻula a poni paha. Kāwili. |
Nā hōʻailona maʻamau o ka lymphoma
Hiki i nā hōʻailona maʻamau o lymphoma ke komo:
- Nā hōʻailona B - e nānā i ke kiʻi ma lalo
- pehu nā pūnana lymph
- luhi luhi ʻole (fatiued)
- pau ka hanu
- ʻili ʻili
- nā maʻi hele ʻole a hoʻi hou mai
- nā hoʻololi i kāu hoʻāʻo koko
- ʻulaʻula haʻahaʻa a me nā platelets
- nui loa nā lymphocytes a/a i ʻole nā lymphocytes i hana pono ʻole
- nā keʻokeʻo i hoʻohaʻahaʻa ʻia (me nā neutrophils)
- kiʻekiʻe lactic acid dehydrogenase (LDH) - he ʻano protein i hoʻohana ʻia e hana i ka ikehu. Inā hōʻino ʻia kāu mau sela e kou lymphoma, hiki i ka LDH ke kahe i waho o kāu mau pūnaewele a i loko o kou koko
- kiʻekiʻe beta-2 microglobulin - he ʻano protein i hana ʻia e nā pūnaewele lymphoma. Hiki ke loaʻa iā ia i loko o kou koko, mimi a i ʻole ka wai o ka spinal cerebral
I ka wā e launa aku ai i kāu kauka
Pono ʻoe e kelepona i kāu kauka inā:
- ua pehu ʻoe i nā pūnaʻi lymph ʻaʻole e hele, a inā ʻoi aku ka nui ma mua o kou manaʻo no kahi maʻi.
- ua pōkole kou hanu me ke kumu ʻole
- ʻoi aku kou luhi ma mua o ka mea maʻamau a ʻaʻole maikaʻi me ka hoʻomaha a me ka hiamoe
- ʻike ʻoe i ke koko ʻokoʻa a i ʻole ka ʻeha ʻana (me ka poʻe, mai kou ihu a i ʻole ka ʻāʻī)
- e ulu ana ʻoe i kahi maʻi maʻamau (ʻo ka ʻulaʻula ʻulaʻula ʻulaʻula hiki ke manaʻo he kahe koko ʻoe ma lalo o kou ʻili)
- ʻoi aku ka ʻili o kou ʻili ma mua o ka maʻamau
- hoʻomohala ʻoe i kahi ʻū maloʻo hou
- ʻike ʻoe i nā hōʻailona B
He mea nui e hoʻomaopopo i ka nui o nā hōʻailona a me nā hōʻailona o DLBCL hiki ke pili i nā kumu ʻē aʻe ma mua o ka maʻi kanesa. No ka laʻana, hiki nō hoʻi i ka pehu nā kōpili lymph inā loaʻa iā ʻoe kahi maʻi. ʻO ka maʻamau naʻe, inā loaʻa iā ʻoe kahi maʻi, e hoʻomaikaʻi nā hōʻailona a hoʻi hou nā lymph nodes i ka nui maʻamau i loko o kekahi mau pule.
Me ka lymphoma, ʻaʻole e pau kēia mau hōʻailona. Hiki paha iā lākou ke ʻoi aku ka ʻino.
Pehea e ʻike ʻia ai ʻo Diffuse Large B-cell Lymphoma (DLBCL).
Hiki ke paʻakikī ka ʻike ʻana i ka DLBCL i kekahi manawa a hiki ke lawe i kekahi mau pule.
Inā manaʻo kāu kauka e loaʻa iā ʻoe ka lymphoma, pono lākou e hoʻonohonoho i nā hoʻokolohua koʻikoʻi. Pono kēia mau ho'āʻo e hōʻoia a hoʻopau paha i ka lymphoma ke kumu o kāu mau hōʻailona. No ka mea he nui nā ʻano subtypes o DLBCL, loaʻa paha iā ʻoe nā hoʻāʻo hou e ʻike ai i kāu mea. He mea koʻikoʻi kēia no ka mea ʻokoʻa ka hoʻokele a me ka mālama ʻana i kāu subtype me nā ʻano subtype ʻē aʻe o DLBCL.
ʻO Biopsy
No ka ʻike ʻana i ka DLBCL pono ʻoe i kahi biopsy. ʻO ka biopsy kahi hana e wehe ai i kahi ʻāpana, a i ʻole nā poʻo lymph i hoʻopilikia ʻia a/ a i ʻole kahi laʻana o ka iwi iwi. A laila nānā ʻia ka biopsy e nā ʻepekema i loko o kahi keʻena hana e ʻike inā he mau loli e kōkua i ke kauka e hōʻoia i ka DLBCL.
Ke loaʻa iā ʻoe kahi biopsy, loaʻa paha iā ʻoe kahi maʻi anesthetic kūloko a i ʻole maʻamau. E pili ana kēia i ke ʻano o ka biopsy a me kahi ʻāpana o kou kino i lawe ʻia mai. Aia nā ʻano biopsies like ʻole a pono paha ʻoe i ʻoi aku ma mua o hoʻokahi no ka loaʻa ʻana o ka laʻana maikaʻi loa.
Biopsy kumu a i ʻole ka nila maikaʻi
Lawe ʻia nā biopsies koʻikoʻi a i ʻole ka nila maikaʻi no ka wehe ʻana i kahi laʻana o ka puʻupuʻu lymph pehu a i ʻole ka tumo e nānā i nā hōʻailona o DLBCL.
Hoʻohana maʻamau kāu kauka i kahi anesthetic kūloko e hoʻopau i ka wahi i ʻole ʻoe e ʻeha i ka wā o ke kaʻina hana, akā e ala ʻoe i kēia biopsy. A laila e hoʻokomo lākou i kahi nila i loko o ka ʻōpū lymph pehu a i ʻole ka puʻupuʻu a wehe i kahi laʻana o ka ʻiʻo.
Inā hohonu i loko o kou kino ka pehu lymph node a puʻupuʻu paha, hiki ke hana ʻia ka biopsy me ke kōkua o ke ultrasound a i ʻole ke alakaʻi x-ray (kiʻi).
Loaʻa paha iā ʻoe kahi maʻi anesthetic maʻamau no kēia (kahi e hiamoe ai ʻoe no kahi manawa liʻiliʻi). Loaʻa paha iā ʻoe kekahi mau humuhumu ma hope.
ʻOi aku ka nui o nā biopsies o ka nila ma mua o ka biopsy nila.
ʻO ka biopsy node excision
Hana ʻia nā biopsies node excisional inā hohonu loa kou ʻōpū lymph a i ʻole ka ʻōpū i loko o kou kino a hiki ʻole ke loaʻa ʻia e kahi biopsy kumu a i ʻole ka nila. Loaʻa iā ʻoe kahi maʻi maʻi maʻi maʻi e hoʻomoe iā ʻoe no kahi manawa liʻiliʻi i noho mālie ʻoe, ʻaʻohe ʻeha.
I loko o kēia kaʻina hana, e hoʻoneʻe ke kauka lapaʻau i ka puʻupuʻu lymph holoʻokoʻa a hoʻouna ʻia i ka pathology no ka hoʻāʻo.
E loaʻa iā ʻoe kahi ʻeha liʻiliʻi me nā humuhumu liʻiliʻi, a me kahi ʻaʻahu ma luna.
Noho mau nā humuhumu no 7-10 mau lā, akā na kāu kauka a kahu hānai paha e aʻo iā ʻoe i ke ʻano o ka mālama ʻana i ka lole, a me ka manawa e hoʻi ai e wehe i nā humuhumu.
Nā ho'āʻo koko
Lawe ʻia nā hoʻāʻo koko i ka wā e hoʻāʻo ai e hōʻoia i kāu lymphoma, akā i loko o kāu mālama ʻana e hōʻoia i ka hana pono ʻana o kāu mau kino a hiki ke hoʻokō i kā mākou lapaʻau.
Results
Ke loaʻa i kāu kauka nā hopena mai nā hoʻāʻo koko a me nā biopsies e hiki iā lākou ke haʻi iā ʻoe inā loaʻa iā ʻoe ka DLBCL a hiki iā ʻoe ke haʻi iā ʻoe i ke ʻano subtype o DLBCL iā ʻoe. A laila makemake lākou e hana i nā hoʻokolohua hou aʻe i ka pae a me ka helu ʻana i kāu DLBCL
ʻO ka hoʻonohonoho ʻana a me ka helu ʻana i ka Diffuse Large B-cell Lymphoma (DLBCL)
Ke ʻike ʻia ʻoe me DLBCL, e nīnau hou kāu kauka e pili ana i kāu lymphoma. E komo pū ana kēia mau mea:
- He aha kāu lymphoma?
- He aha kāu lymphoma?
- He aha kāu ʻano subtype o DLBCL?
Kaomi ma nā poʻomanaʻo ma lalo nei e aʻo hou e pili ana i ka hoʻonohonoho ʻana a me ka hoʻopaʻa ʻana.
ʻO ka hoʻokūkū e pili ana i ka nui o kou kino i hoʻopilikia ʻia e kāu lymphoma - a i ʻole ka lōʻihi o ka laha ʻana mai kahi i hoʻomaka mua ai.
Hiki i nā pūnae B ke hele i kekahi wahi o kou kino. 'O ia ho'i, hiki i nā pūnaewele lymphoma (nā ma'i 'a'ai B-cell), hiki ke hele i kekahi wahi o kou kino. Pono ʻoe e hoʻāʻo hou aʻe e ʻike i kēia ʻike. Kapa ʻia kēia mau hoʻokolohua he staging tests a ke loaʻa iā ʻoe nā hopena, e ʻike ʻoe inā loaʻa iā ʻoe ka pae ʻekahi (I), pae ʻelua (II), pae ʻekolu (III) a i ʻole ka pae ʻehā (IV) DLBCL.
E pili ana kāu pae o DLBCL ma:
- ʻEhia mau wahi o kou kino i loaʻa i ka lymphoma
- Ma kahi e komo ai ka lymphoma inā aia ma luna, ma lalo a ma nā ʻaoʻao ʻelua o kāu diaphragm (he ʻiʻo nui, ʻano dome ma lalo o kou iwi iwi ʻaoʻao e hoʻokaʻawale i kou umauma mai kou ʻōpū)
- Inā ua laha ka lymphoma i kou iwi iwi a i ʻole nā mea ʻē aʻe e like me kou ake, akemāmā, ʻili a iwi paha.
Kapa ʻia nā pae I a me II 'o ka pae mua a i ʻole ka palena palena' (e pili ana i kahi ʻāpana o kou kino).
Ua kapa ʻia nā pae III a me IV he 'pae holomua' (ʻoi aku ka laulā).
Hana 1 | Hoʻopili ʻia hoʻokahi wahi puʻupuʻu lymph, ma luna a ma lalo paha o ka diaphragm*. |
Hana 2 | Hoʻopili ʻia ʻelua a ʻoi aʻe paha nā ʻāpana lymph node ma ka ʻaoʻao hoʻokahi o ka diaphragm*. |
Hana 3 | Hoʻokahi liʻiliʻi liʻiliʻi o ka lymph node ma luna a ma ka liʻiliʻi hoʻokahi wahi lymph node ma lalo o ka diaphragm* e pili ana. |
Hana 4 | Aia ka Lymphoma i loko o nā pūnana lymph he nui a ua laha i nā wahi ʻē aʻe o ke kino (e laʻa i nā iwi, nā māmā, nā ate). |
ʻO ka ʻike hoʻokūkū keu
Hiki i kāu kauka ke kamaʻilio e pili ana i kāu pae ma ka hoʻohana ʻana i kahi leka, e like me A,B, E, X a i ʻole S. Hāʻawi kēia mau leka i ka ʻike hou aku e pili ana i nā hōʻailona āu i loaʻa ai a i ʻole ka hopena o kou kino e ka lymphoma. Kōkua kēia ʻike a pau i kāu kauka e ʻimi i ka hoʻolālā lapaʻau maikaʻi loa no ʻoe.
palapala | Meaning | nui |
A a i ʻole B |
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E & X |
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S |
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(ʻO kou spleen he ʻōkana i loko o kāu ʻōnaehana lymphatic e kānana a hoʻomaʻemaʻe i kou koko, a he wahi ia e hoʻomaha ai kou mau cell B a hana i nā antibodies) |
Nā hoʻāʻo no ke kahua
No ka ʻike ʻana i ka pae āu e loaʻa ai, e noi ʻia paha ʻoe e loaʻa i kekahi o kēia mau hoʻokolohua staging:
Ka pākuʻina o ka tomography (CT)
Lawe kēia mau kiʻi i nā kiʻi o loko o kou umauma, ka ʻōpū a i ʻole ke pelvis. Hāʻawi lākou i nā kiʻi kikoʻī e hāʻawi i ka ʻike hou aku ma mua o kahi X-ray maʻamau.
ʻO ka ʻōmole helu Positron emoate (PET)
He scan kēia e kiʻi i nā kiʻi o loko o kou kino holoʻokoʻa. E hāʻawi ʻia ʻoe i kahi lāʻau lapaʻau e hoʻopaʻa ʻia ai nā cell cancerous - e like me nā cell lymphoma. ʻO ka lāʻau lapaʻau e kōkua ana i ka PET scan e ʻike i kahi o ka lymphoma a me ka nui a me ke ʻano ma ke kuhikuhi ʻana i nā wahi me nā cell lymphoma. Ua kapa ʻia kēia mau wahi he "wela".
Pahu lumbar
ʻO ka ʻoki ʻana i ka lumbar kahi hana e nānā ai inā loaʻa iā ʻoe kahi lymphoma i loko o kou ʻōnaehana ʻōnaehana waena (CNS), e pili ana i kou lolo, spinal cord a me kahi wahi a puni kou mau maka. Pono ʻoe e noho mālie i ka wā o ke kaʻina hana, no laila e loaʻa i nā pēpē a me nā keiki ka maʻi maʻi maʻamau e hoʻomoe iā lākou no kekahi manawa liʻiliʻi ke pau ke kaʻina hana. Pono ka hapa nui o ka poʻe mākua i kahi anesthetic kūloko no ke kaʻina hana e hoʻopau ai i ka wahi.
Na kāu kauka e hoʻokomo i ka nila ma kou kua, a e lawe i kahi wai liʻiliʻi i kapa ʻia ʻo "ka wai o ke kuamoʻo o ka lolo” (CSF) mai a puni kou iwi kuamoʻo. ʻO ka CSF kahi wai e hana like me ka mea hoʻopuʻi i kou CNS. Lawe pū ia i nā protein like ʻole a me nā maʻi e hakakā ana i nā cell immune e like me nā lymphocytes e pale i kou lolo a me ke kuamoʻo. Hiki nō hoʻi iā CSF ke kōkua i ka hoʻokahe ʻana i kekahi wai ʻē aʻe i loaʻa iā ʻoe i loko o kou lolo a i ʻole a puni kou iwi kuamoʻo e pale ai i ka pehu ʻana ma ia mau wahi.
A laila e hoʻouna ʻia ka laʻana CSF i ka pathology a nānā ʻia no nā hōʻailona o ka lymphoma.
Biopsy iwi ʻōiwi
- ʻO ka aspirate iwi iwi (BMA): lawe ʻia kēia hoʻāʻo ʻana i kahi wahi liʻiliʻi o ka wai i loaʻa ma ka hakahaka o ka iwi.
- ʻO ka iwi aspirate trepine (BMAT): lawe kēia ho'āʻo i kahi laʻana liʻiliʻi o ka ʻiʻo iwi iwi.
Hoʻouna ʻia nā laʻana i ka pathology kahi e nānā ʻia ai nā hōʻailona o ka lymphoma.
Hiki ke ʻokoʻa ke kaʻina hana no nā biopsies iwi iwi ma muli o kahi āu e mālama ai, akā e hoʻokomo pinepine ʻia kahi anesthetic kūloko e hoʻopau i ka wahi.
Ma kekahi mau haukapila, hiki ke hāʻawi ʻia iā ʻoe i ka hoʻomaha māmā e kōkua iā ʻoe e hoʻomaha a hiki ke kāpae iā ʻoe mai ka hoʻomanaʻo ʻana i ke kaʻina hana. ʻAʻole pono ka nui o ka poʻe i kēia a loaʻa paha i kahi "whistle green" e omo ai. He lāʻau hōʻeha ʻeha ko loko o kēia puʻupuʻu ʻōmaʻomaʻo (i kapa ʻia ʻo Penthrox a i ʻole methoxyflurane), āu e hoʻohana ai e like me ka mea e pono ai i ke kaʻina hana.
E hōʻoia ʻoe e nīnau i kāu kauka i nā mea i loaʻa e hōʻoluʻolu iā ʻoe i ka wā o ke kaʻina hana, a e kamaʻilio pū me lākou e pili ana i kou manaʻo he koho maikaʻi loa ia no ʻoe.
Hiki ke loaʻa ka ʻike hou aku e pili ana i nā biopsies iwi ma kā mākou ʻaoʻao pūnaewele ma aneʻi.
He ʻokoʻa ka ulu ʻana o kāu mau sela lymphoma, a ʻokoʻa ka nānā ʻana i nā cell maʻamau. ʻO ka pae o kāu lymphoma ka wikiwiki o ka ulu ʻana o kāu mau sela lymphoma, e pili ana i ka nānā ʻana ma lalo o kahi microscope. ʻO nā papa he 1-4 (haʻahaʻa, waena, kiʻekiʻe). Inā loaʻa iā ʻoe kahi lymphoma papa kiʻekiʻe, ʻokoʻa loa ke ʻano o kāu mau pūnaewele lymphoma mai nā pūnaewele maʻamau, no ka mea ke ulu wikiwiki nei lākou e ulu pono. Aia ma lalo kahi ʻike o nā māka.
- G1 - papa haʻahaʻa - ke nānā aku nei kāu mau cell i kahi maʻamau, a ulu lākou a pālahalaha mālie.
- G2 – papa waena – ke hoʻomaka nei kāu mau cell e nānā ʻokoʻa akā aia kekahi mau cell maʻamau, a ulu a laha lākou ma kahi wikiwiki.
- G3 – papa kiʻekiʻe – ʻokoʻa ke ʻano o kāu mau cell me kekahi mau cell maʻamau, a ulu lākou a pālahalaha wikiwiki.
- G4 - papa kiʻekiʻe - ʻokoʻa loa kāu mau cell i ka mea maʻamau, a ulu a palahalaha loa lākou.
Hoʻohui kēia ʻike āpau i ke kiʻi holoʻokoʻa a kāu kauka i kūkulu ai e kōkua i ka hoʻoholo ʻana i ke ʻano o ka lāʻau lapaʻau maikaʻi loa no ʻoe.
He mea nui e kamaʻilio me kāu kauka e pili ana i kāu mau mea pilikia ponoʻī i hiki iā ʻoe ke ʻike maopopo i ka mea e manaʻo ai mai kāu mau lapaʻau.
Nā ʻano liʻiliʻi o ka Diffuse Large B-cell Lymphoma (DLBCL)
Nui nā ʻano subtypes o DLBCL. Ua kapa ʻia nā ʻano subtype ʻelua ma muli o ke kelepona kikoʻī i hoʻomaka ai kāu lymphoma e ulu mai. ʻO ka mea maʻamau ʻo "Activated B-cell (ABC)", me ka hapalua o nā maʻi āpau me DLBCL i loaʻa kēia subtype. ʻO ka subtype nui ʻē aʻe o DLBCL ʻo "Germinal Cell B-cell (GCB)", me kahi 3 i kēlā me kēia 10 poʻe me DLBCL i loaʻa kēia subtype.
Hiki i kāu kauka ke haʻi inā loaʻa iā ʻoe ka subtype GCB a i ʻole ABC ma ka nānā ʻana i kāu mau lymphoma cell i ka maʻi maʻi. He ʻokoʻa ke ʻano o nā ʻano subtype ʻelua ma o ka loaʻa ʻana o nā protein ʻokoʻa ma ka ʻili o nā cell, a me nā hoʻololi genetic ʻokoʻa.
Ke ʻike kāu kauka a me kāu hui lapaʻau inā loaʻa iā ʻoe ka GCB a i ʻole ABC, hiki iā lākou ke hana i nā hoʻokolohua cytogenetic hou aʻe ma kāu mau sela lymphoma. Ke nānā nei kēia mau ho'āʻo ʻana no nā hoʻololi ʻē aʻe o kāu mau chromosomes a me nā genes (i kapa ʻia ʻo rearrangements). Hiki iā ʻoe ke ʻike i ka ʻike hou aku e pili ana i kēia ma lalo o kēia ʻaoʻao ma lalo o ke poʻomanaʻo "E hoʻomaopopo i kāu genetics lymphoma".
Hiki ke kapa ʻia ʻo DLBCL nodal a extra-nodal. ʻO ka Nodal ka mea i hoʻomaka i loko o kāu lymph nodes, akā ʻo ka extra-nodal ʻo ia ka mea i hoʻomaka ma waho o kāu ʻōnaehana lymphatic. ʻO kekahi mau wahi nodal ʻē aʻe e hiki ai i ka DLBCL ke hoʻomaka e komo pū me kou ʻili, nā ū, nā testicles, ate, akemāmā, iwi, lolo, ʻōpū a i ʻole ʻōpū.
E kaomi i nā hae ma lalo inā makemake ʻoe e aʻo hou e pili ana i nā ʻano subtype ʻē aʻe o DLBCL e hana ana i ke koena o nā hihia.
ʻO ka lymphoma B-cell mediastinal mua (PMBCL) he ʻano ʻano ʻino (wikiwiki) ʻo ka Lymphoma non-Hodgkin Lymphoma. Ua hoʻokaʻawale ʻia ʻo ia ma ke ʻano he sub-type o DLBCL, akā ua hōʻano hou ʻia e ka World Health Organization ma ke ʻano he subtype nona iho.
No ka ʻike hou aku e pili ana i ka PMBCL, e ʻoluʻolu e ʻike i kā mākou Primary Mediastinal B - cell lymphoma (PMBCL) ʻaoʻao pūnaewele ma aneʻi, aiʻole kā mākou pepa ʻike ma aneʻi.
T-cell/histiocyte waiwai B-cell lymphoma (T/HRBCL) he subtype kakaikahi o DLBCL hiki ke paʻakikī loa i kāu kauka ke ʻike. He paʻakikī ke ʻike ʻana no ka mea ua like ia me nā ʻano ʻano ʻelua ʻē aʻe o lymphoma. No kēia kumu, hiki i kekahi poʻe me T/HRBCL ke loaʻa i kahi hōʻailona hewa o ka lymphoma o Hodgkin a i ʻole lymphoma T-cell peripheral, ma mua o ka loaʻa ʻana o ka hōʻailona kūpono. Pono ʻoe i kekahi mau hoʻokolohua kūikawā e ʻike ai i ka T/HRBCL i kapa ʻia nā hoʻokolohua immunohistochemistry. He ho'āʻo kūikawā kēia ma kāu biopsies i hiki i kāu kauka ke aʻo hou aku e pili ana i kāu lymphoma.
ʻO nā pūnaewele T kekahi ʻano o ka pūnaewele lymphocyte e kōkua i kāu ʻōnaehana pale e hoʻomanaʻo i nā maʻi i loaʻa iā ʻoe ma mua. Kōkua lākou i ka hoʻopaʻa ʻana i kāu ʻōnaehana pale i ʻole e hana paʻakikī loa, a kākoʻo pū kekahi i nā cell ʻē aʻe o kāu ʻōnaehana pale e hana pono. ʻO nā histiocytes kekahi ʻano a i ʻole cell immune i kapa ʻia he phagocyte. Kōkua nā Phagocytes e pale aku iā ʻoe mai ka maʻi a me ka maʻi no ka mea ʻike lākou i nā sela ʻino a ʻai iā lākou.
Inā loaʻa iā ʻoe ka T/HRBCL – he nui loa kāu mau pūnaewele T a me nā histiocytes (ʻo ia ke kumu i kapa ʻia ai ʻo "waiwai" - T/HR) me ka loaʻa ʻana o nā lymphocytes B-cell cancerous (BCL).
ʻO ka lāʻau lapaʻau maʻamau no T/HRBCL ua like ia me ka hapa nui o nā ʻano subtypes o ka diffuse large B-cell lymphoma (DLBCL), i kūkākūkā ʻia ma hope ma kēia ʻaoʻao pūnaewele.
ʻAʻole i kuhikuhi ʻia ʻo DLBCL maikaʻi EBV he subtype o DLBCL hiki ke loaʻa i ka poʻe ʻōpio, akā pili pinepine i ka poʻe ma mua o 50 mau makahiki. Loaʻa ia i kekahi poʻe i loaʻa i ka maʻi maʻi i kapa ʻia ʻo Epstein-Barr virus (EBV), e pili ana i nā pūnaewele B. ʻO ka EBV ke kumu o ka maʻi kuni (i kapa ʻia ʻo "mono" a i ʻole ka maʻi honi). Eia naʻe, he liʻiliʻi wale nō ka poʻe i loaʻa iā EBV e hoʻomohala i ka DLBCL maikaʻi EBV. ʻO ka mea pōʻino, ʻaʻohe ala e ʻike ai i ka mea nāna e hoʻomohala i kēia lymphoma ma hope o ka maʻi me EBV.
E pili ana nā hōʻailona ma kahi e ulu ai kāu lymphoma. Hoʻomaka maʻamau ia i loko o kāu mau lymph nodes (i kapa ʻia ʻo lymphoma nodal) hiki ke hoʻoulu i kahi puʻupuʻu hou. Aia kēia ma kou ʻāʻī, ka ʻāʻī, ka ʻāʻī a i ʻole ka ʻōpū, akā hiki ma nā wahi āpau o kou kino.
ʻO nā wahi ʻē aʻe e ulu ai a ua like nā hōʻailona e pili ana iā ia me nā mea i helu ʻia ma luna ma ka papa ʻekahi.
ʻO ka hoʻomaʻamaʻa maʻamau no ka lymphoma B-cell nui intravascular e like me ka hapa nui o nā subtypes o diffuse large B-cell lymphoma (DLBCL), i kūkākūkā ʻia ma hope ma kēia ʻaoʻao pūnaewele.
ALK-maikaʻi nui B-cell lymphoma he subtype kakaikahi loa o DLBCL. Hiki iā ia ke pili i nā kānaka o kēlā me kēia makahiki a ʻoi aku ka maʻamau i nā kāne. Loaʻa i nā pūnaewele lymphoma kahi hoʻololi gene e hana ai i kahi protein ma ka ʻili o kā lākou B-Lymphocyte cell i kapa ʻia ʻo 'anaplastic large-cell kinase' (ALK).
ʻO ka hapa nui o nā subtypes o DLBCL he pūmua ma nā pūnaewele lymphoma i kapa ʻia ʻo CD20. Eia nō naʻe, ʻaʻole loaʻa i nā lymphoma B-cell nui maikaʻi ka CD20 protein. No kēia kumu, ʻokoʻa iki ka mālama ʻana mai nā ʻano subtype DLBCL ʻē aʻe. ʻOiai e like ana ka hapa nui o nā lāʻau lapaʻau, inā loaʻa iā ʻoe kēia subtype, ʻo ʻoe ʻaʻole e loaʻa he lāʻau antibody monoclonal i kapa ʻia ʻo rituximab. Hoʻohana wale ʻo Rituximab i ka wā e loaʻa ai ka CD20 ma nā cell lymphoma. No laila, inā ʻoe e noʻonoʻo nei no ke aha ʻoe e loaʻa ʻole ai i nā lāʻau lapaʻau hou e loaʻa ana i nā maʻi ʻē aʻe… ʻo ia paha ke kumu.
Hoʻomaka maʻamau ka lymphoma B-cell nui maikaʻi i loko o kāu mau lymph nodes, no laila ʻo kahi hōʻailona maʻamau āu e ʻike ai ʻo ka pehu o nā lymph nodes.
Eia naʻe, hiki ke hoʻomaka ma nā wahi ma waho o kāu ʻōnaehana lymphatic, me kāu:
- elelo
- nasopharynx (ka wahi ma hope o kou ihu a me kou waha)
- nā ovaries
- ate
- nā ū
- iwi
- 'ōpū
- lolo a wahi epidural paha (kahi e hoʻopuni ana i kou iwi kuamoʻo)
E pili ana kāu mau hōʻailona i kahi e ulu ai ka lymphoma.
ʻO ka lymphoma B-cell nui intravascular he ʻano laha ʻole o ka *extra-nodal DLBCL. Hoʻopilikia nui ia i nā poʻe ʻelemakule ma waena o 50-70 mau makahiki. Loaʻa kēia subtype i nā kāne a me nā wahine. Loaʻa nā pūnaewele lymphoma i loko o ka uhi o loko o kāu mau kīʻaha koko liʻiliʻi. Kapa ʻia kēia mau aʻa koko liʻiliʻi he capillaries.
ʻAʻole hiki ke hoʻonui pinepine ʻia ka lymphoma B-cell nui intravascular. Hiki ke hoʻopilikia i nā kīʻaha koko liʻiliʻi ma kou ʻili a i ʻole kou lolo. Loaʻa paha iā ʻoe nā hōʻailona o ke ʻano o ke kikowaena kikowaena (CNS). Aia kou lolo a me ka iwi kuamoʻo i kāu ʻōnaehana nerve waena, no laila e komo pū nā hōʻailona āu e ʻike ai:
- hilahila
- ka hopu
- pōniuniu
- nawaliwali
ʻO nā hōʻailona ʻē aʻe āu e ʻike ai i kahi kikoʻī i kāu subtype penei:
- ʻulaʻula a puʻupuʻu paha ma kou ʻili
- he akepaʻa i hoʻonui ʻia a / a i ʻole ka spleen
Hoʻohui ʻia kēia mau hōʻailona me nā hōʻailona lymphoma maʻamau i helu ʻia ma luna.
ʻO ka hoʻomaʻamaʻa maʻamau no ka lymphoma B-cell nui intravascular e like me ka hapa nui o nā subtypes o diffuse large B-cell lymphoma (DLBCL), i kūkākūkā ʻia ma hope ma kēia ʻaoʻao pūnaewele.
* ʻO ka extra-nodal, ʻo ia hoʻi, ua hoʻomohala ʻia kāu lymphoma ma waho o kāu mau lymph nodes.
ʻO Lymphoma Pūnaewele Nervous Pilikia Mua (PCNSL) he subtype kakaikahi o DLBCL i manaʻo ʻia he koʻikoʻi no ka ulu wikiwiki ʻana. He mea maʻamau ia i nā poʻe ma waena o 50 a me 60 mau makahiki, akā hiki ke loaʻa i kēlā me kēia makahiki.
Inā loaʻa iā ʻoe ka PCNSL, ua hoʻomaka paha kāu lymphoma i loko o kāu ʻōnaehana nūnū waena, ʻo ia hoʻi kou lolo a me ke kuamoʻo.
Ma mua o 9 o 10 poʻe i loaʻa iā PCNSL, ulu ka lymphoma i loko o ka lolo, spinal cord, eye or leptomeninges (nā ʻāpana ʻelua i loko e hoʻopuni ana i ka lolo a me ke kuamoʻo).
Aia ka pūnaewele maʻamau i ka lolo.
Inā ua hoʻomaka mua kou lymphoma ma nā wahi ʻē aʻe o kou kino a laila ma kekahi manawa ua laha i ka lolo a i ʻole ke kuamoʻo, ua kapa ʻia ʻo 'tuarua' CNS lymphoma (SCNSL).
ʻOkoʻa ka mālama ʻana a me ka hoʻokele ʻana o PCNSL mai nā ʻano subtype ʻē aʻe o DLBCL no ka mea ʻaʻole hiki i nā lāʻau lapaʻau maʻamau ke hiki i kou lolo a me ke kuamoʻo. Hiki iā ʻoe ke heluhelu hou aʻe e pili ana i nā lāʻau lapaʻau no PCNSL ma hope aku ma ka ʻaoʻao pūnaewele ma lalo o ke poʻo.
ʻili (ili) B-cell lymphoma He ʻano liʻiliʻi o DLBCL e ulu ana mai nā pūnae B i kou ʻili. Ma lalo o 1 o 100 poʻe me NHL e ʻike ʻia me kēia subtype.
No kāu kauka e ʻike iā ʻoe me kēia subtype, pono ka lymphoma e hoʻopilikia wale i kou ʻili.
Ma muli o ka hoʻomaka ʻana o kēia lymphoma i kou ʻili, ʻo nā hōʻailona nui āu e ʻike ai he puʻupuʻu, ʻāʻī a i ʻole ka ʻūhā ma nā wahi āpau o kou ʻili.
No ka mālama ʻokoʻa ʻana o nā lymphomas B-cell ʻokoʻa i nā subtypes DLBCL ʻē aʻe, ua hoʻolaʻa mākou i kahi ʻaoʻao pūnaewele ʻē aʻe i kēia mau subtypes.
Hiki iā ʻoe ke ʻike i ka ʻike kikoʻī hou aku e pili ana i ka lymphoma B-cell cutaneous ma aneʻi.
E ʻoluʻolu, inā ua ʻike ʻia ʻoe me kekahi ʻano subtype o DLBCL a ua laha i kou ʻili, pono ʻoe e hoʻomau i ka nānā ʻana i ka ʻike ma kēlā subtype mua. Inā ua laha ka lymphoma i kou ʻili ma hope o ka hoʻomaka ʻana i kahi ʻē aʻe, ua manaʻo ʻia he lymphoma cutaneous lua. ʻOkoʻa ka mālama ʻana i nā lymphoma ʻili mua a me ka lua.
Eia hou, inā loaʻa iā ʻoe ka lymphoma T-cell cutaneous, ʻokoʻa hou kēia.
Hiki iā ʻoe ke ʻike i ka ʻike hou aku e pili ana i ka lymphoma T-cell cutaneous ma aneʻi.
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 DLBCL, ʻokoʻa iki ke ʻano o 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.
Inā loaʻa kahi hoʻololi (ʻokoʻa) i kēia mau chromosomes a i ʻole nā genes, ʻaʻole e holo pono kāu mau protein a me nā cell.
Hiki i nā Lymphocytes ke lilo i mau pūnaewele lymphoma ma muli o nā hoʻololi genetic (i kapa ʻia nā hoʻololi ʻana a i ʻole nā ʻano like ʻole) i loko o nā pūnaewele. Hiki ke nānā ʻia kāu biopsy lymphoma e ke kauka lapaʻau kūikawā e ʻike inā loaʻa iā ʻoe nā hoʻololi gene.
Nā hoʻololi ʻelua Hit a me Triple Hit ma DLBCL
Hiki i kekahi poʻe me DLBCL ke hoʻololi i 2 a i ʻole 3 mau genes kikoʻī e ʻoi aku ka ikaika o ka lymphoma ma mua o DLBCL me ka ʻole o nā hoʻololi. Kapa ʻia kēia mau hoʻololi hou ʻana. Hoʻokomo mau ʻia nā genes i kahi gene i kapa ʻia ʻo MYC, a me kahi gene i kapa ʻia ʻo BCL2 a / a i ʻole BCL6.
Mea hoʻolaha pālua
I kekahi mau hihia, ʻaʻole paha ʻoe i hoʻonohonoho hou i kāu mau genes, akā hiki ke hōʻike ʻia nā protein i ka mana o nā genes ma kāu mau pūnaewele lymphoma. ʻO ia ke ʻano he nui loa kāu mau protein MYC a i ʻole BCL ma kāu mau cell, kahi e paʻakikī iki ai ka mālama ʻana.
Hoʻonohonoho hou a me ka ʻōlelo protein ma Double & Triple Hit, a me Double Expressor Lymphomas |
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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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ʻO nā genes MYC a me BCL maʻamau e kōkua i ka hana ʻana i nā protein e pono ai kāu mau cell e ulu a ulu pono. Inā loaʻa iā ʻoe kahi hoʻonohonoho hou ʻana i kēia mau genes, ʻaʻole hiki i ka protein ke kākoʻo i ka ulu olakino olakino a hiki ke ulu ka lymphoma. Ua kapa ʻia ʻo DLBCL me kēia mau hoʻonohonoho hou ʻana a i ʻole double hit lymphoma (DHL) a i ʻole triple hit lymphoma (THL). Ua kapa ʻia lākou i kekahi manawa he kiʻekiʻe B-cell lymphoma (HGBL).
ʻO ka hoʻāʻo ʻana no ka hoʻololi ʻana
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 ma kāu mau laʻana biopsy.
Eia naʻe, ʻaʻole i uhi ʻia kēia hoʻāʻo ʻana e ka papahana pōmaikaʻi Medicare no laila e hana pinepine ʻia me ke kumu kūʻai hou aku i nā maʻi, ʻo ia hoʻi, pono ʻoe e uku no nā hōʻike. Hiki ke pipiʻi, a ʻokoʻa ke kumukūʻai ma muli o kahi āu e hana ai. ʻO ka manawa pinepine, ʻaʻole e loli ka lāʻau, akā i kekahi mau hihia. Inā loli ka lāʻau inā loaʻa iā ʻoe kēia mau ʻokoʻa, a laila hiki iā ʻoe ke noʻonoʻo e hoʻokō i ka hoʻāʻo, a makemake paha ʻoe e ʻike no ka hoihoi.
Inā koho ʻoe ʻaʻole e loaʻa ka hoʻāʻo e loaʻa iā ʻoe ka mālama maikaʻi a me nā koho lapaʻau.
Loaʻa nā hoʻololi ʻē aʻe ma DLBCL
ʻO kahi hoʻololi ʻē aʻe i hiki ke loaʻa ma DLBCL ʻo "double expressor". He okoa keia pāpālua i ka DLBCL no ka mea ma kahi o ka hoʻonohonoho hou ʻana o nā genes, aia nā genes ma kahi kūpono akā ua hōʻike nui ʻia, ʻo ia hoʻi he nui loa o nā genes ʻelua.
He mea nui nō hoʻi i kāu kauka ke ʻike i nā proteins (a i ʻole nā mea hoʻokipa) i kāu mau sela lymphoma. ʻOiai kemoHoʻohana ka lāʻau lapaʻau ma ka pepehi ʻana i nā cell ulu wikiwiki, hana nā lāʻau ʻē aʻe ma ka huli ʻana i kahi protein kikoʻī ma ka lymphoma cell.
No laila inā loaʻa iā ʻoe nā mea loaʻa kūikawā, hiki iā ʻoe ke loaʻa i ka chemotherapy a me kekahi o nā antibodies monoclonal i manaʻo ʻia. ʻo kahi laʻana:
- Inā loaʻa iā ʻoe ka protein i kapa ʻia CD20 ma kāu mau pūnaewele lymphoma, hiki iā ʻoe ke loaʻa i kahi lāʻau antibody monoclonal e kuhikuhi ana i ka CD20, e like me rituximab (Mabthera a i ʻole Rituxan), obinutuzumab a i ʻole ofatumumab. ʻO kahi lāʻau lapaʻau hou e pili ana i ka CD20, i loaʻa wale i nā hoʻokolohua lapaʻau ʻo mosunetuzumab.
- Inā loaʻa iā ʻoe kahi protein i kapa ʻia CD79b ma kāu mau pūnaewele lymphoma e loaʻa paha iā ʻoe kahi lāʻau lapaʻau e kuhikuhi ana i kēlā protein, i kapa ʻia ʻo polatuzumab vedotin.
E like me kāu e ʻike ai, ʻo ka hoʻomaopopo ʻana i kekahi o nā genetics o kāu lymphoma he mea nui e hoʻomaopopo i kāu mau koho lapaʻau. E ʻoluʻolu e noi mau i kāu kauka e wehewehe i kāu mau hopena iā ʻoe a pehea ka hopena o kēia mau hopena i kāu mau koho.
Lapaʻau no ka Diffuse large B-cell lymphoma (DLBCL)
I ka pau ʻana o kāu mau hopena mai ka biopsy, ka hoʻāʻo cytogenetic a me nā scan staging, e nānā ke kauka i kēia mau mea e hoʻoholo ai i ka lāʻau maikaʻi loa no ʻoe. Ma kekahi mau kikowaena maʻi 'aʻai, e hui pū ke kauka me kahi hui o nā loea e kūkākūkā i ke koho lapaʻau maikaʻi loa. Kapa ʻia kēia a hui multidisciplinary (MDT) hui.
E noʻonoʻo kāu kauka i nā kumu he nui e pili ana i kāu DLBCL. ʻO nā hoʻoholo i ka wā a inā pono ʻoe e hoʻomaka a ʻo ka lāʻau lapaʻau maikaʻi loa e pili ana i kāu:
- ka pae pākahi o ka lymphoma, nā hoʻololi genetic a me nā hōʻailona
- makahiki, ka moʻolelo lapaʻau i hala a me ke ola kino
- ka pono kino a me ka noʻonoʻo o kēia manawa a me nā makemake o ka maʻi.
Hiki ke kauoha ʻia nā hoʻāʻo hou aʻe ma mua o kou hoʻomaka ʻana i ka mālama ʻana i mea e hiki ai i kou puʻuwai, nā māmā a me nā puʻupaʻa ke hoʻokō i ka mālama ʻana. Hiki i kēia mau mea ke komo i ka ECG (electrocardiogram), ka hoʻāʻo ʻana o ka māmā a i ʻole ka hōʻiliʻili mimi 24-hola.
Hiki i kāu kauka a kahu maʻi maʻi ke wehewehe i kāu hoʻolālā lapaʻau a me nā hopena ʻaoʻao hiki iā ʻoe, a aia ma laila e pane i kāu nīnau. He mea nui e nīnau i kāu kauka a i ʻole kahu maʻi maʻi i nā nīnau e pili ana i kekahi mea āu i maopopo ʻole ai.
Hiki iā ʻoe ke kelepona a leka uila paha i ka Lymphoma Australia Nurse Helpline me kāu mau nīnau a hiki iā mākou ke kōkua iā ʻoe e loaʻa ka ʻike kūpono.
ʻO ka laina mālama kahu hānai Lymphoma:
Helu kelepona: 1800 953 081
Email: kahu@lymphoma.org.au
Nā nīnau e nīnau i kāu kauka ma mua o kou hoʻomaka ʻana i ka mālama ʻana no DLBCL
Hiki ke paʻakikī ke ʻike i nā nīnau e nīnau ai ke hoʻomaka ʻoe i ka mālama ʻana. Inā ʻaʻole ʻoe ʻike, ʻaʻole ʻoe i ʻike, pehea ʻoe e ʻike ai i ka mea e nīnau ai?
ʻO ka loaʻa ʻana o ka ʻike kūpono hiki ke kōkua iā ʻoe e hōʻoluʻolu a ʻike i ka mea e manaʻo ai. Hiki iā ia ke kōkua iā ʻoe e hoʻolālā i mua no kāu mea e pono ai.
Hoʻohui mākou i kahi papa inoa o nā nīnau āu e ʻike ai he kōkua. ʻOiaʻiʻo, kū hoʻokahi ke kūlana o kēlā me kēia kanaka, no laila ʻaʻole i uhi kēia mau nīnau i nā mea āpau, akā hāʻawi lākou i kahi hoʻomaka maikaʻi.
Kaomi ma ka loulou ma lalo nei e kiʻi i kahi PDF o nā nīnau no kāu kauka.
Nā ʻano o ka lāʻau anticancer no ka Diffuse large B-cell lymphoma (DLBCL)
Loaʻa nā lāʻau lapaʻau like ʻole no ka Diffuse Large B cell lymphoma a hiki ke ʻokoʻa ma muli o kāu subtype kikoʻī. ʻO ka lapaʻau maikaʻi loa no ʻoe e hilinaʻi ʻia ma nā kumu he nui e like me kāu:
- subtype o DLBCL
- pae a me ka helu o kāu DLBCL
- makahiki
- ʻo ke olakino
- nā lāʻau lapaʻau ʻē aʻe āu i loaʻa ai, no kāu DLBCL a i ʻole nā maʻi ʻē aʻe
- kou makemake i ka manawa i wehewehe ai kāu kauka i nā koho iā ʻoe.
Inā ua mālama ʻoe i kāu lymphoma i ka wā ma mua, e noʻonoʻo ana kāu kauka i ka maikaʻi o ka hana ʻana iā ʻoe, a me ka maikaʻi o nā hopena ʻaoʻao iā ʻoe. A laila hiki i kāu kauka ke hāʻawi i nā koho lapaʻau maikaʻi loa no ʻoe. Inā ʻaʻole ʻoe maopopo i ke kumu i hana ai ke kauka i nā hoʻoholo a lākou i hana ai, e ʻoluʻolu e nīnau iā lākou e wehewehe iā ʻoe - aia lākou e kōkua iā ʻoe.
Aia kekahi o nā ʻano lapaʻau like ʻole e hāʻawi ʻia iā ʻoe ma lalo nei. Kaomi ma nā poʻomanaʻo e aʻo hou e pili ana i ke ʻano lapaʻau āu e makemake ai.
Hāʻawi ʻia ka mālama kākoʻo i nā maʻi a me nā ʻohana e kū nei i ka maʻi koʻikoʻi. Hiki i ka mālama kākoʻo ke kōkua i ka poʻe maʻi i ka liʻiliʻi o nā hōʻailona, a ʻoi aku ka wikiwiki ma o ka hoʻolohe ʻana i kēlā mau ʻano o kā lākou mālama.
No kekahi o ʻoukou me DLBCL, hiki ke ulu aʻe ko ʻoukou mau maʻi leukemic me ka hiki ʻole ke hoʻopaʻa ʻia a hoʻonui i kou iwi iwi, kahe koko, lymph nodes, ate a i ʻole spleen. Ma muli o ka piha o ka iwi iwi me nā pūnaewele DLBCL ʻōpio ʻaʻole hiki ke hana pono, e hoʻopilikia ʻia kou mau koko maʻamau. Hiki ke hoʻokomo ʻia ka lāʻau kākoʻo i nā mea e like me kou hoʻololi ʻana i ke koko a i ʻole platelet ma kahi papa a i ʻole i loko o kahi hui infusion intravenous i ka haukapila. Loaʻa paha iā ʻoe nā lāʻau antibiotic e pale ai a mālama paha i nā maʻi.
Hiki ke komo i ke kūkākūkā me kahi hui mālama kūikawā a i ʻole ka mālama palliative. Hiki ke kamaʻilio e pili ana i ka mālama ʻana i ka wā e hiki mai ana, i kapa ʻia ʻo Advanced Care Planning. ʻO kēia mau mea he ʻāpana o ka hoʻokele multidisciplinary o lymphoma.
Hiki i ka mālama kākoʻo ke komo i ka mālama palliative e kōkua i ka hoʻomaikaʻi ʻana i kāu mau hōʻailona a me nā hopena ʻaoʻao, a me ka mālama hope o ke ola inā pono.
He mea nui e ʻike e hiki ke kāhea ʻia ka hui Palliative Care i kēlā me kēia manawa i kāu ala lapaʻau ʻaʻole wale ma ka hopena o ke ola. Hiki iā lākou ke kōkua i ka hoʻomalu a mālama i nā hōʻailona (e like me ka paʻakikī o ka mālama ʻana i ka ʻeha a me ka nausea) i loaʻa paha iā ʻoe ma muli o kou maʻi a i ʻole ka mālama ʻana.
Inā hoʻoholo ʻoe a me kāu kauka e hoʻohana i ka mālama kākoʻo a hoʻōki paha i ka mālama ʻana i kāu lymphoma, hiki ke hana ʻia nā mea he nui e kōkua iā ʻoe e noho olakino a ʻoluʻolu e like me ka hiki no kekahi manawa.
ʻO ka lāʻau lapaʻau he lāʻau lapaʻau maʻi maʻi e hoʻohana ana i nā kiʻekiʻe kiʻekiʻe o ka radiation e pepehi i nā cell lymphoma a e hōʻemi i nā ʻōpū. Ma mua o ka loaʻa ʻana o ka radiation, e loaʻa iā ʻoe kahi kau hoʻolālā. He mea koʻikoʻi kēia kau no ka poʻe lapaʻau lapaʻau e hoʻolālā pehea e hoʻopaʻa ai i ka radiation i ka lymphoma, a pale aku i ka hōʻino ʻana i nā cell olakino. ʻO ka lōʻihi o ka lāʻau lapaʻau ma waena o 2-4 mau pule. I kēia manawa, pono ʻoe e hele i ke kikowaena radiation i kēlā me kēia lā (Poakahi-Palima) no ka mālama ʻana.
*Inā lōʻihi kou noho ʻana mai ke kikowaena radiation a makemake ʻoe i ke kōkua me kahi e noho ai i ka wā mālama, e ʻoluʻolu e kamaʻilio me kāu kauka a kahu hānai paha e pili ana i ke kōkua i loaʻa iā ʻoe. Hiki iā ʻoe ke kelepona i ka Cancer Council a i ʻole Leukemia Foundation ma kou mokuʻāina a ʻike inā hiki iā lākou ke kōkua i kahi e noho ai.
Hiki iā ʻoe ke loaʻa i kēia mau lāʻau ma ke ʻano he papa a/a i ʻole e hāʻawi ʻia ma ke ʻano he kulu (infusion) i loko o kou aʻa (i loko o kou kahawai koko) ma ke keʻena maʻi maʻi a i ʻole ka haukapila. Hiki ke hui pū ʻia kekahi mau lāʻau chemo me kahi lāʻau immunotherapy. Hoʻopau ʻo Chemo i nā pūnaewele ulu wikiwiki a hiki ke hoʻopilikia i kekahi o kāu mau sela maikaʻi e ulu wikiwiki ana i nā hopena ʻaoʻao.
Loaʻa paha iā ʻoe kahi infusion MAB ma ke keʻena maʻi maʻi a i ʻole ka haukapila. Hoʻopili ʻo MAB i ka cell lymphoma a huki i nā maʻi ʻē aʻe e hakakā ana i nā keʻokeʻo keʻokeʻo a me nā protein i ka maʻi kanesa i hiki ai i kāu ʻōnaehana pale ke kaua i ka DLBCL.
E hana wale ana ʻo MABS inā loaʻa iā ʻoe nā protein a i ʻole nā māka kikoʻī ma kāu mau keena lymphoma. ʻO kahi māka maʻamau ma DLBCL he CD20. Inā loaʻa iā ʻoe kēia māka hiki iā ʻoe ke pōmaikaʻi mai ka mālama ʻana me kahi MAB.
He ʻano hou o ka monoclonal antibody (MAB) nā mea hoʻopaʻapaʻa hoʻopaʻa palekana (ICI) a hana ʻokoʻa iki i nā MABS ʻē aʻe.
Ke hana nei ka ICI i ka wā e hoʻomohala ai kāu mau pūnana maʻi "immune checkpoints" ma luna o lākou i ʻike pinepine ʻia ma kāu mau sela olakino. Hōʻike ka wahi hoʻopaʻa immuen i kāu ʻōnaehana pale ʻana i ke olakino a maʻamau ke kelepona, no laila haʻalele kāu ʻōnaehana pale.
Hana nā ICI ma ke kāohi ʻana i ka wahi hoʻopaʻa immune i hiki ʻole i kāu mau pūnaewele lymphoma ke hoʻohālike hou he ola olakino. ʻAe kēia i kāu ʻōnaehana pale e ʻike iā lākou he maʻi kanesa, a hoʻomaka i kahi hoʻouka kaua iā lākou.
Hoʻohui ʻia ka Chemotherapy me kahi MAB (no ka laʻana, rituximab).
Hiki iā ʻoe ke lawe i kēia mau mea ma ke ʻano he papa a infusion paha i loko o kou vein. Hiki ke lawe ʻia nā lāʻau lapaʻau waha ma ka home, ʻoiai e koi ana kekahi i kahi noho maʻi pōkole. Inā loaʻa iā ʻoe kahi infusion, hiki iā ʻoe ke loaʻa ia ma ka lā keʻena lapaʻau a i ʻole ma ka haukapila. Hoʻopili ʻia nā lāʻau lapaʻau i hoʻopaʻa ʻia i ka cell lymphoma a me nā hōʻailona poloka e pono ai e ulu a hoʻohua hou i nā cell. Hoʻopau kēia i ka ulu ʻana o ka maʻi ʻaʻai a make nā sela lymphoma.
Hana ʻia kahi pūnaʻi pū a i ʻole ka iwi iwi e hoʻololi i kou iwi iwi maʻi me nā pūnaewele hou e hiki ke ulu i loko o ke koko olakino hou. Hana ʻia ka hoʻololi ʻana o ka iwi iwi no nā keiki me DLBCL, aʻo ka hoʻololi ʻana o nā pūnaewele pū no nā keiki ʻelua.
I ka hoʻololi ʻana i ka iwi iwi, hoʻoneʻe pololei ʻia nā pūnaewele mai ka iwi o ka iwi, a e like me ka hoʻololi ʻana i ke ʻano o ke kino, ua wehe ʻia nā pū mai ke koko.
Hiki ke hoʻoneʻe ʻia nā pūnaewele mai kahi mea hāʻawi a hōʻiliʻili ʻia mai iā ʻoe ma hope o kou loaʻa ʻana i ka chemotherapy.
Inā loaʻa iā ʻoe nā pūnaewele kumu mai kahi mea hāʻawi, ua kapa ʻia ʻo ia he ka hoʻololi ʻana i ke ʻano o ke ʻano o ke ʻano allogeneic.
Inā hōʻiliʻili ʻia kāu mau pūnaewele ponoʻī, kapa ʻia ia he ka hoʻololi ʻana i ke ʻano o ke kino.
Hōʻiliʻili ʻia nā puʻupuʻu ma o ke kaʻina hana i kapa ʻia ʻo apheresis. E hoʻopili ʻia ʻoe (a i ʻole kāu mea hāʻawi) i kahi mīkini apheresis a e hoʻoneʻe ʻia kou koko, hoʻokaʻawale ʻia nā pūnaewele a hōʻiliʻili ʻia i loko o kahi ʻeke, a laila hoʻihoʻi ʻia ke koena o kou koko iā ʻoe.
Ma mua o ke kaʻina hana, e loaʻa iā ʻoe ka chemotherapy kiʻekiʻe a i ʻole ka radiotherapy kino holoʻokoʻa e pepehi i kāu mau sela lymphoma āpau. Eia nō naʻe, ʻo kēia lapaʻau kiʻekiʻe e hoʻopau i nā ʻāpana āpau o kou iwi iwi. No laila, e hoʻihoʻi ʻia nā pūnaʻi kumu i hōʻiliʻili ʻia iā ʻoe (hoʻololi ʻia). Hana ʻia kēia ma ke ʻano like me ka hāʻawi ʻia ʻana o ke kahe koko, ma ke kahe ʻana i loko o kou aʻa.
He lāʻau lapaʻau hou ʻo CAR T-cell therapy e hāʻawi wale ʻia inā ua loaʻa iā ʻoe ʻelua mau lāʻau lapaʻau ʻē aʻe no kāu DLBCL.
I kekahi mau hihia, hiki iā ʻoe ke komo i ka lāʻau lapaʻau T-cell ma o ke komo ʻana i kahi hoʻokolohua lapaʻau.
Hoʻokomo ʻia ka lāʻau lapaʻau T-cell CAR i kahi kaʻina hana mua e like me ka transplant cell stem, kahi e hoʻoneʻe ʻia ai kāu lymphocytes T-cell mai kou koko ma ke kaʻina hana apheresis. E like me ʻoe nā lymphocytes B-cell, ʻo nā cell T he ʻāpana o kāu ʻōnaehana pale a hana pū me kāu mau cell B e pale iā ʻoe mai ka maʻi a me ka maʻi.
Ke hoʻoneʻe ʻia nā T-cell, hoʻouna ʻia lākou i kahi keʻena hana i hana hou ʻia. Hana ʻia kēia ma ka hoʻohui ʻana i ka T-cell i kahi antigen e kōkua iā ia e ʻike maopopo i ka lymphoma a hakakā ʻoi aku ka maikaʻi.
ʻO ka chimeric ka loaʻa ʻana o nā ʻāpana me nā kumu like ʻole no laila ke hoʻohui ʻia o kahi antigen i ka T-cell e lilo ia i chimeric.
Ke hana hou ʻia nā T-cell e hoʻihoʻi ʻia iā ʻoe e hoʻomaka e hakakā i ka lymphoma.
ʻO ka lāʻau lapaʻau mua - Hoʻomaka i ka lāʻau lapaʻau
Hoʻomaka i ka lāʻau lapaʻau
Pono ʻoe e hoʻomaka i ka lāʻau lapaʻau ma hope koke o ka hoʻi ʻana mai o kāu mau hopena hōʻike. I kekahi mau hihia, hiki iā ʻoe ke hoʻomaka ma mua o ka pau ʻana o nā hopena.
Hiki ke paʻakikī loa ke hoʻomaka ʻoe i ka mālama ʻana. Nui paha kou mau manaʻo e pili ana i kāu e hoʻokō ai, pehea e mālama ai ma ka home, a i ʻole e loaʻa paha ʻoe i ka maʻi.
E hōʻike i kāu hui lapaʻau inā manaʻo ʻoe makemake ʻoe i ke kākoʻo hou aku. Hiki paha iā lākou ke kōkua ma ke kuhikuhi ʻana iā ʻoe e ʻike i kahi limahana a i ʻole kekahi ʻoihana mālama ola kino e kōkua iā ʻoe e hoʻoponopono i kekahi mau pilikia ola i kēlā me kēia lā. Hiki iā ʻoe ke hele aku i nā kahu hānai Lymphoma ma ke kaomi ʻana i ke pihi "Contact us" ma lalo o kēia ʻaoʻao.
Ke hoʻomaka ʻoe i ka mālama ʻana no ka manawa mua, ua kapa ʻia ʻo ia ka lāʻau lapaʻau mua. Loaʻa paha iā ʻoe ma mua o hoʻokahi lāʻau lapaʻau, a hiki i kēia mau mea ke komo i ka chemotherapy, kahi antibody monoclonal a i ʻole ka lāʻau lapaʻau. I kekahi mau hihia, loaʻa paha iā ʻoe ka lāʻau lapaʻau a i ʻole ke ʻoki ʻana, a i ʻole nā lāʻau lapaʻau.
Nā pōʻaiapuni a me nā protocols
Ke loaʻa iā ʻoe kēia mau lāʻau lapaʻau, e loaʻa iā ʻoe i nā pōʻai. ʻO ia hoʻi, e loaʻa iā ʻoe ka lāʻau lapaʻau, a laila hoʻomaha, a laila kekahi pōʻai (pōkole) o ka mālama ʻana. No ka hapa nui o ka poʻe me DLBCL, ʻoi aku ka maikaʻi o ka chemoimmunotherapy no ka loaʻa ʻana o ke kala ʻana (ʻaʻohe hōʻailona o ke kanesa).
ʻO ke ʻano o kekahi mau ʻano ʻano ʻano like ʻole e ʻoi aku ka maikaʻi o nā lāʻau lapaʻau i hoʻopaʻa ʻia iā ʻoe, a ʻo nā ʻano ʻino ʻē aʻe - a i ʻole nā genetics maʻamau, ʻoi aku ka maikaʻi o ka chemoimmunotherapy.
ʻO kekahi mau hiʻohiʻona o ka chemoimmunotherapy hiki iā ʻoe ke loaʻa inā loaʻa iā ʻoe ka DLBCL:
R-CHOP
ʻO kahi hui maʻamau o rituximab (a MAB) me nā lāʻau chemo cyclophosphamide, doxorubicin, vincristine a me kahi steroid i kapa ʻia prednisolone. Hāʻawi maʻamau i hoʻokahi lā i kēlā me kēia 14 a i ʻole 21 mau lā. Ma ka la 4th i ka lā ma hope o ka mālama ʻana, e loaʻa nō hoʻi ʻoe i kahi injection i loko o kou ʻōpū e kōkua i kou ulu ʻana o ke koko keʻokeʻo.
R-mini-CHOP
E like me ka R-CHOP ma luna akā he liʻiliʻi liʻiliʻi. Hiki ke hoʻohana ʻia inā he ʻelemakule ʻoe a hopohopo paha kāu kauka ʻaʻole ʻoe e ʻae i ka nui piha.
DA-R-EPOCH
ʻO ka hui pū ʻana o nā lāʻau lapaʻau like me R-CHOP akā me ka hoʻohui ʻana o kekahi chemotherapy i kapa ʻia ʻo etoposide. Hāʻawi ʻia kēia protocol ma nā ʻano like ʻole e pili ana i kāu kūlana pilikino. ʻO ka DA ma ka inoa ʻo ia ka "dose adjusted". Hāʻawi ʻia ma kahi o 5 mau lā i kēlā me kēia 21 lā. I ke ono o ka lā, e loaʻa nō hoʻi ʻoe i kahi inikia i loko o kou ʻōpū e kōkua i ka ulu wikiwiki ʻana o kāu mau koko keʻokeʻo. Hiki ke hāʻawi ʻia kēia protocol inā loaʻa iā ʻoe:
- Kiʻekiʻe kiʻekiʻe paʻi pālua (DH), pākolu pā (TH) a i ʻole mea hōʻike pālua (DEL)
- A i ʻole, inā loaʻa iā ʻoe ka lymphoma pili i ka HIV
SMARTE-R-CHOP14
E like me R-CHOP ma luna, akā me ka lāʻau rituximab i hāʻawi ʻia i nā lā like ʻole. Hiki ke hāʻawi ʻia kēia kuʻina inā ʻoi aku ʻoe ma mua o 60 mau makahiki, a aia i kāu mau keena DLBCL ka māka CD20 ma luna o lākou.
Hyper CVAD
Hāʻawi ʻia kēia kuʻuna iā ʻoe inā loaʻa ʻoe i ka mutation triple hit (kahi hoʻonohonoho hou o kāu gene MYC a me kāu mau genes BCL2 a me BCL 6). Hāʻawi ʻia ka Hyper CVAD i ʻelua ʻāpana - Hyper CVAD ʻāpana A a me Hyper CVAD ʻāpana B.
- Mahele A Aia kekahi steroid i kapa ʻia ʻo dexamethasone, a me nā lāʻau chemotherapy cyclophosphamide ʻelua i ka lā no ʻekolu lā, doxorubicin i ka lā ʻehā a me vincristine i nā lā 4 a me 11 o ka protocol. E loaʻa iā ʻoe kekahi lāʻau lapaʻau ʻē aʻe i kapa ʻia ʻo Mesna ʻoiai e loaʻa ana ka cyclophosphamide e kōkua i ka pale ʻana i kou ʻōpū. Ma ka lā 5, e loaʻa iā ʻoe kahi ʻinikua i loko o kou ʻōpū i kapa ʻia ʻo pegfilgratim e kōkua iā ʻoe i ke kino e hana i nā keʻokeʻo keʻokeʻo hou aʻe e pale iā ʻoe mai ka maʻi.
- Mahele B ʻO ka chemotherapy i kapa ʻia methotrexate a me cytarabine. Hāʻawi ʻia ka methotrexate i ka lā 1 a ukali ʻia e ka lāʻau i kapa ʻia ka calcium folinate (leucovorin) e kōkua i kou kino e hoʻopau i ka methotrexate keu a pale i nā hopena ʻaoʻao. A laila e ukali ʻia e ka cytarabine i nā lā 2 a me 3 a me kahi injection o pegfilgratim i ka lā 4.
*E ʻoluʻolu, inā loaʻa iā ʻoe ka lymphoma B-cell nui maikaʻi maikaʻi, loaʻa paha iā ʻoe nā lāʻau lapaʻau like me kēia, akā ʻaʻole e loaʻa ka lāʻau rituximab. ʻO kēia ke kumu no ka loaʻa ʻole o ka hōʻailona CD20 i nā pūnaewele lymphoma i loko o ALK maikaʻi i ka lymphoma B-cell nui, pono ia no ka hana ʻana o ka lāʻau.
- Hiki paha iā ʻoe ke komo i kahi hoʻokolohua lapaʻau.
ʻO ka hoʻopaʻapaʻa ʻana o ka ʻōnaehana pūpū waena (CNS)
Ma kahi o hoʻokahi o kēlā me kēia 20 poʻe me DLBCL hiki ke hoʻi mai ko lākou lymphoma ma hope o ka mālama ʻana i ko lākou CNS. Ua manaʻo mua ʻia ma ka hāʻawi ʻana i ka methotrexate kiʻekiʻe ma hope o kāu chemo-immunotherapy laina mua e hoʻemi ʻia ka pilikia o ka lymphoma e hoʻi mai i kāu CNS.
Eia nō naʻe, ua hōʻike nui ʻia nā haʻawina e like ka hopena o ka maʻi CNS i ka poʻe i loaʻa i ka methotrexate kiʻekiʻe a me ka poʻe i loaʻa ʻole ka methotrexate kiʻekiʻe. No kēia kumu, ʻaʻole hāʻawi hou nā hale mālama maʻi maʻi i kēia koho lapaʻau, no ka mea, ʻoi aku ka nui o nā pilikia ma mua o nā pono.
ʻO ka lāʻau lapaʻau ʻelua (Ma hope o ka hoʻihoʻi ʻana a i ʻole ka maʻi refractory)
Ma hope o ka mālama ʻana, e hele ka hapa nui o ʻoukou i ke kala ʻana. ʻO ke kala ʻana he manawa ia ʻaʻohe ou hōʻailona o DLBCL i koe i loko o kou kino, a i ʻole ke hoʻomalu ʻia ka DLBCL a ʻaʻole koi ʻia ka lāʻau lapaʻau. Eia naʻe, i kekahi manawa hiki i ka DLBCL ke hoʻi hou (hoʻi mai) a hāʻawi ʻia kahi lāʻau lapaʻau ʻē aʻe.
ʻAʻole hiki ke loaʻa i kekahi o ʻoukou ke kala ʻana me kāu lāʻau lapaʻau mua. Inā loaʻa kēia, kapa ʻia kāu DLBCL he "refractory". Inā loaʻa iā ʻoe ka DLBCL refractory makemake paha kāu kauka e hoʻāʻo i kahi lāʻau lapaʻau ʻē aʻe.
Loaʻa iā ʻoe ka lāʻau lapaʻau inā loaʻa iā ʻoe ka DLBCL refractory a i ʻole ma hope o ka hoʻi hou ʻana i kapa ʻia ʻo ka lāʻau lapaʻau lua. ʻO ka pahuhopu o ka lāʻau lapaʻau ʻelua e hoʻihoʻi hou iā ʻoe i ke kala ʻana.
Inā loaʻa iā ʻoe ke kala hou aʻe, a laila e hoʻi hou a loaʻa hou ka lāʻau lapaʻau, ua kapa ʻia kēia mau lāʻau lapaʻau e hiki mai ana ka lāʻau lapaʻau ʻekolu, lāʻau lapaʻau ʻehā a pēlā aku.
Pono paha ʻoe i kekahi mau ʻano lapaʻau no kāu DLBCL. Ke ʻike nei ka poʻe loea i nā lāʻau lapaʻau hou a ʻoi aku ka maikaʻi e hoʻonui ana i ka lōʻihi o ke kala ʻana. Inā ʻaʻole i pane maikaʻi kāu DLBCL i ka lāʻau lapaʻau a i ʻole ka hoʻihoʻi hou ʻana ma hope o ka mālama ʻana (i loko o ʻeono mahina) ʻike ʻia kēia he DLBCL refractory a e pono ke ʻano o ka mālama ʻana.
Hiki ke hoʻopaʻa ʻia ka DLBCL i hoʻihoʻi ʻia a hoʻopaʻa ʻia i ke kala ʻana a i ʻole ka hoʻōla ʻia ʻana me nā lāʻau lapaʻau hou aʻe, akā naʻe, no ka poʻe liʻiliʻi, ʻoi aku ka ʻino o ka DLBCL. E nīnau i kāu kauka e pili ana i kāu mau pilikia ponoʻī a me ka pahuhopu o kāu lapaʻau. E hōʻike lākou iā ʻoe inā hiki iā ʻoe ke manaʻo i ke kala ʻana, hoʻōla, a i ʻole ka mea e manaʻo ai inā ʻaʻole maikaʻi ka lāʻau i kēia manawa.
Pehea e hoʻoholo ʻia ai kāu lāʻau lapaʻau lua
I ka manawa o ka hoʻihoʻi ʻana, e hilinaʻi ke koho ʻana i ka lāʻau lapaʻau i nā kumu he nui.
- Pehea ka lōʻihi o kou kala ʻana
- ʻO kou olakino a me kou mau makahiki
- He aha nā lāʻau lapaʻau DLBCL i loaʻa iā ʻoe ma mua
- ʻO kāu mau makemake.
Hiki ke hana hou kēia ʻano i nā makahiki he nui. Loaʻa nā lāʻau lapaʻau hou no ka maʻi hoʻihoʻi a i ʻole refractory a me kekahi mau lapaʻau maʻamau no ka DLBCL hoʻihoʻi.
Nā lāʻau lapaʻau maʻamau ʻelua no DLBCL
DHAP - he protocol chemotherapy laina lua maʻamau e hoʻohana ana i ka steroid i kapa ʻia ʻo dexamethasone a me nā lāʻau lapaʻau i kapa ʻia he carboplatin a me cytarabine.
hau - he protocol chemotherapy ikaika kēia, a me nā lāʻau lapaʻau i kapa ʻia ʻo ifosphamide, carboplatin a me etoposide. Hāʻawi ʻia kekahi lāʻau lapaʻau ʻē aʻe i kapa ʻia ʻo Mesna e pale i kou ʻōpū.
ESHAP - he protocol hoʻoikaika kino hoʻi kēia me ka steroid i kapa ʻia ʻo methylprednisolone a me chemotherapies etoposide, cytarabine a me cisplatin. Hiki ke hāʻawi ʻia kēia protocol inā ua hoʻi hou ʻoe, a i ʻole ke hoʻolālā nei ʻoe e hoʻololi i ke ʻano o ka stem cell transplant.
GDP - Hiki ke hāʻawi ʻia kēia protocol inā hoʻi hou ʻoe a i ʻole ke hoʻolālā nei i kahi hoʻololi ʻana i ke kelepona. Loaʻa i kahi steroid i kapa ʻia ʻo dexamethasone a me nā chemotherapies gemcitabine a me cisplatin.
Polatuzumab vedotin - he lāʻau lapaʻau hou aʻe a he antibody monoclonal conjugated. Hiki iā ʻoe ke hāʻawi ʻia i kēia lāʻau lapaʻau inā loaʻa iā ʻoe ka māka CD79b ma kāu mau sela lymphoma. Hāʻawi pinepine ʻia ia me kahi ʻano antibody monoclonal ʻē aʻe i kapa ʻia ʻo rituximab (inā loaʻa iā ʻoe ka māka CD20 ma kāu mau lymphoma cell) a me kahi chemotherapy i kapa ʻia he bendamustine. Hoʻohana pinepine ʻia kēia inā ʻaʻole ʻoe i hoʻolālā ʻia no ka transplant cell stem.
Ka hoʻololi ʻana o ka pūnaʻi kumu – hiki ke hāʻawi ʻia i kekahi poʻe me DLBCL i hoʻi hou, akā naʻe, ʻaʻole ia he koho kūpono i kēlā me kēia. E noʻonoʻo kāu kauka i kekahi mau mea ma mua o ka hoʻoholo ʻana inā he koho lapaʻau maikaʻi kēia no ʻoe. E komo pū ana kēia mau mea:
- kou makahiki
- nā maʻi ʻē aʻe (comorbidities) i loaʻa iā ʻoe
- pehea kou pane ʻana i nā lāʻau lapaʻau i hala.
ʻO ka lāʻau lapaʻau ʻekolu
No kekahi poʻe, pono ke kolu a i ʻole ka ʻehā o ka lāʻau lapaʻau.
E noʻonoʻo kāu kauka i kou kūlana pilikino i ka wā e hoʻoholo ai i ke koho lapaʻau maikaʻi loa no ʻoe. Hiki iā ʻoe ke hāʻawi ʻia i nā lāʻau lapaʻau like me nā mea i helu ʻia ma lalo o ka lāʻau lapaʻau mua a me ka lua.
Ua ʻae ʻia kekahi koho hou i kapa ʻia ʻo CAR T-cell therapy no ka poʻe i loaʻa i ʻelua mau ʻano lapaʻau ʻē aʻe. Inā ʻoe ma kāu lālani ʻekolu a ʻehā paha o ka lāʻau lapaʻau a ʻaʻole ʻōlelo kāu kauka i ka lāʻau lapaʻau T-cell CAR makemake mākou e nīnau iā lākou no ia mea. Eia nō naʻe, e like me ka hoʻololi ʻana i nā cell stem, ʻaʻole kūpono ʻo CAR T-cell therapy no kēlā me kēia kanaka.
Nā ho'āʻo hoʻokolohua
Manaʻo ʻia ʻo kēlā me kēia manawa e pono ai ʻoe e hoʻomaka i nā lāʻau lapaʻau hou āu e nīnau ai i kāu kauka e pili ana i nā hoʻokolohua lapaʻau hiki iā ʻoe ke kūpono.
He mea nui nā hoʻokolohua lapaʻau no ka loaʻa ʻana o nā lāʻau hou, a i ʻole nā hui pū ʻana o nā lāʻau e hoʻomaikaʻi ai i ka mālama ʻana DLBCL ma kēia mua aku.
Hiki iā lākou ke hāʻawi iā ʻoe i kahi manawa e hoʻāʻo ai i kahi lāʻau hou, hui pū ʻana o nā lāʻau lapaʻau a i ʻole nā lāʻau lapaʻau ʻē aʻe āu e hiki ʻole ke loaʻa ma waho o ka hoʻokolokolo. Inā makemake ʻoe e komo i kahi hoʻokolohua lapaʻau, e nīnau i kāu kauka i nā hoʻokolohua lapaʻau āu e kūpono ai.
Nui nā lāʻau lapaʻau a me nā hui hoʻohui hou e hoʻāʻo ʻia nei i nā hoʻokolohua lapaʻau a puni ka honua no nā poʻe maʻi me ka maʻi hou a hoʻi hou. DLBCL.
Prognosis no DLBCL - a he aha ka hopena i ka pau ʻana o ka mālama ʻana
ʻO Prognosis ka huaʻōlelo i hoʻohana ʻia e wehewehe i ke ala o kou maʻi, pehea e pane ai i ka mālama ʻana a pehea ʻoe e hana ai i ka wā a ma hope o ka mālama ʻana.
Nui nā kumu e kōkua ai i kāu wānana a ʻaʻole hiki ke hāʻawi i kahi ʻōlelo holoʻokoʻa e pili ana i ka prognosis. Eia naʻe, pane maikaʻi loa ka DLBCL i ka mālama ʻana a hiki ke ho'ōla ʻia nā maʻi he nui me kēia maʻi kanesa - ʻo ia hoʻi ma hope o ka mālama ʻana, ʻaʻohe hōʻailona o DLBCL i kou kino.
Nā mea hiki ke hoʻopili i ka wānana
ʻO kekahi mau mea e pili ana i kāu prognosis penei:
- ʻO ʻoe nā makahiki a me ke olakino holoʻokoʻa i ka manawa o ka maʻi maʻi.
- Pehea ʻoe e pane ai i ka lāʻau lapaʻau.
- He aha inā inā loaʻa iā ʻoe nā genetic mutations.
- ʻO ka subtype o DLBCL iā ʻoe.
Inā makemake ʻoe e ʻike hou aku e pili ana i kāu wānana ponoʻī, e ʻoluʻolu e kamaʻilio me kāu kauka haematologist a i ʻole oncologist. Hiki iā lākou ke wehewehe i kāu mau pilikia a me ka wānana iā ʻoe.
Ola - Noho pū me, a ma hope o ke kanesa
ʻO ke ola olakino, a i ʻole kekahi mau loli ola maikaʻi ma hope o ka mālama ʻana he mea kōkua nui ia i kou ola hou ʻana. Nui nā mea hiki iā ʻoe ke hana e kōkua iā ʻoe e noho maikaʻi me DLBCL.
He nui ka poʻe i ʻike ma hope o ka hōʻoia ʻana i ka maʻi kanesa, a i ʻole ka mālama ʻana, e loli ana kā lākou mau pahuhopu a me nā mea nui i ke ola. ʻO ka ʻike ʻana i ke ʻano o kāu 'maʻamau hou' hiki ke hoʻolōʻihi i ka manawa a hoʻonāukiuki. He ʻokoʻa paha nā manaʻolana o kou ʻohana a me kou mau hoaaloha. Hiki paha iā ʻoe ke kaʻawale, luhi a i ʻole kekahi mau manaʻo like ʻole e loli i kēlā me kēia lā.
ʻO nā pahuhopu nui ma hope o ka mālama ʻana no kāu DLBCL ʻo ka hoʻi ʻana i ke ola a:
- e ʻeleu i kāu hana, ʻohana, a me nā kuleana ola ʻē aʻe
- e hoʻemi i nā hopena ʻaoʻao a me nā hōʻailona o ka maʻi kanesa a me ka mālama ʻana
- ʻike a mālama i nā hopena hope loa
- kōkua iā ʻoe e kūʻokoʻa e like me ka hiki
- hoʻomaikaʻi i kou maikaʻi o ke ola a mālama i ke olakino noʻonoʻo maikaʻi
Hiki ke hāʻawi ʻia iā ʻoe nā ʻano hoʻolaʻa maʻi kanesa. Hiki i kēia ke manaʻo i kekahi o ka laulā ākea o na lawelawe e like me:
- kino kino, hooponopono eha
- hoʻolālā meaʻai a me ka hoʻoikaika kino
- ka manaʻo, ka ʻoihana a me ke aʻo kālā.
