Ka nānā ʻana o ka lymphoma ʻili (ʻili).
ʻO ka Lymphoma kahi ʻano maʻi kanesa e hoʻomaka ana i loko o nā keʻokeʻo keʻokeʻo i kapa ʻia he lymphocytes. Noho maʻamau kēia mau keʻena koko i loko o kā mākou ʻōnaehana lymphatic, akā hiki ke hele i kekahi ʻāpana o ko mākou kino. He mau pūnaewele koʻikoʻi lākou o kā mākou ʻōnaehana pale, hakakā i ka maʻi a me nā maʻi, a me ke kōkua ʻana i nā cell immune ʻē aʻe e hana ʻoi aku ka maikaʻi.
E pili ana i nā Lymphocytes
Loaʻa iā mākou nā ʻano lymphocytes like ʻole, me nā hui nui B-cell lymphocytes a T-cell lymphocytes. Loaʻa i nā lymphocytes B a me T-cell kahi hana kūikawā, me ka "immunological memory". ʻO ia ke ʻano o ka loaʻa ʻana o ka maʻi, ka maʻi, a i ʻole ka poino (a i ʻole ka hoʻololi ʻana) o kekahi o kā mākou mau sela, nānā kā mākou lymphocytes i kēia mau sela a hana i nā "mea hoʻomanaʻo B a i ʻole T-cell".
Mālama kēia mau mea hoʻomanaʻo i ka ʻike a pau e pili ana i ke ʻano o ka hakakā ʻana i ka maʻi, a i ʻole ka hoʻoponopono ʻana i nā cell i poino inā loaʻa hou ka maʻi like ʻole. Ma kēia ala hiki iā lākou ke luku a hoʻoponopono hou i nā cell i ʻoi aku ka wikiwiki a ʻoi aku ka maikaʻi i ka wā aʻe.
- Hana pū nā lymphocytes B-cell i nā antibodies (immunoglobulins) e kōkua i ke kaua ʻana i nā maʻi.
- Kōkua nā T-cell i ka hoʻoponopono ʻana i kā mākou pane pale i hiki i kā mākou ʻōnaehana pale ke hana maikaʻi i ka hakakā ʻana i nā maʻi, akā kōkua pū kekahi i ka hoʻōki ʻana i ka pane ʻana o ka maʻi ke pau ka maʻi.
Hiki i nā Lymphocytes ke lilo i mau pūnaeau lymphoma maʻi maʻi
Hana ʻia nā lymphoma ʻili i ka wā e lilo ai nā pūnaʻi B a i ʻole nā T-cell e hele ana i kou ʻili i ke kanesa. A laila māhele a ulu ʻole ka maʻi kanesa lymphoma, a i ʻole make i ka wā e pono ai.
Hiki i nā mākua a me nā keiki ke loaʻa i nā lymphoma ʻili a ʻo ka hapa nui o ka poʻe me ka lymphoma ʻili e loaʻa i nā pūnae T maʻi maʻi. Ma kahi o 5 wale nō o kēlā me kēia 20 poʻe me ka lymphoma ʻili e loaʻa i kahi lymphoma B-cell.
Hoʻokaʻawale ʻia nā lymphoma maʻamau i:
- molowa – Ke lohi nei ka ulu ʻana o nā lymphoma i loko a hele pinepine lākou ma nā ʻanuʻu kahi e "moe ai" ʻaʻole e pōʻino iā ʻoe. ʻAʻole pono ʻoe i kahi lāʻau lapaʻau inā loaʻa iā ʻoe kahi lymphoma cutaneous palaualelo, ʻoiai e loaʻa i kekahi poʻe. ʻAʻole laha ka hapa nui o nā lymphoma molowa i nā wahi ʻē aʻe o kou kino, ʻoiai hiki i kekahi ke uhi i nā wahi like ʻole o ka ʻili. I ka wā lōʻihi, hiki i kekahi mau lymphoma palaualelo ke piʻi i mua ma ke kahua, ʻo ia hoʻi ua laha lākou i nā wahi ʻē aʻe o kou kino, akā kakaikahi kēia me ka nui o nā lymphomas cutaneous.
- Pākela - He lymphomas e ulu wikiwiki a hiki ke ulu koke a laha i nā wahi ʻē aʻe o kou kino. Inā loaʻa iā ʻoe kahi lymphoma cutaneous aggressive, pono ʻoe e hoʻomaka i ka mālama ʻana ma hope koke o kou ʻike ʻia ʻana me ka maʻi.
Nā hōʻailona o Cutaneous Lymphoma
ʻO ka lymphoma ʻili ʻili ʻole
ʻAʻole paha ʻoe i loaʻa nā hōʻailona ʻike inā loaʻa iā ʻoe kahi lymphoma palaualelo. Ma muli o ka lohi o ka ulu ʻana o nā lymphoma palaualelo, ulu lākou i nā makahiki he nui, no laila e ʻike ʻole ʻia kahi ʻōpala a i ʻole lesion ma kou ʻili. Inā loaʻa iā ʻoe nā hōʻailona hiki iā lākou ke komo:
- he ma'i pau ole
- nā wahi ʻeha a ʻeha paha ma kou ʻili
- palahalaha, ʻulaʻula, ʻili ʻili
- nā ʻeha hiki ke pohā a kahe ke koko a hoʻōla ʻole e like me ka mea i manaʻo ʻia
- ʻulaʻula ākea ma luna o nā wahi nui o ka ʻili
- hoʻokahi, a mau puʻupuʻu paha ma kou ʻili
- Inā he ʻeleʻele kou ʻili, loaʻa paha nā wahi o ka ʻili i ʻoi aku ka māmā ma mua o nā mea ʻē aʻe (ma mua o ka ʻulaʻula).
Patches, papules, plaques and tumors - He aha ka ʻokoʻa?
ʻO nā maʻi i loaʻa iā ʻoe me nā lymphoma ʻili hiki ke lilo i ka ʻūhā maʻamau, a i ʻole e kapa ʻia ʻo ia he patches, papules, plaques a i ʻole ka ʻōpū.
Pāpale – he mau wahi palahalaha o ka ili i like ole me ka ili a puni. Hiki iā lākou ke maʻalahi a scaly a hiki ke nānā aku e like me ka maʻi maʻamau.
Papule - he wahi ʻili liʻiliʻi a paʻa i hoʻokiʻekiʻe ʻia, a me he pimple paʻakikī paha.
Poliki – he mau wahi paʻakikī o ka ʻili i hoʻokiʻekiʻe pinepine ʻia, ʻoi aku ka mānoanoa o ka ʻili i ʻili pinepine ʻia. Hiki ke kuhi pinepine ʻia nā plaques no ka eczema a i ʻole psoriasis.
Nā Tumors - he mau puʻupuʻu, puʻupuʻu a i ʻole nā nodule i lilo i mau ʻeha i hoʻōla ʻole i kekahi manawa.
ʻO Lymphoma ʻili ʻino a ʻoi loa
Inā loaʻa iā ʻoe kahi lymphoma cutaneous koʻikoʻi a kiʻekiʻe paha, loaʻa paha iā ʻoe kekahi o nā hōʻailona ma luna, akā loaʻa iā ʻoe kekahi mau hōʻailona ʻē aʻe. Hiki i kēia mau mea ke komo:
- ʻO nā puʻupuʻu lymph pehu i hiki iā ʻoe ke ʻike a manaʻo paha me he puʻupuʻu ma lalo o kou ʻili - ma kou ʻāʻī, ʻāʻī a i ʻole ka ʻāʻī.
- ʻO ka luhi ka luhi nui ʻaʻole i hoʻomaikaʻi ʻia me ka hoʻomaha a me ka hiamoe.
- He koko ʻokoʻa a ʻeha paha.
- ʻO nā maʻi e hoʻi mau ana a hele ʻole paha.
- Pokole o ka hanu.
- B-hōʻailona.
Pehea e ʻike ʻia ai ka lymphoma cutaneous?
Pono ʻoe i kahi biopsy a i ʻole kekahi mau biopsies e ʻike ai i ka lymphoma cutaneous. ʻO ke ʻano o ka biopsy i loaʻa iā ʻoe e hilinaʻi ʻia i ke ʻano o ka ʻūhū a i ʻole nā ʻeha āu e loaʻa ai, kahi e loaʻa ai ma kou kino a me ka nui o lākou. E hilinaʻi nō hoʻi ia inā ʻo kou ʻili wale nō ka mea i hoʻopilikia ʻia, a i ʻole ua laha ka lymphoma i nā wahi ʻē aʻe o kou kino e like me kou lymph nodes, nā ʻōkana, ke koko a i ʻole ka iwi iwi. Aia ma lalo nei kekahi o nā ʻano biopsies i ʻōlelo ʻia no ʻoe.
ʻ binaehana ʻili
ʻO ka biopsy ka ʻili i ka wā e wehe ʻia ai kahi laʻana o kou ʻūhū a i ʻole ʻeha a hoʻouna ʻia i ka maʻi maʻi no ka hoʻāʻo ʻana. I kekahi mau hihia, inā loaʻa iā ʻoe kahi lesion hoʻokahi, hiki ke wehe ʻia ka ʻeha holoʻokoʻa. Aia nā ala like ʻole e hana ai i ka biopsy ʻili, a hiki i kāu kauka ke kamaʻilio me ʻoe e pili ana i ka biopsy ʻili kūpono no kou kūlana.
ʻO ka biopsy Lymph node
Inā loaʻa iā ʻoe ka pehu lymph nodes i ʻike ʻia a ʻike ʻia paha, a i ʻole i hōʻike ʻia ma nā scans, loaʻa paha iā ʻoe kahi biopsy e ʻike ai inā ua laha ka lymphoma i kāu mau lymph nodes. ʻElua ʻano nui o nā biopsies lymph node i hoʻohana ʻia e ʻike i ka lymphoma.
Nā lākou:
Biopsy kikine ʻehā - kahi e hoʻohana ʻia ai ka nila e wehe i kahi laʻana o kāu puʻu lymph i hoʻopilikia ʻia. E loaʻa iā ʻoe kahi anesthetic kūloko e hoʻopau i ka wahi i ʻole ʻoe e ʻeha i kēia kaʻina hana. I kekahi mau hihia, hiki i ke kauka a i ʻole radioologist ke hoʻohana i kahi ultrasound e alakaʻi i ka nila i kahi kūpono no ka biopsy.
ʻO ka biopsy ʻokiʻoki - me kahi biopsy excisional e loaʻa paha iā ʻoe kahi maʻi maʻi maʻamau no laila e hiamoe ʻoe ma ke kaʻina hana. Hoʻopau ʻia kahi puʻupuʻu lymph holoʻokoʻa a i ʻole lesion i ka wā a me ka biopsy excisional i hiki ke nānā ʻia ka node a i ʻole lesion holoʻokoʻa i ka pathology no nā hōʻailona o ka lymphoma. Loaʻa paha iā ʻoe kekahi mau humuhumu a me kahi ʻaʻahu i kou ala ʻana. Hiki i kāu kahu ke kamaʻilio me ʻoe e pili ana i ka mālama ʻana i ka ʻeha, a i ka manawa/inā pono ʻoe e wehe i nā humuhumu.
ʻO nā ʻano liʻiliʻi o nā lymphomas T-cell indolent cutaneous
ʻO ka Mycosis Fungoides ka subtype maʻamau o ka lymphoma T-cell ʻokiʻoki indolent. Hoʻopilikia pinepine ia i ka poʻe ʻelemakule, a ʻoi aku ka nui o nā kāne ma mua o nā wahine, akā hiki i nā keiki ke hoʻomohala i ka MF. I nā keiki, pili like ia i nā keikikāne a me nā kaikamahine a ʻike pinepine ʻia ma kahi o 10 mau makahiki.
Hoʻopilikia wale ʻo MF i kou ʻili, akā ma kahi o 1 i ka 10 poʻe e loaʻa i kahi ʻano MF ʻoi aku ka koʻikoʻi hiki ke laha i kou mau lymph nodes, koko a me nā ʻōpū o loko. Inā loaʻa iā ʻoe kahi MF koʻikoʻi, pono ʻoe e mālama e like me nā lāʻau lapaʻau i hāʻawi ʻia no nā lymphoma T-cell ʻē aʻe koʻikoʻi.
ʻO ka ALCL ʻili mua kahi lymphoma molowa (e ulu mālie) e hoʻomaka ana i loko o nā pūnaʻi T ma nā papa o kou ʻili.
Kapa ʻia kēia ʻano lymphoma i kekahi manawa he subtype o lymphoma cutaneous a i kekahi manawa i kapa ʻia he subtype o Anaplastic Large Cell Lymphoma (ALCL). ʻO ke kumu o ka hoʻokaʻawale ʻokoʻa ʻana no ka loaʻa ʻana o nā ʻano lymphoma i nā ʻano like ʻole o nā ʻano ALCL e like me ke ʻano nui loa o nā pūnaewele i ʻokoʻa loa ke ʻano o kāu mau pūnae T maʻamau. Eia nō naʻe, maʻamau, pili wale ia i kou ʻili a ulu mālie.
ʻAʻole like me nā ʻano subtypes koʻikoʻi o ka lymphoma cutaneous a me ka ALCL, ʻaʻole pono ʻoe i kahi lapaʻau no PcALCL. Hiki paha iā ʻoe ke noho me PcALCL no ke koena o kou ola, akā he mea nui e ʻike, hiki iā ʻoe ke ola maikaʻi me ia, a ʻaʻohe hopena maikaʻi ʻole i kou olakino. Hoʻopilikia wale ia i kou ʻili a ʻokoʻaʻole laha ma mua o kou ʻili i nā wahi ʻē aʻe o kou kino.
Hoʻomaka maʻamau ka PcALCL me ka ʻūhū a i ʻole nā puʻupuʻu ma kou ʻili e ʻeha a ʻeha paha, akā ʻaʻole paha e hōʻeha iā ʻoe. I kekahi manawa, ua like paha ia me ka ʻeha ʻaʻole hoʻōla e like me kou manaʻo. ʻO kēlā me kēia lāʻau lapaʻau o PcALCL he mea ia e hoʻomaikaʻi ai i ka ʻeha a i ʻole ka ʻeha, a i ʻole e hoʻomaikaʻi i ke ʻano o ka lymphoma ma mua o ka mālama ʻana i ka lymphoma ponoʻī. Eia naʻe, inā pili ka PcALCL i kahi ʻāpana liʻiliʻi loa o ka ʻili, hiki ke wehe ʻia me ka ʻoki ʻana a i ʻole ma o ka radiotherapy.
He mea maʻamau ka PcALCL i nā poʻe ma waena o 50-60 mau makahiki, akā hiki ke hoʻopilikia i kēlā me kēia makahiki, me nā keiki.
Hiki ke loaʻa ka SPTCL i nā keiki a me nā mākua akā ʻoi aku ka maʻamau i nā pākeke, me ka awelika o ka makahiki ma ka hōʻoia ʻana he 36 mau makahiki. Ua kapa ʻia ʻo ia no ka mea ua like ia me kahi maʻi ʻē aʻe i kapa ʻia ʻo panniculitis, ka mea i loaʻa i ka wā e ʻā ai ka ʻiʻo momona ma lalo o ka ʻili, e ulu ai nā puʻupuʻu. Ma kahi o hoʻokahi o ʻelima mau kānaka me ka SPTCL e loaʻa pū kekahi maʻi auto-immune e hoʻouka ai kāu ʻōnaehana pale i kou kino.
Loaʻa ka SPTCL i ka wā e hele ai nā pūnaʻi T maʻi ʻaʻai a noho i loko o nā papa hohonu o kou ʻili a me nā ʻiʻo momona, e piʻi mai ana nā puʻupuʻu ma lalo o kou ʻili a hiki iā ʻoe ke ʻike a ʻike paha. Hiki paha iā ʻoe ke ʻike i kekahi mau palaka ma kou ʻili. ʻO ka hapa nui o nā liona ma kahi o 2cm ka nui a i ʻole ka liʻiliʻi.
ʻO nā hopena ʻaoʻao ʻē aʻe āu e loaʻa ai me SPTCL e komo pū ana:
- ke koko a i ʻole ke koko ʻokoʻa
- nā'ōpū
- haemophagocytic lymphohistiocytosis - kahi maʻi i loaʻa iā ʻoe ka nui o nā cell immune i hoʻoikaika ʻia e hōʻino i kou iwi iwi, nā ʻāpana koko olakino a me nā kino.
- ʻO ke akepaʻa i hoʻonui ʻia a/a i ʻole ka spleen.
Hiki i ka Lymphomatoid papulosis (LyP) ke hoʻopilikia i nā keiki a me nā mākua. ʻAʻole ia he kanesa no laila ʻaʻole ia he ʻano lymphoma. Eia nō naʻe, manaʻo ʻia he precursor no ka lymphoma T-cell cutaneous e like me Mycosis Fungoides a i ʻole Primary Cutaneous Anaplastic Large Cell Lymphoma, a ʻoi aku ka kakaikahi. ʻO Hodgkin Lymphoma. Inā ua ʻike ʻia ʻoe me kēia maʻi ʻaʻole pono ʻoe i kahi lapaʻau, akā e nānā pono ʻia e kāu kauka no nā hōʻailona o ka huli ʻana o ka LyP i ke kanesa.
He maʻi ia e pili ana i kou ʻili kahi e loaʻa ai iā ʻoe nā puʻupuʻu e hele mai a hele i kou ʻili. Hiki ke hoʻomaka liʻiliʻi nā ʻeha a nui aʻe. Hiki iā lākou ke pohā a kahe ke koko ma mua o ka maloʻo ʻana a hele aku me ka ʻole o ka lāʻau lapaʻau. Hiki iā ia a hiki i 2 mau mahina no ka hele ʻana o nā ʻeha. Eia nō naʻe, inā hoʻoulu lākou i ka ʻeha a i ʻole nā hōʻailona hōʻoluʻolu ʻē aʻe paha e loaʻa iā ʻoe ka lāʻau lapaʻau e hoʻomaikaʻi ai i kēia mau hōʻailona.
Inā loaʻa pinepine ʻoe i nā ʻōpala a i ʻole nā ʻeha e like me kēia, e ʻike i kāu kauka no kahi biopsy.
ʻO nā ʻano liʻiliʻi o nā lymphoma ʻili kino B-cell
ʻO ka Lymphoma maʻamau ʻo Primary Cutaneous Follicle Center (pcFCL) kahi lymphoma B-cell molowa (e ulu mālie). He mea maʻamau ia ma ka honua komohana a pili i nā poʻe maʻi kahiko, me ka awelika o ka makahiki ma ka maʻi maʻi he 60 mau makahiki.
ʻO kēia ka subtype maʻamau o Cutaneous B-Cell Lymphoma. He molowa (ke ulu mālie) a ulu aʻe i nā mahina, a i ʻole nā makahiki. ʻIke ʻia ma ke ʻano he ʻulaʻula ʻulaʻula a ʻulaʻula paha a i ʻole he maʻi koko ma ka ʻili o kou poʻo, ʻāʻī, umauma, a i ʻole ʻōpū. ʻAʻole pono ka poʻe he nui i ka lāʻau lapaʻau no ka pcFCL akā inā loaʻa iā ʻoe nā hōʻailona hōʻoluʻolu, a i ʻole pilikia i kona helehelena, hiki ke hāʻawi ʻia iā ʻoe ka lāʻau lapaʻau e hoʻomaikaʻi i nā hōʻailona a i ʻole ke ʻano o ka lymphoma.
ʻO ka Primary Cutaneous Marginal Zone Lymphoma (pcMZL) ka lua o ka subtype maʻamau o nā lymphomas cutaneous B-cell a pili i nā kāne ʻelua ʻoi aku ka nui o nā wahine, akā hiki nō naʻe ke loaʻa i nā keiki. He mea maʻamau ia i ka poʻe ʻelemakule ma luna o 55 mau makahiki, a me ka poʻe i loaʻa i ka maʻi Lyme ma mua.
Hiki ke hoʻololi i ka ʻili ma kahi hoʻokahi, a i ʻole ma kekahi mau wahi a puni kou kino. ʻOi aku ka maʻamau e hoʻomaka ana ma kou mau lima, ka umauma a i ʻole ke kua me he ʻulaʻula, ʻulaʻula a poni a i ʻole nā puʻupuʻu.
Loaʻa kēia mau hoʻololi i kahi manawa lōʻihi, no laila ʻaʻole ʻike nui ʻia. ʻAʻole pono ʻoe i ka mālama ʻana i ka pcMZL, akā hiki ke hāʻawi ʻia nā lāʻau lapaʻau inā loaʻa iā ʻoe nā hōʻailona e hopohopo ai ʻoe.
He ʻano liʻiliʻi loa kēia o ka CBCL i loaʻa i nā poʻe maʻi i pale ʻia a loaʻa iā Epstein-Barr virus - ka maʻi e hoʻoulu ai i ka maʻi glandular.
Hoʻokahi wale nō maʻi maʻi maʻi ma kou ʻili a i kāu ʻāpana ʻōpū a i ʻole waha. ʻAʻole pono ka hapa nui o nā kānaka i ka lapaʻau ʻana no kēia ʻano subtype o CBCL. Eia naʻe, inā e lawe ana ʻoe i nā lāʻau lapaʻau immunosuppressive, hiki i kāu kauka ke nānā i ke ʻano o ka maʻi e hiki ai i kāu ʻōnaehana pale ke ola iki.
I nā hihia koʻikoʻi, pono paha ʻoe e mālama me kahi antibody monoclonal a i ʻole ka lāʻau anti-viral.
Nā ʻano liʻiliʻi o Aggressive Lymphoma
Ua kapa ʻia ʻo Sezary Syndrome no ka mea ua kapa ʻia nā pūnaewele T maʻi kanesa.
ʻO ia ka lymphoma T-cell cutaneous ʻoi loa a ʻaʻole like me nā ʻano CTCL ʻē aʻe, ʻike ʻia ka lymphoma (Sezary) ʻaʻole wale ma nā papa o kou ʻili, akā i loko o kou koko a me ka iwi iwi. Hiki iā lākou ke hoʻolaha i kāu mau lymph nodes a me nā mea ʻē aʻe.
Hiki i ka Sezary Syndrome ke hoʻopilikia i kekahi akā ua maʻamau iki i nā kāne ma mua o 60 mau makahiki.
ʻO nā hōʻailona e loaʻa iā ʻoe me Sezary Syndrome penei:
- B-hōʻailona
- ʻinoʻino nui
- pehu lymph node
- akepaʻa akepaʻa a me / a i ʻole pelu
- ka mānoanoa o ka ʻili ma nā poho lima a i ʻole ka wāwae
- mānoanoa o kou manamana lima a me kou manamana wāwae
- pau ka lauoho
- ka hāʻule ʻana o kou poʻi maka (kapa ʻia kēia ectropion).
Ma muli o ke ʻano ulu wikiwiki o nā cell Sezary, hiki iā ʻoe ke pane maikaʻi i ka chemotherapy e hana ana ma ka luku ʻana i nā cell ulu wikiwiki. Eia nō naʻe, he mea maʻamau ka hoʻihoʻi ʻana me Sezary Syndrome, ʻo ia hoʻi, ʻoiai ma hope o ka pane maikaʻi ʻana, e hoʻi hou mai ana ka maʻi a pono e mālama hou.
He lymphoma T-cell nui loa keia e ulu koke ana ma ka ili ma ke kino holookoa. Hiki i nā ʻeha ke lilo i papules, nodules a i ʻole nā maʻi koko e hiki ke ʻeha a ʻike ʻia e like me nā ʻeha hāmama. Ua like paha kekahi me nā pāpaʻi a i ʻole nā ʻōpala a ke koko kekahi.
Hiki i nā ʻōuli ʻē aʻe ke:
- B-hōʻailona
- Pau ka maʻi
- luhi
- diarrhea
- luaʻi
- pehu lymph node
- hoʻonui i ke akepaʻa a i ʻole ka spleen.
Ma muli o ke ʻano koʻikoʻi, hiki i ka PCAETL ke hoʻolaha i nā wahi i loko o kou kino me nā lymph nodes a me nā mea ʻē aʻe.
Pono ʻoe i ka mālama ʻana me ka chemotherapy ma hope koke o ka hōʻoia ʻana.
ʻO ka ʻili mua (ʻili) hoʻopuehu nui B-cell lymphoma He ʻano liʻiliʻi liʻiliʻi o ka lymphoma e pili ana ma lalo o 1 o 100 poʻe me NHL.
He mea maʻamau kēia ma mua o nā ʻano subtypes o Cutaneous B-Cell Lymphomas. ʻOi aku ka maʻamau i nā wahine ma mua o nā kāne a makemake i ka ulu ʻana a i ʻole ka ulu wikiwiki. ʻO ia hoʻi me ka hoʻopili ʻana i kou ʻili, hiki iā ia ke laha koke i nā wahi ʻē aʻe o kou kino, me kāu mau lymph nodes a me nā ʻāpana ʻē aʻe.
Hiki iā ia ke ulu ma luna o nā pule a i nā mahina, a pili pinepine ia i ka poʻe ʻelemakule ma kahi o 75 mau makahiki. Hoʻomaka pinepine ia ma kou mau wāwae (Leg-type) ma ke ʻano he hoʻokahi a ʻoi aʻe paha nā lesions/tumour akā hiki ke ulu pū ma kou mau lima a me kou ʻōpū (ka umauma, hope a me ka ʻōpū).
Kapa ʻia ʻo ia ʻo Primary Cutaneous Diffuse Large B-cell Lymphoma no ka mea ʻoiai e hoʻomaka ana ia i loko o nā pūnaʻi B ma nā ʻāpana o kou ʻili, ua like nā lymphoma cell me nā mea i loaʻa ma nā ʻano subtypes o Diffuse Large B-cell Lymphoma (DLBCL). No kēia kumu, ua mālama like ʻia kēia ʻano subtype o B-cell Lymphoma me nā ʻano subtype ʻē aʻe o DLBCL. No ka 'ike hou aku ma DLBCL, kaomi maanei.
ʻO ka hoʻopaʻa ʻana o Cutaneous Lymphoma
Ke hōʻoia ʻia he lymphoma ʻili kou, pono ʻoe e hoʻāʻo hou e ʻike inā ua laha ka lymphoma i nā wahi ʻē aʻe o kou kino.
Ke kaulike
E hana kāu kauka i kahi hoʻokolohua kino a nānā i ka ʻili ma kou kino holoʻokoʻa e ʻike i ka nui o kou ʻili i hoʻopilikia ʻia e ka lymphoma. Hiki iā lākou ke noi i kou ʻae e kiʻi i nā kiʻi i loaʻa iā lākou kahi moʻolelo o kona ʻano ma mua o kou hoʻomaka ʻana i kekahi lapaʻau. E hoʻohana lākou i kēia mau mea e nānā inā loaʻa ka hoʻomaikaʻi ʻana me ka mālama ʻana. ʻO ka ʻae kāu koho, ʻaʻole pono ʻoe e kiʻi i nā kiʻi inā ʻaʻole ʻoluʻolu ʻoe i kēia, akā inā ʻae ʻoe, pono ʻoe e kau inoa i kahi palapala ʻae.
ʻO Positron Emission Tomography (PET) Scan
ʻO ka PET scan kahi scan o kou kino holoʻokoʻa. Hana ʻia ia ma kahi ʻāpana kūikawā o ka haukapila i kapa ʻia ʻo "lāʻau lapaʻau nuklea" a e hāʻawi ʻia ʻoe i kahi lāʻau lapaʻau radioactive e hoʻomoʻa ʻia e nā cell lymphoma. Ke lawe ʻia ka nānā ʻana, e hoʻomālamalama nā wahi me ka lymphoma i ka scan e hōʻike i kahi o ka lymphoma a me ka nui a me ke ʻano.
Hoʻopili ʻia ka Tomography (CT).
ʻO ka CT scan he X-ray kūikawā e lawe i nā kiʻi 3 dimensional o loko o kou kino. ʻO ka maʻamau e nānā i kahi ʻāpana o kou kino e like me kou umauma, ʻōpū a i ʻole pelvis. Hiki ke hōʻike ʻia kēia mau kiʻi inā ua pehu ʻoe i nā pūnaʻi lymph i loko o kou kino, a i ʻole nā wahi i ʻike ʻia i ka maʻi kanesa i loko o kou mau kino.
Biopsy Iwi Iwi
ʻAʻole pono ka hapa nui o nā kānaka me ka lymphoma ʻili i kahi biopsy iwi iwi. Eia naʻe, inā he subtype koʻikoʻi kāu, pono paha ʻoe e nānā inā ua laha ka lymphoma i kou iwi iwi.
ʻElua ʻano biopsies i lawe ʻia i ka wā biopsy iwi iwi:
- 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
Pūnaehana hoʻonohonoho TNM/B no ka lymphoma ʻili
Hoʻohana ka hoʻonohonoho ʻana o ka lymphoma cutaneous i kahi ʻōnaehana i kapa ʻia ʻo TNM. Inā loaʻa iā ʻoe ka MF a i ʻole SS e hoʻohui ʻia kahi leka hou - TNMB.
T = nui o Tumour - a i ʻole ka nui o kou kino i hoʻopilikia ʻia e ka lymphoma.
N = lymph Ne pili ana - e nānā inā ua hele ka lymphoma i kāu lymph nodes, a me ka nui o nā lymph nodes i loaʻa ka lymphoma i loko.
M = Metastasis - nānā inā, a pehea ka lōʻihi o ka laha ʻana o ka lymphoma i loko o kou kino.
B = Blood - (MF a SS wale nō) nānā i ka nui o ka lymphoma i loko o kou koko a me ka iwi iwi.
ʻO TNM/B ka hoʻopaʻa ʻana o ka Lymphoma ʻili |
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ʻO Lymphoma ʻili |
Mycosis fungoides (MF) a i ʻole Sezary Syndrome (SS) wale nō |
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TʻO Tumoraʻili pahapilikia |
T1 – hoʻokahi wale nō lesion āu.T2 - ua ʻoi aku ʻoe ma mua o hoʻokahi ʻili ʻili akā aia nā ʻeha ma kahi ʻāpana, a i ʻole ʻelua mau wahi pili kokoke kou kino.T3 - loaʻa iā ʻoe nā ʻeha ma nā wahi he nui o kou kino. |
T1 - liʻiliʻi ma mua o 10% o kou ʻili i pili.T2 - ʻoi aku ma mua o 10 % o kou ʻili i pili.T3 - loaʻa iā ʻoe hoʻokahi a ʻoi aku ka nui o nā maʻi maʻi ma mua o 1cm.T4 – loaʻa iā ʻoe ka erythema (ʻulaʻula) e uhi ana ma mua o 80% o kou kino. |
NʻO LymphNodes |
N0 - kou lymph nodes ʻike maʻamau.N1 - hoʻokahi pūʻulu o nā lymph nodes i komo.N2 - ʻelua a ʻoi aku paha nā pūʻulu lymph nodes ma kou ʻāʻī, ma luna o kou clavicle, underarms, ʻāʻī a i ʻole nā kuli.N3 - nā pūnaʻi lymph i loko, a i ʻole kokoke i kou umauma, nā māmā a me nā alaloa, nā kīʻaha koko nui (aortic) a i ʻole nā pūhaka. |
N0 – He mea maʻamau kou mau ʻōpū lymph.N1 - loaʻa iā ʻoe nā ʻōpū lymph abnormal me nā loli haʻahaʻa.N2 - Loaʻa iā ʻoe nā ʻano lymph nodes me nā loli kiʻekiʻe.Nx - loaʻa iā ʻoe nā ʻōpū lymph abnormal, akā ʻaʻole ʻike ʻia ka papa. |
MMetastasis(palaha) |
M0 - ʻaʻohe o kāu mau lymph nodes i pili.M1 - ua laha ka lymphoma i kou mau ʻōpū lymph ma waho o kou ʻili. |
M0 - ʻaʻohe o kāu mau ʻōpū i loko, e like me ke akemāmā, ate, puʻupaʻa, lolo.M1 - ua laha ka lymphoma i hoʻokahi a ʻoi aʻe paha o kou mau kino i loko. |
Bke koko |
N / A |
B0 - emi iho ma lalo o 5% (5 o kēlā me kēia 100) lymphocytes maʻi ʻaʻai i loko o kou koko.Ua kapa ʻia kēia mau maʻi maʻi ʻaʻai i loko o kou koko.B1 - ʻOi aku ma mua o 5% o nā lymphocytes i loko o kou koko he Sezary cell.B2 - ʻOi aku ma mua o 1000 Sezary cell i kahi liʻiliʻi loa (1 microliter) o kou koko. |
Hiki i kāu kauka ke hoʻohana i nā leka ʻē aʻe e like me "a" a i ʻole "b" no ka wehewehe hou ʻana i kāu mau sela lymphoma. Hiki paha iā lākou ke kuhikuhi i ka nui o kāu lymphoma, ke ʻano o ka nānā ʻana o nā cell, a inā i hele mai lākou a pau mai kahi cell abnormal (clones) a ʻoi aku paha i hoʻokahi cell abnormal.E noi i kāu kauka e wehewehe i kāu pae a me kāu papa, a me ke ʻano o kāu lapaʻau. |
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Lapaʻau no Indolent Cutaneous Lymphoma
ʻAʻole hiki ke ho'ōla ʻia ka hapa nui o nā lymphoma palaualelo akā naʻe, ʻaʻole pono ka mālama ʻana i ka nui o nā poʻe me nā lymphoma ʻili palaualelo.
ʻAʻole hoʻi e pōʻino i kou olakino nā lymphoma ʻokoʻa ʻokoʻa, no laila, ʻo nā lāʻau āpau āu e mālama ai i kāu mau hōʻailona ma mua o ka hoʻōla ʻana i kou maʻi.
ʻO kekahi mau hōʻailona e pōmaikaʻi mai ka mālama ʻana, penei:
- eha
- maneo
- ʻeha a ʻeha paha e kahe mau ana ke koko
- hilahila a hopohopo paha e pili ana i ke ʻano o ka lymphoma.
Hiki i nā ʻano o ka lapaʻau ke komo i kēia mau mea.
Lapaʻau kūloko a ʻili paha.
ʻO nā lāʻau lapaʻau maʻamau he mau ʻaila āu e hamo ai i kahi o ka lymphoma, ʻoiai ʻo ka lāʻau i kuhikuhi ʻia i ka ʻili ke komo pū me ka radiotherapy a i ʻole phototherapy. Aia ma lalo kahi hiʻohiʻona o kekahi mau lapaʻau e hāʻawi ʻia iā ʻoe.
Corticosteroids - he mea ʻawaʻawa no nā pūnaewele lymphoma a kōkua i ka luku ʻana iā lākou. Hiki iā lākou ke hōʻemi i ka mumū a kōkua i ka hoʻomaikaʻi ʻana i nā hōʻailona e like me ka ʻili.
ʻO nā Retinoids - he mau lāʻau like loa me ka huaʻa A. Hiki iā lākou ke kōkua i ka hoʻohaʻahaʻa ʻana i ka mumū, a hoʻoponopono i ka ulu ʻana o nā cell ma ka ʻili. Hoʻohana liʻiliʻi ʻia lākou, akā kōkua i kekahi mau ʻano lymphoma ʻili.
Kiʻi kiʻi He ʻano lāʻau lapaʻau e hoʻohana ana i nā kukui kūikawā (pinepine UV) ma nā wahi o kou ʻili i loaʻa i ka lymphoma. Hoʻopilikia ka UV i ke kaʻina o ka ulu ʻana o nā cell, a ma ka hōʻino ʻana i ke kaʻina ulu, ua luku ʻia ka lymphoma.
ʻO ke kelepona - hoʻohana i nā kukui X e hoʻopōʻino i ka DNA o ka cell (ke genetic material o ka cell) i hiki ʻole ai i ka lymphoma ke hoʻoponopono iā ia iho. ʻO kēia ke kumu e make ai ke kelepona. He mau lā a he mau pule paha ma hope o ka hoʻomaka ʻana o ka mālama ʻana i ka radiation no ka make ʻana o nā cell. Hiki ke hoʻopau ʻia kēia hopena no kekahi mau mahina, ʻo ia hoʻi, hiki ke luku ʻia nā sela lymphoma maʻi maʻi ma kahi i mālama ʻia a hiki i nā mahina ma hope o ka pau ʻana o ka mālama ʻana.
I kekahi mau hihia, hiki ke ʻoki ʻia ʻoe, ma lalo o kahi anesthetic kūloko a maʻamau paha e wehe i ka ʻāpana āpau o ka ʻili i loaʻa i ka lymphoma. ʻOi aku kēia inā loaʻa iā ʻoe hoʻokahi lesion a i ʻole kekahi mau liona liʻiliʻi. Hoʻohana maʻamau ia ma ke ʻano he ʻāpana o ke kaʻina hana e ʻike ai i kāu lymphoma, ʻaʻole ma ke ʻano he lāʻau lapaʻau.
Nā lāʻau lapaʻau
Inā loaʻa iā ʻoe nā wahi he nui o kou kino i hoʻopilikia ʻia e ka lymphoma, hiki iā ʻoe ke pōmaikaʻi mai kahi mālama ʻōnaehana e like me ka chemotherapy, immunotherapy a i ʻole ka lāʻau lapaʻau. Hōʻike ʻia kēia mau kikoʻī ma lalo o ka pauku aʻe - Hoʻomaʻamaʻa no ka lymphoma cutaneous aggressive.
Lapaʻau ʻana no ka Lymphoma Cutaneous Aggressive a i ʻole Advanced Cutaneous Lymphoma
Hoʻohana like ʻia nā lymphoma ʻili aʻe a / a i ʻole nā ʻano lymphoma ʻē aʻe a hiki ke komo:
Nā lāʻau lapaʻau
He ʻano lāʻau lapaʻau ʻo Chemotherapy e hoʻouka pololei i nā cell ulu wikiwiki, no laila hiki ke hana maikaʻi i ka luku ʻana i nā lymphomas ulu wikiwiki. Akā ʻaʻole hiki iā ia ke haʻi i ka ʻokoʻa ma waena o ke olakino a me ke kanesa e ulu wikiwiki ana, no laila hiki ke hoʻoulu i kekahi mau hopena ʻaoʻao i makemake ʻole ʻia e like me ka nalowale o ka lauoho, nausea a me ka luaʻi ʻana, a i ʻole ka maʻi a me ka constipation.
Hiki i nā Immunotherapies ke kōkua i kāu ʻōnaehana pale e ʻimi a hakakā maikaʻi i ka lymphoma. Hiki iā lākou ke hana i kēia ma nā ʻano he nui. Hoʻopili kekahi, e like me nā antibodies monoclonal i ka lymphoma e kōkua i kāu ʻōnaehana pale e "ʻike" i ka lymphoma i hiki iā ia ke ʻike a luku iā ia. Hiki iā lākou ke hoʻopili i ke ʻano o ka paia o ka pā lymphoma, e make ai lākou.
- ʻO Rituximab he laʻana o kahi antibody monoclonal hiki ke hoʻohana ʻia e mālama i ka hele mai B-cell lymphomas me ka lymphoma B-cell cutaneous inā loaʻa iā lākou kahi māka CD20 ma luna o lākou.
- Mogamulizumab he laʻana o ka antibody monoclonal i ʻae ʻia no ka poʻe me ʻO Mycosis Fungides a i ʻole Sezary Syndrome.
- ʻO Brentuximab vedotin he laʻana o ka "conjugated" monoclonal antibody i ʻae ʻia no kekahi mau ʻano ʻē aʻe Pūnaewele T lymphoma i loaʻa kahi hōʻailona CD30 ma luna o lākou. Loaʻa iā ia kahi mea ʻawaʻawa i hoʻopili ʻia (conjugated) i ka antibody, a hāʻawi ka antibody i ke ʻawaʻawa pololei i loko o ka cell lymphoma e luku iā ia mai loko.
ʻO nā mea ʻē aʻe, e like me nā interleukins a me nā interferon, he mau protein kūikawā i kū maoli i loko o ko mākou kino, akā hiki ke lawe ʻia i lāʻau lapaʻau. Hana lākou ma ka hoʻoikaika ʻana i kāu ʻōnaehana pale, kōkua iā ia e hoʻāla i nā cell immune ʻē aʻe, a ma ka haʻi ʻana i kou kino e hana i nā cell immune hou aku e hakakā ai i ka lymphoma.
Loaʻa paha iā ʻoe nā immunotherapies iā lākou iho, a i hui pū ʻia me nā ʻano lapaʻau ʻē aʻe e like me ka chemotherapy.
ʻO nā lāʻau lapaʻau i hoʻopaʻa ʻia he mau lāʻau i hoʻopaʻa ʻia i kahi mea kikoʻī i ka cell lymphoma, no laila ʻoi aku ka liʻiliʻi o nā hopena ʻaoʻao ma mua o nā lāʻau lapaʻau ʻē aʻe. Ke hana nei kēia mau lāʻau lapaʻau ma ka hoʻopau ʻana i nā hōʻailona e pono ai ke ola o nā sela lymphoma. Ke loaʻa ʻole kēia mau hōʻailona, pau ka ulu ʻana o nā sela lymphoma, a pōloli paha no ka loaʻa ʻole o nā meaʻai e pono ai ke ola.
Ke kuʻi ʻōnaʻi ʻōnaeho
Hoʻohana wale ʻia ka hoʻololi ʻana o ka stem cell inā ʻaʻole i pane kāu lymphoma i nā lāʻau lapaʻau ʻē aʻe (he refractory), a i ʻole e hoʻi mai ma hope o ka manawa o ke kala ʻana (hoʻi hou). He lāʻau lapaʻau nui ia kahi e hoʻoneʻe ʻia ai kāu iho, a i ʻole nā pūnaewele kumu o ka mea hāʻawi (ke koko ʻole loa) ma o ke kaʻina hana i kapa ʻia ʻo apheresis, a laila hāʻawi ʻia iā ʻoe i kekahi manawa ma hope, ma hope o kou loaʻa ʻana i ka chemotherapy kiʻekiʻe.
Me ka lymphoma cutaneous, ʻoi aku ka maʻamau o ka loaʻa ʻana o nā pūnaewele mai kahi mea hāʻawi ma mua o kāu ponoʻī. Ua kapa ʻia kēia ʻano o ka hoʻololi ʻana i ke ʻano he Allogeneic Stem Cell transplant.
ʻO ke kiʻi kiʻi extracorporeal (ECP)
ʻO ka photopheresis extracorporeal kahi lapaʻau i hoʻohana nui ʻia no MF a me SS kiʻekiʻe. He kaʻina hana ia o ka "holoi" i kou koko a me ka hoʻoikaika ʻana i kāu mau mea pale i ka lymphoma e make ai nā pūnaewele lymphoma. Inā makemake ʻoe i kēia lāʻau lapaʻau, hiki i kāu kauka ke hāʻawi iā ʻoe i ka ʻike hou aku.
Nā ho'āʻo hoʻokolohua
Manaʻo ʻia ʻo kēlā me kēia manawa e pono ai ʻoe e hoʻomaka i ka mālama ʻana e nīnau ʻoe i kāu kauka e pili ana i nā hoʻokolohua lapaʻau hiki iā ʻoe ke kūpono. He mea nui nā hoʻokolohua lapaʻau no ka ʻimi ʻana i nā lāʻau lapaʻau hou, a i ʻole nā hui pū ʻana o nā lāʻau e hoʻomaikaʻi ai i ka mālama ʻana i ka lymphoma ʻili i ka wā e hiki mai ana.
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 lapaʻau hou e hoʻāʻo ʻia nei i nā hoʻokolohua lapaʻau a puni ka honua no nā poʻe maʻi me nā lymphomas cutaneous hou i ʻike hou ʻia.
ʻO nā koho lapaʻau no ka lymphoma cutaneous hōʻeuʻeu a hope paha | |
B-cell cutaneous | T-cell cutaneous |
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E nīnau pū i kāu kauka haematologist a i ʻole oncologist e pili ana i nā hoʻokolohua lapaʻau āu e ʻae ai. | |
He aha ka hopena inā ʻaʻole holo ka lāʻau lapaʻau, a hoʻi hou mai ka lymphoma
I kekahi manawa ʻaʻole pono ka mālama ʻana i ka lymphoma i ka wā mua. Ke hana ʻia kēia, kapa ʻia ʻo ia he lymphoma refractory. I nā hihia ʻē aʻe, hiki ke hana maikaʻi ka mālama ʻana, akā ma hope o ka manawa o ke kala ʻana hiki ke hoʻi mai ka lymphoma - ua kapa ʻia kēia he relapse.
Inā loaʻa iā ʻoe ka lymphoma hou a i ʻole refractory, makemake kāu kauka e hoʻāʻo i kahi lapaʻau ʻē aʻe i ʻoi aku ka maikaʻi no ʻoe. Ua kapa ʻia kēia mau lāʻau lapaʻau ʻē aʻe he lapaʻau laina lua, a ʻoi aku ka maikaʻi ma mua o ka lapaʻau mua.
E kamaʻilio me kāu kauka e pili ana i nā manaʻolana o kāu mālama ʻana, a he aha ke kumumanaʻo inā ʻaʻole hana kekahi o ia mau mea.
He aha kāu e manaʻo ai ke pau ka mālama ʻana
Ke hoʻopau ʻoe i kāu mālama ʻana, makemake mau kāu kauka lapaʻau e ʻike mau iā ʻoe. E loaʻa iā ʻoe nā hōʻoia maʻamau me nā hoʻāʻo koko a me nā scans. ʻEhia ka manawa e loaʻa ai kēia mau hoʻāʻo ʻana ma muli o kou kūlana pilikino a hiki i kāu kauka hematologist ke haʻi iā ʻoe i ka nui o ko lākou makemake e ʻike iā ʻoe.
He manawa hoʻohauʻoli a pilikia paha ke hoʻopau ʻoe i ka mālama ʻana - i kekahi manawa ʻelua. ʻAʻohe ala kūpono a hewa ʻole. Akā, he mea nui e kamaʻilio e pili ana i kou mau manaʻo a me kāu mea e pono ai me kāu poʻe aloha.
Loaʻa ke kākoʻo inā pilikia ʻoe i ka hoʻopau ʻana i ka lāʻau lapaʻau. E kamaʻilio me kāu hui lapaʻau - kāu kauka haematologist a i ʻole kahu maʻi maʻi maʻi kūikawā no ka mea hiki iā lākou ke kuhikuhi iā ʻoe no nā lawelawe aʻoaʻo i loko o ka haukapila. Hiki i kāu kauka kūloko (ke kauka lapaʻau - GP) ke kōkua pū me kēia.
Nā kahu hānai Lymphoma
Hiki iā ʻoe ke hāʻawi i kekahi o kā mākou Lymphoma Care Nurses i kelepona a leka uila. E kaomi wale i ka pihi "Contact Us" ma lalo o ka pale no nā kikoʻī pili.
hōʻuluʻulu manaʻo
- ʻO ka lymphoma maʻemaʻe kahi subtype o Non-Hodgkin Lymphoma i loaʻa mai i nā keʻena koko maʻi maʻi i kapa ʻia ʻo lymphocytes, hele a noho i nā papa o kou ʻili.
- ʻAʻole pono ka mālama ʻia ʻana o Indolent Cutaneous Lymphomas no ka mea ʻaʻole pinepine lākou i ka pōʻino i kou olakino, akā loaʻa paha iā ʻoe ka lāʻau lapaʻau e mālama ai i nā hōʻailona inā hōʻoluʻolu lākou iā ʻoe, a i ʻole e laha ka lymphoma i kou lymph nodes a i ʻole nā wahi ʻē aʻe o kou kino.
- Pono ʻo Aggressive Cutaneous Lymphomas e lapaʻau ma hope koke o kou ʻike ʻia ʻana.
- Aia kekahi mau kauka lapaʻau like ʻole e mālama i kāu mālama, a e hilinaʻi ʻia kēia i kou kūlana.
- Inā pili kāu lymphoma i kou olakino noʻonoʻo a i ʻole kou naʻau, hiki iā ʻoe ke noi i kāu kauka no ka hāʻawi ʻana aku i kahi psychologist e kōkua iā ʻoe e hoʻokō.
- Nui nā lāʻau lapaʻau e hoʻomaikaʻi i kāu mau hōʻailona; akā, pono paha ʻoe i nā lāʻau lapaʻau no ka mālama ʻana i ka lymphoma, a hiki i kēia mau mea ke komo i ka chemotherapy, nā antibodies monoclonal, nā mea lapaʻau i hoʻopaʻa ʻia a me nā transplant cell stem.
