Remission, Relapse thiab Refractory Lymphoma yog dab tsi?
Kev Zam Txim
Kev tshem tawm tag nrho yog thaum koj qhov kev soj ntsuam & kev kuaj pom tsis pom muaj tus kab mob qog nqaij hlav hauv koj lub cev tom qab kho.
Kev tshem tawm ib nrab yog thaum tseem muaj lymphoma hauv koj lub cev, tab sis nws tsawg dua li ib nrab ntawm qhov nws tau ua ua ntej kho.
Relapse
Refractory
Remission verses ib txoj kev kho
Kev kho yog thaum koj tsis muaj cov tsos mob ntawm lymphoma tshuav nyob hauv koj lub cev thiab nws tsis zoo li yuav rov qab los. Cov kws kho mob feem ntau nyiam siv lo lus tshem tawm, vim peb paub tias lymphoma tuaj yeem rov qab los.
Ntev npaum li koj nyob hauv kev zam txim yuav tsawg dua rau qhov mob qog ntshav qog ntshav qab zib, yog li koj tus kws kho mob tuaj yeem hais tias koj kho tau zoo, tab sis feem ntau lawv yuav siv lo lus tshem tawm. Qhov no yog vim hais tias thaum muaj coob tus neeg yuav tsis muaj lawv cov lymphoma rov qab los, peb tsis paub meej tias leej twg yuav thiab leej twg yuav tsis rov qab los.
Qee tus neeg yuav muaj qee yam kev pheej hmoo uas ua rau nws muaj feem yuav rov qab los, tab sis koj yuav tsum tham nrog koj tus kws kho mob txog koj tus kheej cov kev pheej hmoo thiab kev pheej hmoo rau kev kho, kev kho mob lossis rov qab los.
Yuav ua li cas thaum lymphoma relapses?
Koj tus kws kho mob tseem yuav saib xyuas koj tom qab koj ua tiav kev kho mob, thiab ib qho ntawm cov laj thawj lawv ua qhov no yog saib xyuas cov tsos mob thiab cov tsos mob ntawm koj cov qog ntshav qab zib. Los ntawm kev txuas ntxiv mus ntsib koj tsis tu ncua, lawv yuav tuaj yeem khaws cov kev rov qab los sai sai, thiab xaj kom kuaj ntxiv lossis pib kho dua thaum xav tau.
Txawm hais tias nws yuav tsis txaus siab kom pom tias koj cov qog ntshav qab zib tau rov qab los, nws tseem ceeb heev kom paub tias txawm tias lymphoma rov qab los feem ntau teb tau zoo rau kev kho mob, thiab tej zaum yuav ua rau koj rov qab kho dua.
Relapses muaj ntau heev nyob rau hauv cov neeg uas muaj indolent lymphomas vim hais tias indolent lymphomas tsis pom zoo kho. Hloov chaw, koj yuav nyob nrog tus mob qog nqaij hlav tsis muaj zog rau tag nrho koj lub neej. Txawm li cas los xij, nyob nruab nrab ntawm kev kho mob thiab thaum lub sij hawm tshem tawm, ntau tus neeg ua lub neej zoo thiab ntau tus kuj muaj lub neej zoo li qub.
Hauv qee qhov tsis tshua muaj, tus kab mob qog nqaij hlav tsis muaj zog tuaj yeem hloov mus rau qhov sib txawv, thiab muaj kev sib kis ntau dua ntawm lymphoma. Transformed lymphoma yog txawv rau ib tug relapse. Yog xav paub ntxiv txog kev hloov pauv lymphoma nyem qhov txuas hauv qab no.
Vim li cas lymphoma relapse?
Relapse tuaj yeem tshwm sim rau ntau yam. Qee qhov no suav nrog:
- Tsis muaj kev paub kho mob rau qee cov qog ntshav qog ntshav, tshwj xeeb tshaj yog cov qog ntshav qog ntshav. Yog li, thaum txoj kev kho mob zoo ntawm kev tswj tus kab mob nws tsis tuaj yeem kho nws. Thaum koj muaj cov qog ntshav qog ntshav tsis txaus, yuav muaj qee cov qog ntshav qog ntshav uas muaj peev xwm sawv thiab loj hlob.
- Qee qhov kev hloov caj ces tsis tuaj yeem kho tau los ntawm kev kho tam sim no. Yog li, txawm tias tsis muaj cov tsos mob ntawm lymphoma tshuav nyob hauv koj lub cev, qee qhov kev hloov caj ces yuav ua rau lymphoma loj hlob ntxiv.
- Txawm tias thaum kuaj xyuas thiab kuaj pom tias tsis muaj lymphoma nyob hauv koj lub cev, qee zaum muaj cov kab mob qog nqaij hlav qog nqaij hlav uas muaj tsawg lossis tsawg dhau los kuaj pom los ntawm kev kuaj tam sim no thiab kuaj. Yog tias cov no tshwm sim, lawv tuaj yeem loj hlob thiab ntau ntxiv tom qab kev kho mob xaus.
Yuav ua li cas sai li sai tau rov qab tshwm sim?
Yog tias koj muaj tus kab mob qog nqaij hlav hnyav xws li Hodgkin Lymphoma lossis qhov mob hnyav heev (loj hlob sai) Tsis yog-Hodgkin Lymphoma, kev kho yuav zoo dua. Txawm li cas los xij, yog tias koj rov qab ua dua, feem ntau nws yuav tshwm sim hauv ob peb xyoos tom qab kho tiav.
Yog tias koj muaj qhov tsis txaus ntseeg (loj hlob qeeb) Non-Hodgkin Lymphoma, qhov rov tshwm sim ntau dua. Txawm hais tias tus mob rov qab tuaj yeem tshwm sim nyob rau lub hlis tom qab kev kho mob tiav, feem ntau kev kho mob yuav kav ntau xyoo ua ntej qhov rov tshwm sim.
Kawm txog kev kho cov qog ntshav qog ntshav qab zib nrog Dr Michael Dickinson
Hematologist
Yuav ua li cas koj thiaj paub yog tias lymphoma relapsed?
Lymphoma tuaj yeem rov qab rau tib qhov ntawm koj lub cev lossis nws tuaj yeem cuam tshuam rau lwm qhov ntawm koj lub cev txij li thaum koj muaj cov qog ntshav qog ua ntej. Tej zaum koj yuav lossis tsis muaj tsos mob thiab yog tias koj ua, lawv yuav suav nrog:
- Cov qog nqaij hlav tshiab los yog cov qog nqaij hlav uas tsis muaj feem cuam tshuam txog kev kis kab mob lossis mob
- Drenching hmo sweats
- Unexplained poob phaus
- Kev qaug zog uas phem dua li qub
- Khaus
- Cov tawv nqaij ua pob liab liab
- Zawv plab
- Mob los yog tsis xis nyob tsis piav qhia
- B-cov tsos mob.
Yuav ua li cas yog lymphoma relapses
- Biopsy ntawm cov qog ntshav qog ntshav tshiab los yog pob
- Kev kuaj ntshav
- Positron emission tomography (PET) scan
- Tham tomography (CT) scan
- Lumbar puncture yog tias lymphoma xav tias nyob hauv nruab nrab paj hlwb.
Yuav ua li cas yog tias kuv lymphoma refractory rau kev kho mob?
Nws tuaj yeem ntxhov siab kom pom tias koj qhov kev kho mob tam sim no tsis ua haujlwm los kho, nres lossis ua kom koj cov qog ntshav qis. Kev ntshai, npau taws lossis ntxhov siab yog qhov qub. Nws yog ib qho tseem ceeb kom nkag siab tias, vim tias qhov kev kho mob no tsis ua haujlwm raws li tau npaj tseg, nws tsis txhais hais tias kev cia siab ploj lawm. Ntau tus lymphomas uas tsis teb zoo rau kev kho thawj kab, tseem tuaj yeem muaj cov lus teb zoo rau kev kho thib ob lossis thib peb.
Refractory lymphoma tuaj yeem tshwm sim thaum cov qog ntshav qog ntshav tsim muaj kev tiv thaiv kev nyab xeeb lossis cov chaw kuaj xyuas uas ua rau lawv tiv thaiv cov qauv kev kho mob. Qee qhov kev hloov pauv caj ces kuj tuaj yeem ua rau nws tsis tshua muaj peev xwm rau qee qhov kev kho mob qog noj ntshav kom ua haujlwm tau zoo.
Thaum qhov no tshwm sim koj tus kws kho mob yuav xav sim ntau hom kev kho mob uas ua haujlwm sib txawv rau koj cov kev kho mob tam sim no.
Kuv yuav ua li cas thiaj paub yog tias kuv tus mob lymphoma refractory?
Koj yuav muaj kev tshuaj ntsuam xyuas tom qab koj tau ua tiav tsawg kawg ob lossis peb lub voj voog ntawm koj txoj kev kho mob. Raws nraim thaum koj muaj cov kev tshuaj ntsuam no yuav nyob ntawm koj tus kheej qhov xwm txheej, subtype thiab hom kev kho mob. Nug koj tus kws kho mob thaum koj yuav kuaj thiab kuaj ntxiv.
Feem ntau tom qab pib kho koj yuav pom tias koj cov qog nqaij hlav o lossis lwm yam tsos mob zoo dua tom qab ob peb lub voj voog ntawm kev kho mob. Txawm li cas los xij, qee zaum koj tuaj yeem pom, lossis kev tshuaj ntsuam xyuas yuav qhia tau tias lymphoma tsis tau zoo dua thiab koj yuav muaj cov chaw tshiab ntawm lymphoma.
Koj tus kws kho mob tuaj yeem txuas ntxiv nrog koj qhov kev kho mob tam sim no thiab kuaj xyuas ntau dua tom qab kev kho ntau zaus, lossis lawv yuav txiav txim siab hloov koj txoj kev kho tam sim ntawd. Lawv yuav tham nrog koj txog cov kev xaiv zoo tshaj plaws rau koj tus kheej qhov xwm txheej.
Cov kev kho mob rau relapsed los yog refractory lymphoma
Cov kev kho mob uas koj tau muab yog tias koj muaj tus kab mob rov qab los yog refractory lymphoma yuav nyob ntawm ntau yam, suav nrog:
- subtype, theem thiab qhov chaw/s ntawm koj cov lymphoma
- genetic mutations koom nrog hauv koj cov lymphoma
- yog tias koj tau muaj lub sijhawm zam txim thiab yog tias muaj, ntev npaum li cas koj tau nyob hauv kev zam txim
- koj lub hnub nyoog thiab kev noj qab nyob zoo
- koj tau tiv nrog cov kev kho mob yav dhau los li cas
- koj qhov kev tsim nyog rau kev sim tshuaj
- koj tus kheej nyiam.
Hom kev kho mob rau relapsed los yog refractory lymphoma
Nrog rau kev sim tshuaj thiab cov kev kho tshiab tau pom zoo rau kev kho mob lossis kev tswj cov qog ntshav qog ntshav hauv Australia, peb muaj ntau txoj kev xaiv ntawm kev kho mob thib ob thiab thib peb ntau dua li yav dhau los. Yog li ntawd, vim hais tias ntawm tej yam saum toj no, tsis muaj ib tug loj-fits-tag nrho cov mus kom ze rau kev kho mob. Txawm li cas los xij, qee qhov kev kho mob muaj nyob rau hauv kev kho mob thib ob thiab thib peb suav nrog:
- Kev koom tes nrog kev sim tshuaj
- Combination tshuaj kho mob
- Salvage chemotherapy (siab koob tshuaj chemotherapy)
- Stem cell hloov (autologous & allogeneic)
- Targeted therapy
- immunotherapy
- Tshuaj lom neeg
- Radiotherapy
- Chimeric antigen receptor (CAR) T-cell therapy
- Tawm daim ntawv lo nkag mus rau cov tshuaj.
Tawm daim ntawv lo nkag mus rau tshuaj
Qee zaum, tej zaum koj tuaj yeem nkag mus rau cov tshuaj uas tsis yog nyiaj txiag rau pej xeem, tab sis tau tshaj tawm tias muaj kev nyab xeeb thiab raug cai siv hauv Australia los ntawm Therapeutic Goods Administration (TGA).
Tej yam tseem ceeb yuav tsum paub txog:
- Qhov no yuav tsis yog qhov kev xaiv rau txhua tus neeg vim tias txhua lub xeev muaj cov cai thiab cov cai sib txawv.
- Tej zaum koj yuav tau mus ncig rau qee qhov lossis tag nrho cov kev kho mob.
- Nws tuaj yeem kim heev raws li koj yuav tsum tau them nyiaj rau tus kheej, lossis them rau koj tus kheej. Yog li, nws yog ib yam uas yuav tsum tau ua tib zoo xav thiab tham nrog koj tus kws kho mob hematologist kom nkag siab tag nrho.
- Qee qhov xwm txheej, koj tuaj yeem nkag mus rau cov tshuaj ntawm "kev hlub tshua" uas lub tuam txhab kws kho mob them rau qee lossis tag nrho cov nqi ntawm cov tshuaj tsis muaj npe. Nug koj tus kws kho mob seb qhov no yog ib qho kev xaiv rau koj.
Tau txais kev xav thib ob
Nws yog qhov ntau heev rau cov neeg mob thov kom muaj kev xav thib ob. Qhov no yog ib qho kev xaiv zoo los hnov cov kev xav ntawm tus kws kho mob hematologist thib ob uas tuaj yeem paub meej cov ntaub ntawv muab rau koj los ntawm koj thawj tus kws kho mob hematologist, lossis muab cov kev xaiv sib txawv. Tsis muaj laj thawj xav phem txog kev thov kom muaj kev xav thib ob. Feem ntau cov kws kho mob hematologist zoo siab rau koj nrhiav kev xav thib ob - Nws yog koj txoj kev noj qab haus huv tom qab tag nrho.
Yog tias koj xav tau qhov kev xav thib ob tham nrog koj tus kws kho mob hematologist. Feem ntau, lawv tuaj yeem npaj qee yam rau koj, lossis koj tuaj yeem tham nrog koj tus kws kho mob. Qhov no yog ib kauj ruam tseem ceeb hauv kev ua kom koj tau txais cov ntaub ntawv koj xav tau kom tau txais kev kho mob zoo rau koj tus kheej.
Kawm ntxiv txog 'tawm daim ntawv lo nkag' hauv video hauv qab no
Kev npaj kho mob
Kev cuam tshuam nrog lub siab lub ntsws thiab lub cev muaj zog ntawm kev muaj lymphoma, thiab kev kho mob tuaj yeem ua rau qaug zog. Nws yog ib qho tseem ceeb kom ncav cuag thiab tau txais kev txhawb nqa thaum koj xav tau. Feem ntau peb muaj cov neeg hauv peb lub neej uas xav pab, tab sis tsis paub yuav ua li cas. Qee tus neeg kuj txhawj xeeb txog kev hais txog koj yuav mus li cas vim lawv txhawj xeeb lawv yuav hais qhov tsis ncaj ncees, dhau los lossis chim siab rau koj. Qhov no tsis txhais hais tias lawv tsis quav ntsej.
Nws tuaj yeem pab qhia rau tib neeg paub tias koj xav tau dab tsi. Los ntawm kev paub meej txog yam koj xav tau, koj tuaj yeem tau txais kev pab thiab kev txhawb nqa koj xav tau, thiab cov neeg koj hlub tuaj yeem muaj kev xyiv fab los pab koj hauv txoj kev muaj txiaj ntsig. Muaj qee lub koom haum uas tau muab cov phiaj xwm ua ke uas koj tuaj yeem siv los tswj xyuas qee qhov kev saib xyuas. Koj tuaj yeem xav sim:
Kev npaj kho mob ua ntej
Kev npaj saib xyuas ua ntej yog ib txoj hauv kev zoo kom paub tseeb tias koj pab neeg kho mob thiab tsev neeg paub tias koj ua dab tsi kho, thiab tsis xav kom muaj yav tom ntej.
Txhua tus yuav tsum muaj txoj kev npaj saib xyuas ua ntej. Cov ntaub ntawv xav tau thiab txheej txheem los tsim ib txoj kev npaj saib xyuas ua ntej yuav txawv ntawm lub xeev mus rau ib lub xeev. Yog xav paub ntxiv txog kev npaj kho mob siab heev, thiab nkag mus rau cov ntaub ntawv tsim nyog rau koj lub xeev, nyem qhov txuas hauv qab no.
Palliative kev saib xyuas
Ntau tus neeg xav tias kev saib xyuas palliative yog hais txog kev saib xyuas thaum kawg ntawm lub neej. Thaum qhov no yog ib lub luag haujlwm, lawv kuj muaj lwm lub luag haujlwm tseem ceeb. Lawv kuj pab tswj cov tsos mob thiab cov kev mob tshwm sim uas nyuaj rau kev kho mob uas koj tuaj yeem ntsib ntawm txhua lub sijhawm thaum koj lymphoma. Lub hom phiaj tseem ceeb yog pab kom koj muaj lub neej zoo tshaj plaws thaum koj kho thiab thaum kawg ntawm lub neej.
Symptom/side-effect management
Lymphoma thiab nws cov kev kho mob tuaj yeem ua rau muaj ntau yam tsos mob thiab cov kev mob tshwm sim. Thaum koj tus kws kho mob hematologist lossis tus kws kho mob oncologist tuaj yeem pab nrog ntau yam ntawm cov no, qee zaum cov tsos mob lossis cov kev mob tshwm sim xav tau kev tswj hwm tshwj xeeb. Pab neeg saib xyuas palliative yog cov kws tshaj lij ntawm kev tswj cov no. Lawv kuj muaj kev nkag mus rau cov tshuaj uas koj tus kws kho mob hematologist lossis tus kws kho mob oncologist tsis tau tso cai los sau. Pab neeg saib xyuas palliative yog ib qho chaw zoo los txhim kho koj lub neej zoo.
Qee cov tsos mob lossis cov kev mob tshwm sim uas lawv tuaj yeem pab koj tswj tau suav nrog:
- mob - nrog rau peripheral neuropathy
- xeev siab los yog tsis ntuav
- ntxhov siab vim
- ua tsis taus pa
Kev tu lub neej kawg
Kev sim ua tau zoo, txhais tau hais tias muaj ntau txoj kev kho tshiab uas tau txhim kho cov txiaj ntsig zoo rau cov neeg mob qog nqaij hlav - txawm tias rov qab los thiab rov qab mob qog noj ntshav. Ntau tus neeg ua neej nyob ntev thiab noj qab nyob zoo txawm tias tom qab kuaj mob qog noj ntshav. Hmoov tsis zoo, qee zaum tib neeg tuag los ntawm lymphoma.
Lub luag haujlwm feem ntau nkag siab txog kev saib xyuas palliative yog pab cov neeg uas nyob ze rau qhov kawg ntawm lawv lub neej kom muaj kev tswj hwm lawv lub neej tas li. Lawv zoo heev ntawm kev txhawb nqa koj los xav txog, thiab npaj koj cov kev xav tau thiab qhov twg koj xav siv koj lub sijhawm, thaum ua kom koj muaj kev nyab xeeb, nrog lub neej zoo nyob rau lub sijhawm no.
Txhawb nqa thaum koj nyob ze rau qhov kawg ntawm koj lub neej
Palliative care kuj tseem tuaj yeem pab koj tsev neeg thiab cov neeg koj hlub kom nkag siab tias muaj dab tsi tshwm sim, thiab xyuas kom lawv muaj kev txhawb nqa lawv xav tau nyob rau lub sijhawm no thiab. Lwm yam uas lawv tuaj yeem pab nrog suav nrog:
- npaj cov cuab yeej rau koj siv hauv tsev yog tias koj xaiv nyob hauv tsev
- tham nrog cov neeg koj hlub txog cov teeb meem rhiab xws li koj lub neej kawg thiab kev pam tuag
- txuas koj mus rau cov kev pabcuam sib txawv hauv zej zog
- xyuas kom koj txoj kev ntseeg thiab kev ntseeg ntawm sab ntsuj plig raug txhawb nqa hauv koj txoj kev tuag
- kev sab laj thiab kev txhawb siab.
Ntsiab lus
- Kev kho yog thaum tsis muaj lymphoma nyob hauv koj lub cev thiab nws tsis rov qab los.
- Kev tshem tawm tuaj yeem ua tiav lossis ib nrab ua rau tsis muaj cov tsos mob ntawm lymphoma hauv koj lub cev (ua tiav), lossis thaum cov qog ntshav qog ntshav tau txo qis ntau dua li ib nrab (ib nrab).
- Lymphoma tuaj yeem rov qab los (rov qab los) tom qab lub sijhawm tshem tawm. Kev zam txim tuaj yeem kav ntev lub lis piam, hli lossis ntau xyoo.
- Thaum aggressive lymphomas relapse, nws feem ntau nyob rau hauv thawj ob peb xyoos tom qab ua tiav kev kho mob. Ntev npaum li koj nyob hauv kev zam txim, qhov muaj feem yuav kho tau ntau dua.
- Indolent lymphomas feem ntau relapse, tab sis kuj feem ntau teb zoo rau kev kho mob. Koj yuav nyob nrog tus mob qog ntshav qog ntshav tsis txaus rau tag nrho koj lub neej, tab sis tuaj yeem ua neej nyob zoo thaum lub sijhawm zam txim.
- Qee zaum, lymphoma tsis tau zoo dua nrog kev kho thawj kab - qhov no yog hu ua refractory.
- Refractory lymphoma tseem tuaj yeem teb tau zoo rau kev kho kab thib ob thiab thib peb.
- Kev npaj saib xyuas ua ntej yog qhov tseem ceeb los xyuas kom koj tsev neeg thiab kws kho mob paub txog kev xav txog koj txoj kev kho mob.
- Kev kho mob Palliative tuaj yeem pab nrog cov tsos mob thiab kev tswj kev mob tshwm sim.
- Qee tus neeg yuav xav tau kev saib xyuas thaum kawg ntawm lub neej yog tias lawv cov lymphoma tsis teb rau kev kho mob. Palliative care tuaj yeem yog qhov kev txhawb nqa zoo, thiab xyuas kom koj muaj lub neej zoo tshaj plaws thaum lub sijhawm kawg ntawm lub neej, thiab muab kev txhawb nqa xav tau rau koj cov neeg koj hlub.
