Ka nānā 'ana o ka lymphoblastic lymphoma (LL)
ʻO Lymphoblastic Lymphoma (LL) kahi lymphoma ʻaʻole Hodgkin lymphoma (NHL). He mea kakaikahi loa ia a aia ma kahi o 2% o nā NHL a pau. Hoʻokumu ʻo LL mai kēlā me kēia B-lymphoblasts (B-lymphoblastic lymphoma) or T-lymphoblasts (T-lymphoblastic lymphoma).
ʻO ka lymphoblast kahi pūnaewele makua ʻole e hiki ke ulu i lymphocyte makua. ʻO nā B-lymphoblasts he mau B-lymphocytes i oʻo ʻole a ʻo T-lymphoblasts he mau T-lymphocytes ʻai ʻole. ʻOi aku ka maʻamau o T-cell lymphoblastic lymphoma ma mua o B-cell lymphoblastic lymphoma.
He aha ka ʻokoʻa ma waena o ka lymphoblastic lymphoma a me ka leukemia?
He like loa ka lymphoblastic lymphoma a me ka ma'i leukemia lymphoblastic ma ia mau mea elua hana lapaʻau a me ka nānā ʻana ma lalo o kahi microscope. ʻO nā keʻokeʻo keʻokeʻo keʻokeʻo maʻi ʻaʻai like ʻole a hoʻomohala ʻia mai ka cell hoʻokahi.
ʻO ka ʻokoʻa ma waena o ka lymphoma a me ka maʻi leukemia e hilinaʻi nui ʻia ma kahi e loaʻa ai ka pakeneka kiʻekiʻe o nā maʻi maʻi maʻi i ka maʻi maʻi.
ʻO nā mea koʻikoʻi no ka hōʻailona o ka lymphoblastic lymphoma e komo pū ana:
- Ma lalo o 25% o ka iwi iwi e hōʻike i ke kanesa
- Loaʻa pinepine nā wahi like ʻole e like me nā lymph nodes
- Hiki i ka lymphoma ke hoʻopili i nā ʻāpana ʻē aʻe o ke kino e like me ka spleen, thymus, koko, ʻili a kokoke i nā ʻāpana a i ʻole nāʻiʻo.
- Hiki iā B-cell a i ʻole T-cell i hoʻopili ʻia (cell of origin)
Nā kumu no ka hōʻoia ʻana o ka maʻi leukemia lymphoblastic acute:
- ʻOi aku ma mua o 25% o nā pūnaewele iwi o ka iwi olakino e hoʻololi ʻia me nā sela lymphoblastic malignant
- E loaʻa nā pūnaewele lymphoblast malignant (i kapa ʻia nā mea hoʻohūhū) aia i loko o nā laʻana koko pili
- Hiki iā B-cell a i ʻole T-cell i hoʻopili ʻia (cell of origin)
Loaʻa i ka lymphoblastic lymphoma kahi wānana maikaʻi, ma kahi o 85% o ka poʻe ʻōpio e loaʻa i ke kala piha ma hope o kēia manawa. lapaʻau laina mua maʻamau me ka hoʻohana ' chemotherapy. ʻO ka poʻe i ʻoi aku ma mua o 40 mau makahiki, ʻoi aku ka maikaʻi o ka nānā ʻana ma kahi o 45-50% lāʻau lapaʻau me ka lāʻau lapaʻau maʻamau. Ke manaʻo mau nei ka noiʻi e hoʻomaikaʻi i nā helu ola lōʻihi a aia nā ho'āʻo hoʻokolohua e noiʻi ana pehea e hoʻokō ai i kēia.
ʻO wai ka mea i pili i ka lymphoblastic lymphoma?
Hiki i ka lymphoblastic lymphoma (LL) ke hoʻopilikia i kekahi o nā makahiki. He mea maʻamau i nā kāne ma mua o nā wahine. He mea maʻamau ka LL ma keiki a nā'ōpio (awelika makahiki 20 makahiki), a ma lalo o 35 makahiki. ʻO ka poʻe i ʻike ʻia ma luna o nā makahiki he 40 hiki ke loaʻa ka manawa kiʻekiʻe o ka hoʻi hou ʻana ma mua o ka poʻe ʻōpio.
ʻAʻole ʻike ʻia ke kumu o ka lymphoblastic lymphoma. E like me nā maʻi maʻi ʻē aʻe, ʻaʻole ia he maʻi maʻi a ʻaʻole hiki ke hoʻoili ʻia i nā poʻe ʻē aʻe. ʻOiai ʻaʻole maopopo nā kumu kumu o LL, aia kekahi nā mea pilikia nā mea e pili ana i ka hoʻomohala ʻana o LL.
Hiki i kēia mau mea pilikia ke komo:
- ʻO ka maʻi mua me ka maʻi Epstein-Barr (EBV) - ʻo kēia maʻi ke kumu maʻamau o ka maʻi maʻi glandular
- Nawaliwali ka ʻōnaehana pale ma muli o kahi maʻi hoʻoilina ʻole (autoimmune maʻi)
- ʻO ka maʻi HIV
- ʻO ka lāʻau immunosuppressant i lawe ʻia e pale i ka hōʻole ʻana ma hope o ka hoʻololi ʻana o ke kino
- ʻO ka loaʻa ʻana o kahi kaikunāne a i ʻole kaikuahine me Hodgkin lymphoma (ʻoi aku nā māhoe) ua manaʻo ʻia i kahi pilina pili genetic ʻohana i ka maʻi (ʻoiai he kakaʻikahi a ʻaʻole ʻōlelo ʻia no nā ʻohana e hoʻāʻo ʻia)
- ʻAʻohe moʻolelo ʻohana ka hapa nui o nā kānaka
Nā ʻano lymphoblastic lymphoma (LL)
Hiki ke hoʻokaʻawale ʻia ka lymphoblastic lymphoma (LL) i nā lymphoma lymphoblastic B-cell a i ʻole T-cell lymphoblastic lymphoma. Hōʻike ʻia nā ʻano subtype ʻelua i nā ʻano like me kekahi, ua like loa ko lākou hōʻike ʻana me ka maʻi leukemia lymphoblastic acute (ALL).
ʻO ka mua o ka T-cell lymphoblastic lymphoma
ʻO ka precursor T-cell lymphoblastic lymphomas ma kahi o 90% o nā lymphoma lymphoblastic makua. Hele pinepine mai ka T-cell mai ka thymus (he okana ma ka umauma luna ma hope o ka sternum). Ma muli o ka wahi o ka thymus, hoʻopilikia pinepine ʻia nā nodes lymph ma ke kino luna. Hōʻike pinepine ka poʻe i kā lākou kauka me ka nui ma ka ʻāpana o ka umauma luna. Ua ʻike ʻia kēia ʻano nui he mediastinal (kahi umauma). Puka mai kēia lymphoma mai nā pūnaewele lymphocyte i oʻo ʻole i ke ala e lilo ai i mau lymphocytes T-cell makua.
ʻO ka lymphoma lymphoblastic precursor B-cell
ʻAʻole maʻamau ka lymphoma lymphoblastic precursor ma mua o ka maʻi maʻi lymphoblastic B-acute (B-ALL). Hoʻokumu ʻia nā pūnaewele lymphoma mai nā lymphocytes B-cell mua ʻole. Hōʻike pinepine ka poʻe i kā lākou kauka me nā puʻupuʻu lymph i hoʻopilikia ʻia a me ka extranodal (ka ʻiʻo ma waho o nā lymph nodes). ʻO ke komo ʻana o ka pūnaewele extranodal ka loaʻa ʻana o nā pūnaewele lymphoma i ka ʻili, ka iwi, ka ʻōnaehana nūnū waena a i ʻole ka iwi iwi.
Nā hōʻailona o ka lymphoblastic lymphoma
ʻO nā hōʻailona mua i ʻike ʻia e ka hapa nui o ka poʻe he puʻupuʻu a i ʻole kekahi mau puʻupuʻu i hele ʻole ma hope o kekahi mau pule. Hiki paha iā ʻoe ke ʻike i hoʻokahi a ʻoi aʻe paha nā puʻupuʻu ma ka ʻāʻī, ka ʻāʻī a i ʻole ka ʻāʻī. ʻO kēia mau puʻupuʻu he mau lymph nodes, kahi e ulu ʻole ai nā lymphocytes maʻamau. Hoʻomaka pinepine kēia mau puʻupuʻu ma kekahi ʻāpana o ke kino, ʻo ka maʻamau ke poʻo, ka ʻāʻī a i ʻole ka umauma a laila pālahalaha pinepine ʻia ma ke ʻano wānana mai kekahi ʻāpana o ka ʻōnaehana lymphatic a i kekahi.
I nā pae kiʻekiʻe (maʻi ākea), hiki ke laha ka maʻi i nā māmā, ate, iwi, iwi iwi a i ʻole nā ʻāpana ʻē aʻe. Ma kahi o 50-75% o nā poʻe maʻi i loaʻa i ka lymphoma e pili ana i ka ʻāpana mediastinal (ka umauma).
Hiki i nā hōʻailona maʻamau o lymphoblastic lymphoma ke komo:
- ʻO ka pehu ʻole o ka lymph nodes ma ka ʻāʻī, underarm, ʻāʻī a i ʻole ka umauma
- ʻĀpiki maʻalahi
- ʻeleʻele o ka ʻili
- ʻO ka pōkole o ka hanu - ma muli o ka hoʻonui ʻia ʻana o nā lymph nodes ma ka umauma
- Cough (ʻo ka maʻamau maloʻo cough)
- 'Oloke
- Paʻakikī ke hoʻōla mai kahi maʻi
- ʻili ʻili (pruritus)
B nā hōʻailona ʻo ia nā mea a nā kauka i kapa ai i kēia mau hōʻailona a hiki ke komo:
- ʻO ka wela o ka pō (ʻoi aku i ka pō, nā lole hiamoe a me nā moena)
- ʻO ke kuni mau
- ʻO ka pohō kaumahaʻole
He mea nui e hoʻomaopopo i ka nui o kēia mau hōʻailona e pili ana i nā kumu ʻē aʻe ma mua o ka maʻi kanesa a i kekahi manawa paʻakikī i nā kauka ke ʻike.
ʻike,
A nā lāʻau kanu koi mau ʻia no ka hōʻoia ʻana o Lymphoblastic lymphoma. A nā lāʻau kanu he hana e wehe i a limu lymph a i ʻole nā ʻiʻo ʻino ʻē aʻe e nānā iā ia ma lalo o ka microscope e kahi mea maʻi. Hiki ke hana ʻia ka biopsy ma lalo o ka anesthetic maʻamau a i ʻole ka anesthetic kūloko ma muli o ka wahi.
An biopsy node excisional ʻo ia ka koho noiʻi maikaʻi loa, ʻoiai ʻo ia ka mea e hōʻiliʻili ai i ka nui o ka ʻiʻo e hiki ai ke hana i ka hoʻāʻo pono no kahi hōʻailona.
A biopsy iwi iwi (BMA) a koi ʻia hoʻi ka hōʻiliʻili koko ʻaoʻao no ka hōʻoia ʻana i ka lymphoblastic lymphoma - i mea e hoʻokaʻawale ai ia mai ka leukemia lymphoblastic acute. He kaʻina hana ka BMA no ka hōʻiliʻili ʻana i nā pūnaewele mai ka iwi iwi, ʻohi ʻia kēia mau cell mai ke kua o ka iwi pelvic.
Ke kali nei i nā hualoaʻa hiki ke lilo i manawa paʻakikī. Hiki ke kōkua ke kamaʻilio ʻana me ka ʻohana, nā hoaaloha a i ʻole kahi kahu hānai kūikawā.
ʻO ka hoʻopaʻa ʻana, nā hoʻāʻo a me nā scans
I ka manawa a ʻike, o lymphoblastic lymphoma (LL), pono e ho'āʻo hou aku e ʻike i kahi ʻē aʻe o ke kino i loaʻa ai ka lymphoma. Kapa ʻia kēia e hoʻokū nei. ʻO ke kau ʻana o ka lymphoma e kōkua i ke kauka e hoʻoholo i ka lāʻau maikaʻi loa.
ʻEhā mau ʻanuʻu mai ka pae 1 (lymphoma ma kahi ʻāpana) a hiki i ka pae 4 (lymphoma i laha ʻia).
- Anuu mua 'o ia ho'i ka pae 1 a me kekahi pae 2 lymphoma. Hiki ke kapa ʻia kēia 'localised'. ʻO ka pae 1 a i ʻole 2 ʻo ia ka loaʻa ʻana o ka lymphoma ma kahi wahi a i ʻole kekahi mau wahi kokoke.
- ʻIa pae kiʻekiʻe 'o ia ho'i, 'o ka lymphoma ka pae 3 a i 'ole ka pae 4, a he lymphoma laha. I ka hapanui o nā hihia, ua laha ka lymphoma i nā ʻāpana o ke kino i mamao loa mai kekahi i kekahi.
Hiki ke komo i kekahi o nā ho'āʻo e pono ai:
- Kānana x-ray - e kōkua kēia mau kiʻi e ʻike i ke ʻano o ka maʻi i loko o ka umauma
- ʻO ka ʻōmole helu Positron emoate (PET) - hana ʻia e hoʻomaopopo i nā wahi āpau o ka maʻi i loko o ke kino ma mua o ka hoʻomaka ʻana o ka mālama ʻana
- Ka pākuʻina o ka tomography (CT)
- Pahu lumbar
- Biopsy iwi ʻōiwi
- Nā ho'āʻo koko (e like me: helu koko piha, kemika koko a me ka erythrocyte sedimentation rate (ESR) no ka huli ʻana i nā hōʻike o ka mumū)
Hiki i nā maʻi ke hana i kekahi mau nā hoʻokolohua kumu ma mua o ka hoʻomaka ʻana o kekahi lapaʻau e nānā i nā hana o ke kino. Hoʻohana pinepine ʻia kēia mau mea i ka wā a ma hope o ka pau ʻana o ka mālama ʻana no ka loiloi inā ua pili ka lāʻau i ka hana o nā kino. I kekahi manawa pono e hoʻoponopono ʻia ka mālama ʻana a me ka mālama ʻana e kōkua i ka mālama ʻana i nā hopena ʻaoʻao. Hiki i kēia mau mea ke komo:
- Ke kaulike
- Nā ʻike koʻikoʻi (ke koko, ka mahana, a me ka helu pulse)
- ʻImi puʻuwai
- Kiʻi ʻāʻī
- Nā hoʻāʻo hanu
- Nā ho'āʻo koko
He manawa lōʻihi paha e hana ʻia ai nā biopsies a me nā hoʻāʻo e pono ai (he awelika o 1-3 mau pule), akā he mea nui i nā kauka ke loaʻa ke kiʻi piha o ka lymphoma a me ke olakino ākea o ka mea maʻi hana i nā hoʻoholo lapaʻau maikaʻi loa
Hana hou ʻia ka nui o ka hoʻāʻo ʻana i ka hoʻomaʻamaʻa ʻana a me ka hana o ke kino ma hope o ka mālama ʻana no ka nānā ʻana inā ua hana ka lapaʻau lymphoma a me ka hopena i loaʻa i ke kino.
Ka wānana o ka lymphoblastic lymphoma
He kūlana maikaʻi loa ko Lymphoblastic lymphoma, me ka hapa nui o nā maʻi i pane maikaʻi loa i ka mālama ʻana a loaʻa iā 85% ka lāʻau. ʻO ka poʻe i ʻike ʻia ma luna o nā makahiki he 40, ʻoi aku ka maikaʻi o ka hopena ma mua o nā maʻi ʻōpio, ʻo 45-50% ka nui o ka mālama ʻana.
ʻO ke ola lōʻihi a me nā koho lapaʻau e hilinaʻi ʻia ma nā ʻano kumu like ʻole:
- makahiki ma ka hōʻoia
- ka nui a i ʻole ka pae o ka maʻi kanesa
- ke ʻano o nā pūnae lymphoma ma lalo o ka microscope (ke ʻano, ka hana a me ke ʻano o nā cell)
- pehea e pane ai ka lymphoma i ka lāʻau lapaʻau
- lymphoma biology, e komo pū ana
- nā hiʻohiʻona o nā pūnaewele lymphoma
- ʻokoʻa ka ʻokoʻa o nā cell lymphoma mai nā cell maʻamau
- pehea ka wikiwiki o ka ulu ʻana o nā cell lymphoma.
E kamaʻilio me kāu kauka e pili ana i kāu maʻi pilikino, nā koho lapaʻau a me ka wānana.
Ka mālama ʻana i ka lymphoblastic lymphoma
Ke pau nā hualoaʻa mai ka biopsy a me nā scan staging, e nānā ke kauka i kēia mau mea no ka hoʻoholo ʻana i ka lāʻau lapaʻau maikaʻi loa. 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 nā kauka i nā kumu he nui e pili ana i ka lymphoma a me ke olakino maʻamau o ka mea maʻi e hoʻoholo ai i ka wā a me ka lāʻau e pono ai. Hoʻokumu ʻia kēia ma:
- ʻO ka pae a me ka pae o ka lymphoma
- Ōuli
- ʻO ka makahiki, ka mōʻaukala olakino a me ke olakino maʻamau
- Ke ola kino a me ka noʻonoʻo o kēia manawa
- Nā Kūlana Pilikino
- Nā makemake ʻohana
No ka mea he lymphoma e ulu wikiwiki ana ka lymphoblastic lymphoma, pono paha e hoʻomaka ka lāʻau lapaʻau i loko o kekahi mau lā ma hope o ka hōʻoia ʻana. ʻO nā kaʻina lapaʻau no ka lymphoblastic lymphoma ka mea maʻamau i nā kaʻina like i hoʻohana ʻia no ka mālama ʻana i ka leukemia lymphoblastic acute, no ka like o nā maʻi.
ʻO ka hapa nui o nā ala lapaʻau e komo
- ʻO ka induction phase, e hoʻohana ana i ka chemotherapy multi-agent intensive
- ʻO ka chemotherapy pae hoʻohui
- ʻO ka lāʻau chemotherapy
ka ka lāʻau lapaʻau mua maʻamau ʻO nā protocols i hoʻohana ʻia hiki ke komo:
- Hyper CVAD (cyclophosphamide, Doxorubicin, Vincristine, Cytarabine, Methotrexate, Dexamethasone)
- BFM 2000 (Prednisone, Methotrexate, Daunorubicin, Vincristine, Asparaginase, Mercaptopurine, Cyclophosphamide, Cytarabine, Dexamethasone, Doxorubicin, Tioguanine, Etoposide, Ifosfamide) *Hoʻohana ʻia kēia protocol i ka poʻe ʻōpio (25 mau makahiki a ʻoi aʻe).
Nā hopena maʻamau o ka lāʻau lapaʻau
Nui nā hopena ʻaoʻao like ʻole o ka lāʻau lapaʻau a pili kēia i ka lāʻau i hāʻawi ʻia. Hiki i ke kauka lapaʻau a/a i ʻole kahu maʻi maʻi ke wehewehe i nā hopena ʻaoʻao kikoʻī ma mua o ka mālama ʻana. ʻO kekahi o nā hopena ʻaoʻao maʻamau o ka lāʻau lapaʻau hiki ke komo:
- Anemia (ke koko ʻulaʻula haʻahaʻa e lawe ana i ka oxygen a puni ke kino)
- ʻO Thrombocytopenia (nā platelets haʻahaʻa e kōkua ana i ka hoʻopaʻa ʻana a me ke koko)
- Neutropenia (ke koko keʻokeʻo haʻahaʻa e kōkua i ke kaua ʻana i ka maʻi)
- ʻO ka naʻi a me ka luaʻi
- Ka luhi (ka luhi a me ka nele o ka ikehu)
- Hoemi i ka momona
Pono ka hui lapaʻau, kauka, kahu maʻi maʻi a i ʻole lāʻau lapaʻau, e hāʻawi i ka ʻike e pili ana i:
- He aha ka lāʻau e hāʻawi ʻia
- He aha nā hopena maʻamau a hiki ke loaʻa no ka mālama ʻana
- He aha nā hopena ʻaoʻao āu e pono ai e hōʻike i ka hui lapaʻau
- He aha nā helu hoʻokaʻaʻike, a ma hea e hele ai inā pilikia 7 lā o ka pule a me 24 mau hola i kēlā me kēia lā
Mālama i ka momona
Hiki i kekahi mau lapaʻau no ka lymphoma ke hoʻemi i ka momona a ʻoi aku paha kēia me kekahi mau protocol chemotherapy (hui pū ʻana o nā lāʻau lapaʻau) a me ka chemotherapy kiʻekiʻe i hoʻohana ʻia ma mua o ka hoʻololi ʻana i ke kelepona. Hoʻonui ka radiotherapy i ke pelvis i ka liʻiliʻi o ka momona. Hiki i kekahi mau lāʻau lapaʻau antibody ke hoʻopilikia i ka momona, akā ʻaʻole maopopo kēia.
Pono ke kauka e aʻo inā pili paha ka ulu ʻana a i ʻole e mālama ʻia ka mālama ʻana ma mua o ka hoʻomaka ʻana o ka mālama ʻana.
Malama hahai
Ke hoʻopau ʻia ka mālama ʻana, hana ʻia nā scan staging post treatment e nānā i ka maikaʻi o ka hana ʻana. E hōʻike ana nā scans i ke kauka inā loaʻa kahi:
- Pane piha (CR a ʻaʻohe hōʻailona o ka lymphoma i koe) a i ʻole
- pane hapa (PR a i ʻole he lymphoma i kēia manawa, akā ua hoʻemi ʻia ka nui)
Inā maikaʻi nā mea a pau, e hana ʻia nā koho maʻamau no kēlā me kēia 3-6 mahina e nānā i kēia mau mea:
- E nānā i ka pono o ka lāʻau lapaʻau
- E nānā i nā hopena ʻaoʻao mai ka lāʻau lapaʻau
- E nānā i nā hopena hope loa mai ka mālama ʻana i ka manawa
- E nānā i nā hōʻailona o ka hoʻi hou ʻana o ka lymphoma
He mea koʻikoʻi nō hoʻi kēia mau koho i hiki i ka mea maʻi ke hāpai i kekahi hopohopo e pono ai lākou e kūkākūkā me ka hui lapaʻau. ʻO kahi hoʻokolohua kino a me nā hoʻāʻo koko he mau hoʻokolohua maʻamau no kēia mau koho. Ma waho aʻe o ka manawa ma hope o ka mālama ʻana e nānā i ka hana ʻana o ka mālama ʻana, ʻaʻole i hana pinepine ʻia nā scans ke ʻole he kumu no lākou. No kekahi poʻe maʻi hiki ke emi pinepine i ka manawa
ʻO ka lymphoma lymphoblastic i hoʻihoʻi hou ʻia
Hoʻihoʻi hou ʻia ʻO ka lymphoma ka wā i hoʻi mai ai ke kanesa. Hōʻike ʻO ka lymphoma ka wā e pane ʻole mai ai ke kanesa nā lāʻau lapaʻau mua. No kekahi poʻe, hoʻi hou mai ka lymphoblastic lymphoma a i kekahi mau hihia kakaʻikahi ʻaʻole ia e pane i ka lāʻau lapaʻau mua (refractory). No kēia mau maʻi aia kekahi mau lāʻau lapaʻau ʻē aʻe i hiki ke kūleʻa a hiki ke komo:
- ʻO ka chemotherapy hui pū ʻana kiʻekiʻe hahai ʻia e kekahi:
- Ke kuʻi ʻana o ke koʻokoʻo autologous
- ʻO ka hoʻololi ʻana i ke ʻano o ke ʻano o ka allogeneic stem cell transplant.
- ʻO ka chemotherapy hui
- immunotherapy
- ʻO ke kelepona
- Ke komo ʻana i ka hoʻokolohua lapaʻau
ina he manaʻo ʻia ka hoʻihoʻi hou ʻana e pono e hana ʻia kahi biopsy ʻē aʻe pinepine me nā hoʻokolohua hoʻokūkū like i wehewehe ʻia ma luna o ka kūlana pauku.
Lapaʻau ma lalo o ka hoʻokolokolo ʻana no ka lymphoblastic lymphoma (LL)
Nui nā lāʻau lapaʻau e hoʻāʻo ʻia nei i kēia manawa nā ho'āʻo hoʻokolohua ma Australia a puni ka honua no nā poʻe maʻi me ka lymphoma hou i ʻike ʻia a hoʻi hou. No ka papa inoa o nā lāʻau lapaʻau i kēia manawa e noiʻi ʻia nei:
- Chimeric antigen receptor T-cell therapy (CAR-T-cell therapy)
- ʻO Blinatumomab
He aha ka hana ma hope o ka mālama ʻana?
Nā hopena hope
I kekahi manawa a hopena ʻaoʻao hiki ke hoʻomau a ulu paha nā mahina a i ʻole mau makahiki ma hope o ka pau ʻana o ka mālama ʻana. Kapa ʻia kēia he hopena hope.
Hoʻopau i ka mālama ʻana
He manawa paʻakikī kēia no nā poʻe he nui a hiki ke pili kekahi o nā hopohopo maʻamau i:
- Helu
- ʻO ke ʻano noʻonoʻo
- Ola kino
- 'ana ma
- Hana, aʻo a me nā hana pilikanaka
ʻO ke olakino a me ke olakino
ʻO ke ola olakino, a i ʻole kekahi mau loli ola maikaʻi ma hope o ka mālama ʻana he mea kōkua nui ia ma hope o ka pau ʻana o ka mālama ʻana. ʻO ka hana ʻana i nā hoʻololi liʻiliʻi e like me ka ʻai ʻana a me ka hoʻonui ʻana i ke olakino hiki ke hoʻomaikaʻi i ke olakino a me ka maikaʻi a kōkua i ke kino e ola hou. He nui nā hoʻolālā mālama ponoʻī hiki ke kōkua i ka wā ho'ōla.
