Chidule cha Chronic Lymphocytic Leukemia (CLL) / Small Lymphocytic Lymphoma (SLL)
CLL ndiyofala kwambiri kuposa khansa ya SLL ndipo ndi khansa yachiwiri yodziwika bwino ya B-cell, mwa anthu opitilira zaka 70. Umapezekanso kwambiri mwa amuna kuposa akazi, ndipo nthawi zambiri umakhudza anthu osakwana zaka 40.
Ma lymphoma ambiri osachiritsika sachiritsika, zomwe zikutanthauza kuti mukapezeka ndi CLL / SLL, mudzakhala nawo moyo wanu wonse. Komabe, chifukwa ikukula pang'onopang'ono anthu ena amatha kukhala moyo wathunthu popanda zizindikiro ndipo safuna chithandizo chilichonse. Ena ambiri, komabe, amakhala ndi zizindikiro nthawi ina ndipo amafunikira chithandizo.
Kuti mumvetse CLL / SLL, muyenera kudziwa pang'ono za ma lymphocyte a B-Cell
B-cell lymphocytes:
- amapangidwa m'mafupa anu (gawo la spongy pakati pa mafupa anu), koma nthawi zambiri amakhala mu ndulu ndi ma lymph nodes anu.
- ndi mtundu wa maselo oyera a magazi.
- limbana ndi matenda ndi matenda kuti mukhale athanzi.
- kumbukirani matenda omwe mudakhala nawo m'mbuyomu, kotero ngati mutatenganso matenda omwewo, chitetezo chamthupi chanu chimatha kulimbana nacho moyenera komanso mwachangu.
- imatha kuyenda kudzera m'mitsempha, kupita ku gawo lililonse la thupi lanu kukalimbana ndi matenda kapena matenda.
Kodi chimachitika ndi chiyani kwa B-maselo anu mukakhala ndi CLL / SLL?
Mukakhala ndi CLL / SLL ma lymphocyte anu a B-cell:
- kukhala achilendo ndi kukula mosalamulirika, kuchititsa B-cell lymphocyte ochuluka.
- musafe pamene ayenera kupanga njira kwa maselo atsopano athanzi.
- zimakula mwachangu, motero sizimakula bwino ndipo sizigwira ntchito moyenera polimbana ndi matenda ndi matenda.
- akhoza kutenga malo ochuluka kwambiri m’mafupa anu moti maselo ena a magazi, monga maselo ofiira a magazi ndi mapulateleti sangakule bwino.
Kumvetsetsa CLL/SLL
Pulofesa Con Tam, katswiri wodziwa za magazi ku Melbourne wa CLL/ SLL akufotokoza CLL/SLL ndikuyankha ena mwa mafunso omwe mungakhale nawo.
Kanemayu adajambulidwa mu Seputembara 2022
Kukumana ndi odwala ndi CLL
Ngakhale mutapeza zambiri kuchokera kwa madotolo ndi anamwino, zitha kukuthandizani kumva kuchokera kwa munthu yemwe adakumanapo ndi CLL / SLL.
Pansipa tili ndi kanema wankhani ya Warren pomwe iye ndi mkazi wake Kate amagawana zomwe adakumana nazo ndi CLL. Dinani pa kanema ngati mukufuna kuwonera.
Zizindikiro za CLL / SLL
CLL / SLL ndi khansa yomwe ikukula pang'onopang'ono, kotero simungakhale ndi zizindikiro panthawi yomwe mwapezeka. Nthawi zambiri, mudzapezeka mutayezetsa magazi, kapena kuyezetsa thupi ndi zina. M'malo mwake, anthu ambiri omwe ali ndi CLL / SLL amakhala ndi moyo wautali wathanzi. Komabe, mutha kukhala ndi zizindikiro nthawi ina mukukhala ndi CLL / SLL.
Zizindikiro zomwe mungapeze
- kutopa modabwitsa (kutopa). Kutopa kotereku sikumakhala bwino mukapuma kapena kugona
- kupuma
- kuvulala kapena kutuluka magazi mosavuta kuposa nthawi zonse
- matenda omwe samachoka, kapena amabwereranso
- kutuluka thukuta usiku kuposa nthawi zonse
- kuonda popanda kuyesa
- chotupa chatsopano m'khosi mwanu, m'manja mwanu, m'chiuno mwanu, kapena mbali zina za thupi lanu - izi sizikhala zopweteka.
- Magazi otsika monga:
- Anemia - kuchepa kwa hemoglobin (Hb). Hb ndi mapuloteni a m'maselo ofiira a m'magazi anu omwe amanyamula mpweya kuzungulira thupi lanu.
- Thrombocytopenia - otsika mapulateleti. Mapulateleti amathandiza magazi anu kuundana kuti musakhetse magazi komanso kuti musavulale mosavuta. Mapulateleti amatchedwanso thrombocytes.
- Neutropenia - Maselo oyera otsika otchedwa neutrophils. Ma neutrophils amalimbana ndi matenda ndi matenda.
- B-zizindikiro (onani chithunzi)
Mukafuna uphungu
Nthawi zambiri pamakhala zifukwa zina zazizindikirozi, monga matenda, kuchuluka kwa zochita, kupsinjika, mankhwala ena kapena ziwengo. Koma ndikofunikira kuti inu onani dokotala wanu ngati mukukumana ndi zizindikiro izi zomwe zimakhalapo kwa nthawi yoposa sabata, kapena ngati zibwera mwadzidzidzi popanda chifukwa chodziwika.
Kodi CLL / SLL imazindikiridwa bwanji
Zitha kukhala zovuta kuti dokotala azindikire CLL / SLL. Zizindikiro nthawi zambiri zimakhala zosamveka bwino, ndipo zimakhala zofanana ndi zomwe mungakhale nazo ndi matenda ena ofala, monga matenda ndi ziwengo. Mwinanso simungakhale ndi zizindikiro, chifukwa chake zimakhala zovuta kudziwa nthawi yoyenera kuyang'ana CLL / SLL. Koma ngati mupita kwa dokotala ndi zizindikiro zilizonse zili pamwambazi, angafune kukuyesani magazi ndi kuyezetsa thupi.
Ngati akukayikira kuti mungakhale ndi khansa ya m'magazi monga lymphoma kapena leukemia, amalangiza kuti ayesedwe kwambiri kuti adziwe bwino zomwe zikuchitika.
Zamoyo
Kuti muzindikire CLL / SLL mudzafunika ma biopsies a ma lymph nodes otupa, ndi mafupa anu. Biopsy ndi pamene kachidutswa kakang'ono kamene kamachotsedwa ndi kufufuzidwa mu labotale pogwiritsa ntchito maikulosikopu. Katswiriyu adzayang'ana njira, ndi momwe maselo anu akukulirakulira.
Pali njira zosiyanasiyana zopezera biopsy yabwino. Dokotala wanu adzatha kukambirana zamtundu wabwino kwambiri pazochitika zanu. Ena mwa ma biopsy omwe amapezeka kwambiri ndi awa:
Excisional node biopsy
Mtundu uwu wa biopsy umachotsa lymph node yonse. Ngati lymph node yanu ili pafupi ndi khungu lanu ndipo imamveka mosavuta, mungakhale ndi mankhwala oletsa kupweteka komweko kuti muchepetse malowo. Kenaka, dokotala wanu adzadula (omwe amatchedwanso kuti incision) pakhungu lanu pafupi, kapena pamwamba pa lymph node. Ma lymph node anu adzachotsedwa kudzera mu incision. Mutha kusoka pambuyo pa njirayi ndi kuvala pang'ono pamwamba.
Ngati lymph node ndi yozama kwambiri kuti adotolo amve, mungafunikire kuchitidwa opaleshoni yachipatala kuchipatala. Mutha kukupatsirani mankhwala oletsa kukomoka - omwe ndi mankhwala oti mugone pamene ma lymph node akuchotsedwa. Pambuyo pa biopsy, mudzakhala ndi bala laling'ono, ndipo mukhoza kukhala ndi zomangira zovala pang'ono pamwamba.
Dokotala wanu kapena namwino adzakuuzani momwe mungasamalirire bala, ndi pamene akufuna kukuwonaninso kuti achotse zilondazo.
Core kapena finene singano biopsy
Mtundu woterewu wa biopsy umangotenga chitsanzo kuchokera ku lymph node yomwe yakhudzidwa - samachotsa node yonse. Dokotala wanu adzagwiritsa ntchito singano kapena chipangizo china chapadera kuti atenge chitsanzo. Nthawi zambiri mudzakhala ndi mankhwala ochititsa dzanzi. Ngati lymph node ndi yozama kwambiri kuti dokotala wanu asawone ndi kumva, mutha kukhala ndi biopsy ku dipatimenti ya radiology. Izi ndizothandiza pama biopsies akuya chifukwa radiologist amatha kugwiritsa ntchito ultrasound kapena X-ray kuti awone ma lymph node ndikuwonetsetsa kuti apeza singanoyo pamalo oyenera.
A core singano biopsy imapereka chitsanzo chachikulu cha biopsy kuposa biopsy yabwino ya singano.
Bone Marrow biopsy
Biopsy iyi imatenga chitsanzo kuchokera m'mafupa anu pakati pa fupa lanu. Nthawi zambiri amatengedwa kuchokera m'chiuno, koma malingana ndi momwe zinthu ziliri, zikhoza kutengedwa kuchokera ku mafupa ena monga chifuwa chanu (sternum).
Mudzapatsidwa mankhwala ogonetsa am'deralo ndipo mutha kukhala ndi sedation, koma mudzakhala ogalamuka chifukwa cha njirayi. Mukhozanso kupatsidwa mankhwala ochepetsa ululu. Dokotala adzayika singano pakhungu lanu ndi m'fupa lanu kuti achotse fupa laling'ono la mafupa.
Mutha kupatsidwa gown kuti musinthe kapena kuvala zanu. Ngati mumavala zovala zanu, onetsetsani kuti zili zotayirira ndipo zimapereka mwayi wosavuta m'chiuno mwanu.
Kuyesa ma biopsy anu
Kuyeza kwanu kwa biopsy ndi magazi kudzatumizidwa ku matenda ndikuyang'aniridwa ndi maikulosikopu. Mwanjira iyi madotolo amatha kudziwa ngati CLL / SLL ili m'mafupa anu, magazi ndi ma lymph nodes, kapena ngati ili ndi gawo limodzi kapena awiri mwa magawo awa.
Katswiri wazachipatala adzachitanso mayeso ena pa ma lymphocyte otchedwa "flow cytometry". Uku ndi kuyesa kwapadera kuyang'ana mapuloteni aliwonse kapena "zolembera m'maselo" pa ma lymphocyte omwe amathandizira kuzindikira CLL / SLL, kapena ma subtypes a lymphoma. Mapuloteni ndi zolemberazi zithanso kudziwitsa dokotala za mtundu wamankhwala omwe angakuthandizireni bwino.
Kudikirira zotsatira
Zitha kutenga masabata angapo kuti zotsatira zanu zonse zibwererenso. Kudikira zotsatira izi kungakhale nthawi yovuta kwambiri. Zitha kuthandiza kulankhula ndi abale kapena abwenzi, khansala kapena kulumikizana nafe ku Lymphoma Australia. Mutha kulumikizana ndi Anamwino athu a Lymphoma Care potumiza imelo nurse@lymphoma.org.au kapena kuyimba pa 1800 953 081.
Mwinanso mungakonde kulowa nawo m'gulu lamagulu athu ochezera a pa Intaneti kuti mucheze ndi ena omwe adakumanapo ndi zomwezi. Mutha kutipeza pa:
Kusintha kwa CLL / SLL
Masitepe ndi momwe dokotala angafotokozere kuchuluka kwa thupi lanu lomwe limakhudzidwa ndi lymphoma, komanso momwe maselo a lymphoma akukulira.
Mungafunike kukhala ndi mayeso owonjezera kuti mudziwe gawo lanu.
Kuti mudziwe zambiri za masitepe, chonde dinani ma toggles omwe ali pansipa.
Mayesero owonjezera omwe mungakhale nawo kuti muwone momwe CLL / SLL yanu yafalikira ndikuphatikizapo:
- Positron emission tomography (PET) scan. Ichi ndi scan yanu thupi lonse zomwe zimawunikira madera omwe angakhudzidwe ndi CLL / SLL. Zotsatira zitha kuwoneka zofanana ndi chithunzi chakumanzere.
- Computed tomography (CT) scan. Izi zimapereka sikani yatsatanetsatane kuposa X-ray, koma malo enaake monga chifuwa kapena pamimba.
- Lumbar puncture - Dokotala wanu adzagwiritsa ntchito singano kuti atenge chitsanzo cha madzi pafupi ndi msana wanu. Izi zimachitika kuti muwone ngati lymphoma yanu ili mu ubongo kapena msana. Mwina simungafunikire mayesowa, koma dokotala wanu adzakuuzani ngati mutero.
Chimodzi mwazosiyana kwambiri mu CLL / SLL (kupatula malo awo) ndi momwe amachitira.
Kodi staging zikutanthauza chiyani?
Mukapezeka, dokotala wanu adzayang'ana zotsatira zanu zonse kuti adziwe kuti CLL / SLL yanu ili pati. Mankhwalawa amauza dokotala kuti:
- kuchuluka kwa CLL / SLL m'thupi lanu
- ndi madera angati a thupi lanu omwe ali ndi B-maselo a khansa ndi
- momwe thupi lanu likulimbana ndi matendawa.
Dongosololi lidzayang'ana pa CLL yanu kuti muwone ngati mukutero, kapena mulibe izi:
- kuchuluka kwa ma lymphocyte m'magazi anu kapena m'mafupa - izi zimatchedwa lymphocytosis (lim-foe-cy-toe-sis)
- kutupa kwa ma lymph nodes - lymphadenopathy (limf-a-den-op-ah-thee)
- ndulu yokulirapo - splenomegaly (splen-oh-meg-ah-lee)
- kuchepa kwa maselo ofiira a magazi m'magazi anu - kuchepa kwa magazi (a-nee-mee-yah)
- kuchepa kwa mapulateleti m'magazi anu - thrombocytopenia (throm-bow-cy-toe-pee-nee-yah)
- chiwindi chokulitsa - hepatomegaly (hep-at-o-meg-a-lee)
Zomwe siteji iliyonse imatanthauza
| Gawo la RAI 0 | Lymphocytosis ndipo palibe kukula kwa ma lymph nodes, ndulu, kapena chiwindi, komanso pafupi ndi maselo ofiira a magazi ndi mapulateleti. |
| Gawo la RAI 1 | Lymphocytosis ndi ma lymph nodes okulirapo. Mphuno ndi chiwindi sizikulidwa ndipo kuchuluka kwa maselo ofiira a magazi ndi mapulateleti ndi abwinobwino kapena otsika pang'ono. |
| Gawo la RAI 2 | Lymphocytosis kuphatikiza ndulu yokulirapo (ndipo mwina chokulitsa chiwindi), chokhala ndi ma lymph nodes okulitsa kapena opanda. Maselo ofiira a m'magazi ndi mapulateleti ndi abwinobwino kapena otsika pang'ono |
| Gawo la RAI 3 | Lymphocytosis kuphatikiza magazi m'thupi (maselo ofiira ochepa kwambiri), okhala ndi ma lymph nodes, ndulu, kapena chiwindi. Kuwerengera kwa mapulaneti kuli pafupi koyenera. |
| Gawo la RAI 4 | Lymphocytosis kuphatikiza thrombocytopenia (mapulateleti ochepa kwambiri), okhala kapena opanda magazi m'thupi, ma lymph nodes, ndulu, kapena chiwindi. |
*Lymphocytosis imatanthauza ma lymphocyte ochuluka kwambiri m'magazi anu kapena m'mafupa
Gawo lanu limakonzedwa motengera:
- chiwerengero ndi malo omwe ma lymph nodes akhudzidwa
- ngati ma lymph nodes omwe akhudzidwa ali pamwamba, pansi kapena mbali zonse za diaphragm (Chidutswa chanu ndi minofu yaikulu, yooneka ngati dome pansi pa nthiti yanu yomwe imalekanitsa chifuwa chanu ndi mimba yanu)
- ngati nthenda yafalikira m’mafupa, kapena ku ziwalo zina monga chiwindi, mapapo, fupa kapena khungu
| 1 internship | dera limodzi la lymph node limakhudzidwa, kaya pamwamba kapena pansi pa diaphragm * |
| 2 internship | madera awiri kapena angapo a ma lymph node amakhudzidwa mbali imodzi ya diaphragm * |
| 3 internship | Malo ochepera a lymph node m'mwamba ndi gawo limodzi la m'munsi mwa diaphragm* amakhudzidwa |
| 4 internship | Lymphoma ili mu ma lymph nodes angapo ndipo yafalikira kumadera ena a thupi (monga mafupa, mapapo, chiwindi). |
Kuonjezera apo, pakhoza kukhala chilembo "E" mutatha siteji. E amatanthauza kuti muli ndi SLL mu chiwalo chakunja kwa mitsempha yanu, monga chiwindi, mapapo, mafupa kapena khungu. | |
Mafunso kwa dokotala musanayambe mankhwala
Kuonana ndi madokotala kungakhale kovutitsa maganizo ndipo kuphunzira za matenda anu ndi mankhwala amene mungakhale nawo kungakhale ngati kuphunzira chinenero china. Pophunzira
Zingakhale zovuta kudziwa mafunso oyenera kufunsa pamene mukuyamba kulandira chithandizo. Ngati simukudziwa, zomwe simudziwa, mungadziwe bwanji zomwe mungafunse?
Kukhala ndi chidziwitso choyenera kungakuthandizeni kudzidalira komanso kudziwa zomwe mungayembekezere. Zingakuthandizeninso kukonzekera pasadakhale zomwe mungafunike.
Talemba mndandanda wa mafunso omwe mungawapeze kukhala othandiza. Zoonadi, mkhalidwe wa aliyense ngwosiyana, chotero mafunso ameneŵa samakhudza chirichonse, koma amapereka chiyambi chabwino.
Dinani ulalo womwe uli pansipa kuti mutsitse PDF yosindikizidwa ya mafunso kwa dokotala wanu.
Kumvetsetsa chibadwa chanu cha CLL / SLL
Pali zinthu zambiri zamtundu zomwe zitha kukhudzidwa mu CLL / SLL yanu. Ena angakhale akuthandizira kukula kwa matenda anu, ndipo ena amapereka chidziŵitso chothandiza ponena za mtundu wamankhwala wabwino koposa umene uli kwa inu. Kuti mudziwe zomwe zimayambitsa ma genetic muyenera kukhala ndi mayeso a cytogenetic.
Mayeso a Cytogenetic
Mayeso a Cytogenetics amachitidwa pamagazi anu ndi ma biopsies kuti muwone kusintha kwa ma chromosome anu kapena majini. Nthawi zambiri timakhala ndi ma chromosomes 23, koma ngati muli ndi CLL / SLL ma chromosome anu amatha kuwoneka mosiyana pang'ono.
Ma Chromosomes
Maselo onse a thupi lathu (kupatula maselo ofiira a magazi) ali ndi nyukiliyasi yomwe ndi kumene ma chromosome athu amapezeka. Ma chromosome omwe ali mkati mwa maselo ndi timizere tambiri ta DNA (deoxyribonucleic acid). DNA ndi mbali yaikulu ya chromosome imene imasunga malangizo a selo ndipo mbali imeneyi imatchedwa jini.
Chibadwa
Majini amauza mapuloteni ndi maselo m'thupi lanu momwe angawonekere kapena kuchita. Ngati pali kusintha (kusintha kapena kusintha) m'ma chromosome kapena majini, mapuloteni ndi maselo anu sangagwire ntchito bwino ndipo mukhoza kudwala matenda osiyanasiyana. Ndi CLL/SLL zosinthazi zitha kusintha momwe ma B-cell lymphocyte anu amakulira ndikukulira, kuwapangitsa kukhala a khansa.
Zosintha zazikulu zitatu zomwe zingachitike ndi CLL / SLL zimatchedwa kuchotsedwa, kusuntha ndi kusintha.
Kusintha kofala mu CLL / SLL
Kuchotsa ndi pamene mbali ina ya chromosome yanu ikusowa. Ngati kuchotsa kwanu kuli gawo la chromosome ya 13 kapena 17 kumatchedwa "del(13q)" kapena "del(17p)". “q” ndi “p” auze adotolo kuti ndi gawo liti la chromosome lomwe likusowa. Ndi chimodzimodzi kufufutidwa zina.
Ngati muli ndi translocation, zikutanthauza kuti gawo laling'ono la ma chromosome awiri - chromosome 11 ndi chromosome 14 mwachitsanzo, kusinthana malo wina ndi mzake. Izi zikachitika, zimatchedwa “t(11:14)”.
Ngati muli ndi masinthidwe, zitha kutanthauza kuti muli ndi chromosome yowonjezera. Izi zimatchedwa Trisomy 12 (chromosome yowonjezera 12). Kapena mutha kukhala ndi masinthidwe ena otchedwa IgHV mutation kapena Tp53 mutation. Zosintha zonsezi zitha kuthandiza dokotala kuti akupatseni chithandizo chabwino kwambiri, choncho chonde onetsetsani kuti mwafunsa dokotala wanu kuti afotokoze zomwe mwasintha.
Muyenera kuyezetsa cytogenetic mukapezeka ndi CLL / SLL komanso musanalandire chithandizo. Mayesero a cytogenetic ndi pamene wasayansi akuyang'ana magazi anu ndi chitsanzo cha chotupa, kuti ayang'ane kusiyana kwa majini (kusintha) komwe kungakhudzidwe ndi matenda anu.
Aliyense amene ali ndi CLL / SLL ayenera kuyezetsa majini musanayambe chithandizo.
Ena mwa mayesowa mudzafunika kukhala nawo kamodzi kokha chifukwa zotsatira zake zimakhala zofanana mmoyo wanu wonse. Mayeso ena, mungafunike kukhala nawo musanalandire chithandizo chilichonse, kapena nthawi zosiyanasiyana paulendo wanu ndi CLL / SLL. Izi ndichifukwa chakuti m'kupita kwa nthawi, kusintha kwatsopano kwa chibadwa kumatha kuchitika chifukwa cha chithandizo, matenda anu kapena zinthu zina.
Mayeso odziwika kwambiri a cytogenetic omwe mudzakhala nawo ndi awa:
Kusintha kwa IgHV
Muyenera kukhala ndi izi musanalandire chithandizo choyamba kokha. IgHV sisintha pakapita nthawi, choncho imayenera kuyesedwa kamodzi kokha. Izi zidzafotokozedwa ngati IgHV yosinthika kapena IgHV yosasinthika.
FISH mayeso
Muyenera kumwa izi musanalandire chithandizo choyamba. Kusintha kwa ma genetic pamayeso anu a FISH kumatha kusintha pakapita nthawi, choncho ndi bwino kuti ayezedwe musanayambe mankhwala nthawi yoyamba, komanso nthawi zonse panthawi yonse ya chithandizo chanu. Itha kuwonetsa ngati muli ndi kufufutidwa, kusamutsa kapena chromosome yowonjezera. Izi zidzanenedwa ngati del(13q), del(17p), t(11:14) kapena Trisomy 12. Ngakhale izi ndizosiyana kwambiri kwa anthu omwe ali ndi CLL /SLL mungakhale ndi zosiyana, komabe malipoti adzakhala zofanana ndi izi.
(FISH imayimira Fluorescent In Situ Hybridation ndipo ndi njira yoyesera yochitidwa mu pathology)
Kusintha kwa TP53
Muyenera kumwa izi musanalandire chithandizo choyamba. TP53 imatha kusintha pakapita nthawi, choncho tikulimbikitsidwa kuti ayezedwe musanayambe kumwa mankhwala nthawi yoyamba, komanso pafupipafupi panthawi yonse ya chithandizo chanu. TP53 ndi jini yomwe imapereka code ya puloteni yotchedwa p53 kuti ipangidwe. p53 ndi chotupa chomwe chimapondereza mapuloteni ndipo chimalepheretsa maselo a khansa kukula. Ngati muli ndi kusintha kwa TP53, simungathe kupanga mapuloteni a p53, zomwe zikutanthauza kuti thupi lanu silingathe kuletsa maselo a khansa kuti ayambe kukula.
Chifukwa chiyani kuli kofunikira?
Ndikofunikira kumvetsetsa izi popeza tikudziwa kuti si anthu onse omwe ali ndi CLL / SLL omwe ali ndi ma genetic osiyanasiyana. Kusiyanaku kumapereka chidziwitso kwa dokotala wanu za mtundu wa chithandizo chomwe chingagwire ntchito, kapena sichingagwire ntchito pa CLL / SLL yanu.
Chonde lankhulani ndi dokotala wanu za kuyezetsa kumeneku komanso zomwe zotsatira zanu zikutanthawuza pazosankha zanu zamankhwala.
Mwachitsanzo, tikudziwa ngati muli ndi kusintha kwa TP53, IgHV yosasinthika kapena del(17p) simuyenera kulandira chithandizo chamankhwala. popeza sichingagwire ntchito kwa inu. Koma izi sizikutanthauza kuti palibe chithandizo. Pali mankhwala omwe amayang'aniridwa omwe angagwire ntchito bwino kwa anthu omwe ali ndi izi. Tikambirana zimenezi m’chigawo chotsatira.
Chithandizo cha CLL / SLL
Zotsatira zanu zonse kuchokera ku biopsy, kuyezetsa magazi kwa cytogenetic ndi masikanidwe akamaliza, adokotala aziwunikanso izi kuti akupatseni chithandizo chabwino kwambiri. Kumalo ena a khansa, dokotala wanu amathanso kukumana ndi gulu la akatswiri kuti akambirane njira yabwino kwambiri yochizira. Izi zimatchedwa a Multidisciplinary team (MDT) msonkhano.
Kodi dongosolo langa lamankhwala limasankhidwa bwanji?
Dokotala wanu aziganizira zambiri za CLL / SLL yanu. Zosankha za nthawi kapena ngati muyenera kuyamba komanso chithandizo chomwe chili chabwino kwambiri chimachokera pa:
- siteji yanu ya lymphoma, kusintha kwa majini ndi zizindikiro
- zaka zanu, mbiri yakale yachipatala ndi thanzi labwino
- umoyo wanu wakuthupi ndi wamaganizo komanso zokonda za odwala.
Mayesero ena
Dokotala wanu adzayitanitsa mayeso ambiri musanayambe chithandizo kuti atsimikizire kuti mtima wanu, mapapo ndi impso zimatha kuthana ndi mankhwalawa. Mayeso owonjezera angaphatikizepo ECG (electrocardiogram), kuyesa ntchito yamapapu kapena kusonkhanitsa mkodzo wa maola 24.
Dokotala wanu kapena namwino wa khansa akhoza kukufotokozerani dongosolo lanu la mankhwala ndi zotsatira zake. Atha kuyankhanso funso lililonse lomwe mungakhale nalo. Ndikofunika kuti mufunse dokotala wanu ndi/kapena namwino wa khansa mafunso pa chilichonse chomwe simukuchidziwa.
Lumikizanani nafe
Kudikirira zotsatira zanu kungakhale nthawi yowonjezereka ndi nkhawa kwa inu ndi okondedwa anu. Ndikofunika kupanga maukonde amphamvu othandizira panthawiyi. Mudzawafunanso ngati muli ndi chithandizo.
Lymphoma Australia ikufuna kukhala gawo la netiweki yanu yothandizira. Mutha kuyimbira foni kapena kutumiza imelo ku Lymphoma Australia Namwino Helpline ndi mafunso anu ndipo titha kukuthandizani kuti mudziwe zambiri. Mutha kujowinanso masamba athu ochezera kuti muthandizidwe kwambiri. Tsamba lathu la Lymphoma Down Under pa Facebook ndi malo abwino kwambiri olumikizirana ndi ena ozungulira Australia ndi New Zealand omwe akukhala ndi lymphoma.
Namwino wa namwino wa Lymphoma:
Foni: 1800 953 081
Email: nurse@lymphoma.org.au
Njira zochizira zingaphatikizepo izi:
Penyani ndi Kudikirira (kuwunika mwachangu)
Pafupifupi anthu 1 mwa 10 aliwonse omwe ali ndi CLL/SLL sangafunikire chithandizo. Ikhoza kukhala yokhazikika popanda zizindikiro kwa miyezi kapena zaka zambiri. Koma ena a inu mungakhale ndi maulendo angapo a mankhwala otsatiridwa ndi chikhululukiro. Ngati simukufuna chithandizo nthawi yomweyo kapena kukhala ndi nthawi pakati pa kukhululukidwa, mudzayang'aniridwa ndi wotchi ndikudikirira (komwe kumatchedwanso kuyang'anira mwachangu). Pali mankhwala ambiri abwino a CLL omwe alipo, motero amatha kuwongoleredwa kwa zaka zambiri.
Chithandizo Chothandizira
Thandizo lothandizira likupezeka ngati mukukumana ndi matenda aakulu. Zingakuthandizeni kukhala ndi zizindikiro zochepa, ndikuchira msanga.
Maselo a khansa ya m'magazi (ma cell a khansa a B m'magazi anu m'mafupa) amatha kukula mosalekeza ndikudzaza mafupa anu, magazi, ma lymph nodes, chiwindi kapena ndulu. Chifukwa fupa lili ndi ma cell a CLL / SLL ang'ono kwambiri kuti agwire bwino ntchito, maselo anu abwinobwino amakhudzidwa. Thandizo lothandizira lingaphatikizepo zinthu monga kuikidwa magazi kapena kuikidwa magazi, kapena mutha kukhala ndi maantibayotiki kuti mupewe kapena kuchiza matenda.
Chisamaliro chothandizira chingaphatikizepo kukambirana ndi gulu lapadera la chisamaliro (monga cardiology ngati muli ndi vuto ndi mtima wanu) kapena chisamaliro chothandizira kuthana ndi zizindikiro zanu. Zitha kukhalanso kukambirana pazokonda zanu pazosowa zachipatala m'tsogolomu. Izi zimatchedwa Advanced Care Planning.
Kusamalidwa
Ndikofunikira kudziwa kuti gulu la Palliative Care litha kuyitanidwa nthawi iliyonse munjira yanu yamankhwala osati kumapeto kwa moyo. Magulu osamalira odwala ndiabwino kuthandizira anthu pazosankha zomwe akuyenera kupanga kumapeto kwa moyo wawo. koma, samangoyang’anira anthu amene akumwalira. Amakhalanso akatswiri pakuwongolera zovuta kuwongolera zizindikiro nthawi iliyonse paulendo wanu ndi CLL / SLL. Chifukwa chake musawope kufunsa zomwe apereka.
Ngati inu ndi dokotala mwasankha kugwiritsa ntchito chithandizo chothandizira, kapena kusiya chithandizo chamankhwala cha lymphoma yanu, zinthu zambiri zingatheke kukuthandizani kuti mukhale athanzi komanso omasuka kwa nthawi ndithu.
Chemotherapy (Chemotherapy)
Mutha kumwa mankhwalawa ngati piritsi kapena kuperekedwa ngati dontho (kulowetsedwa) mumtsempha wanu (m'magazi anu) ku chipatala cha khansa kapena chipatala. Mankhwala angapo a chemo amatha kuphatikizidwa ndi mankhwala a immunotherapy. Chemo imapha ma cell omwe amakula mwachangu kotero amatha kukhudzanso ena mwama cell anu abwino omwe amakula mwachangu kumabweretsa zotsatira zoyipa.
Monoclonal Antibody (MAB)
Mutha kukhala ndi kulowetsedwa kwa MAB ku chipatala cha khansa kapena chipatala. Ma MAB amamatira ku cell ya lymphoma ndikukopa matenda ena omwe amalimbana ndi maselo oyera amagazi ndi mapuloteni ku khansa. Izi zimathandizira chitetezo chanu chamthupi kulimbana ndi CLL / SLL.
Chemo-immunotherapy
Chemotherapy (mwachitsanzo, FC) kuphatikiza ndi immunotherapy (mwachitsanzo, rituximab). Koyambirira kwa mankhwala a immunotherapy nthawi zambiri amawonjezeredwa ku chidule cha regimen ya chemotherapy, monga FCR.
Njira yochiritsira
Mutha kumwa mankhwalawa ngati piritsi kunyumba kapena kuchipatala. Njira zochiritsira zomwe zimagwiritsidwa ntchito zimagwirizanitsa ndi maselo a lymphoma ndikuletsa zizindikiro zomwe zimafunika kuti zikule ndikupanga maselo ambiri. Izi zimalepheretsa kukula kwa khansa, ndikupangitsa maselo a lymphoma kufa. Kuti mumve zambiri pazamankhwala awa, chonde onani athu Zowona za Oral Therapies.
Stem cell transplant (SCT)
Ngati ndinu wachinyamata ndipo muli ndi CLL / SLL yankhanza (ikukula mwachangu), SCT ingagwiritsidwe ntchito, koma izi ndizosowa. Kuti mudziwe zambiri za ma stem cell transplants, onani zolemba zowona Kusintha kwa Lymphoma
Kuyambira Therapy
Anthu ambiri omwe ali ndi CLL/SLL sadzafuna chithandizo akapezeka koyamba. M’malo mwake, mudzakhala maso ndi kudikira. Izi ndizofala kwa anthu omwe ali ndi matenda a siteji 1 kapena 2, komanso anthu ena omwe ali ndi matenda a siteji 3.
Ngati muli ndi gawo 3 kapena 4 CLL/SLL mungafunike kuyamba kulandira chithandizo. Mukayamba kumwa mankhwala koyamba, amatchedwa chithandizo choyamba. Mutha kukhala ndi mankhwala opitilira m'modzi, ndipo awa angaphatikizepo chemotherapy, anti-monoclonal antibody kapena chithandizo chomwe mukufuna.
Mukakhala ndi mankhwalawa, mudzakhala nawo mozungulira. Izi zikutanthauza kuti mudzakhala ndi chithandizo, ndiye kupuma, ndiye kuzungulira kwina (kuzungulira) kwa mankhwala. Kwa anthu ambiri omwe ali ndi CLL/SLL chemoimmunotherapy ndi othandiza kuti athetse chikhululukiro (palibe zizindikiro za khansa).
Kusintha kwa ma genetic ndi chithandizo
Zovuta zina za majini zingatanthauze kuti chithandizo chomwe mukuchifuna chidzakuthandizani, ndipo zolakwika zina za majini - kapena ma genetics atha kutanthauza kuti chemoimmunotherapy idzagwira ntchito bwino.
Normal IgHV (IgHV yosasinthika) KAPENA 17p kuchotsedwa KAPENA a kusintha kwamtundu wanu wa TP53
CLL/SLL yanu mwina sangayankhe ku chemotherapy, koma ikhoza kuyankha ku chimodzi mwazochiza zomwe mukufuna m'malo mwake:
- Ibrutinib - mankhwala omwe amawunikira otchedwa BTK inhibitor
- Acalabrutinib - mankhwala omwe amawongolera (BTK inhibitor) okhala ndi kapena opanda anti-monoclonal antibody yotchedwa obinutuzumab
- Venetoclax & Obinutuzumab - venetoclax ndi mtundu wamankhwala omwe amayang'aniridwa otchedwa BCL-2 inhibitor, obinutuzumab ndi monoclonal antibody.
- Idelalisib & rituximab - idelalisib ndi mankhwala omwe amawatsata otchedwa PI3K inhibitor, ndipo rituximab ndi monoclonal antibody.
- Mukhozanso kukhala oyenerera kutenga nawo mbali pa mayesero a zachipatala - Funsani dokotala wanu za izi
Mfundo zofunika - Ibrutinib ndi Acalabrutinib pano ndi TGA zovomerezeka, kutanthauza kuti akupezeka ku Australia. Komabe, pakadali pano sanatchulidwe PBS ngati chithandizo choyamba mu CLL/SLL. Izi zikutanthauza kuti amawononga ndalama zambiri kuti apeze. Zitha kukhala zotheka kupeza mwayi wopeza mankhwalawo pa "zifukwa zachifundo", kutanthauza kuti mtengo wake ndi gawo limodzi kapena ulipiridwa kwathunthu ndi kampani yopanga mankhwala. Ngati muli nazo yachibadwa (yosasinthika) IgHV, kapena 17p kuchotsa, funsani dokotala wanu za mwayi wopeza mankhwalawa mwachifundo.
Lymphoma Australia ikulimbikitsa anthu omwe ali ndi CLL/SLL poika zolembera ku Komiti Yopereka Uphungu Wazamankhwala (PBAC) kuti iwonjezere mndandanda wa PBS wa mankhwalawa kwa chithandizo choyamba; kupanga mankhwalawa kuti athe kupezeka kwa anthu ambiri omwe ali ndi CLL/SLL.
Mutha kuthandizanso kudziwitsa anthu ndikuyika zomwe mwapereka ku PBAC pamndandanda wa PBS ngati chithandizo choyambirira kuwonekera kuno.
Mndi IgHV, kapena kusiyanasiyana kwina osati pamwamba
Mutha kupatsidwa chithandizo chokhazikika cha CLL/SLL kuphatikiza chemotherapy kapena chemoimmunotherapy. The immunotherapy (rituximab kapena obinutuzumab) idzagwira ntchito ngati maselo anu a CLL/SLL ali ndi cholembera pamwamba chomwe chimatchedwa CD20 pa iwo. Dokotala wanu akhoza kukudziwitsani ngati maselo anu ali ndi CD20.
Pali mankhwala angapo osiyana ndi kuphatikiza dokotala wanu angasankhe ngati muli ndi kusintha kwa IgHV . Izi zikuphatikizapo:
- Bedamustine & rituximab (BR) - bendamustine ndi chemotherapy ndipo rituximab ndi monoclonal antibody. Onsewa amaperekedwa ngati kulowetsedwa.
- Fludarabine, cyclophosphamide ndi rituximab (FC-R). Fludarabine ndi cyclophosphamide ndi chemotherapy ndipo rituximab ndi monoclonal antibody.
- Chlorambucil & Obinutuzumab – chlorambucil ndi piritsi la chemotherapy ndipo obinutuzumab ndi antibody monoclonal. Amaperekedwa makamaka kwa anthu achikulire, ofooka kwambiri.
- Chlorambucil - piritsi la chemotherapy
- Mukhozanso kukhala oyenerera kutenga nawo mbali pamayesero azachipatala
Ngati mukudziwa dzina lamankhwala omwe mudzakhala nawo, mutha kuwapeza zambiri apa.
Kukhululuka ndi Kubwereranso
Mukatha kulandira chithandizo ambiri a inu mudzapita kuchikhululukiro. Kukhululukidwa ndi nthawi yomwe mulibe zizindikiro za CLL/SLL zotsalira m'thupi lanu, kapena pamene CLL/SLL ili pansi pa ulamuliro ndipo safuna chithandizo. Kukhululukidwa kumatha zaka zambiri, koma pamapeto pake CLL imabwereranso (kuyambiranso) ndipo chithandizo china chimaperekedwa.
Refractory CLL / SLL
Ochepa a inu simungalandire chikhululukiro ndi mankhwala anu oyamba. Izi zikachitika, CLL / SLL yanu imatchedwa "refractory". Ngati muli ndi CLL / SLL, dokotala wanu angafune kuyesa mankhwala ena.
Chithandizo chomwe mumapeza ngati muli ndi CLL / SLL kapena mutayambiranso amatchedwa njira yachiwiri. Cholinga cha chithandizo chachiwiri ndikukupatsani chikhululukiro kachiwiri.
Ngati muli ndi chikhululukiro china, ndiye kuti mwayambiranso ndi kulandira chithandizo chochulukirapo, mankhwala otsatirawa amatchedwa mankhwala a mzere wachitatu, chithandizo cha mzere wachinayi ndi zina zotero.
Mungafunike mitundu ingapo ya chithandizo cha CLL/SLL yanu. Akatswiri akupeza mankhwala atsopano komanso othandiza kwambiri omwe akuwonjezera kutalika kwa kukhululukidwa. Ngati CLL/SLL yanu siinayankhe bwino pa chithandizocho kapena pali kubwereranso mwamsanga pambuyo pa chithandizo (m'miyezi isanu ndi umodzi) izi zimadziwika kuti refractory CLL/SLL ndipo chithandizo chamtundu wina chidzafunika.
Momwe chithandizo chachiwiri chimasankhidwira
Panthawi yobwereranso, kusankha chithandizo kudzadalira zifukwa zingapo kuphatikizapo.
- Kwa nthawi yayitali bwanji mudakhala mu chikhululukiro
- Thanzi lanu lonse ndi zaka zanu
- Ndi chithandizo chanji cha CLL chomwe mudalandira m'mbuyomu
- Zokonda zanu.
Chitsanzochi chikhoza kubwerezanso kwa zaka zambiri. Njira zochiritsira zatsopano zomwe zakonzedwanso zilipo za matenda obwerera m'mbuyo kapena osachiritsika ndipo njira zina zochizira zobwereranso ku CLL/SLL zingaphatikizepo izi:
- Venetoclax - mankhwala omwe akuwongolera (BCL2 inhibitor) - piritsi
- Ibrutinib (Ibruvica) - Thandizo lolunjika (BTK inhibitor) - piritsi
- Acalabrutinib - Thandizo lolunjika (BTK inhibitor) - piritsi
- Idelalisib ndi Rituximab - idelalisib ndi mankhwala omwe amatsata (PI3K inhibitor) ndipo rituximab ndi antibody monoclonal. Idelalisib ndi piritsi ndipo rituximab imaperekedwa ngati kudontha m'mitsempha yanu.
Zambiri pazamankhwala omwe akuyembekezeredwa zitha kupezeka Pano.
Ngati ndinu wachichepere komanso wokwanira (kupatula kukhala ndi CLL/SLL) mutha kukhala ndi Kusintha kwamtundu wa tsinde cell transplantation.
Ndibwino kuti nthawi iliyonse yomwe mukufuna kuyamba mankhwala atsopano mumafunsa dokotala za mayesero a zachipatala omwe mungakhale oyenerera. Mayesero azachipatala ndi ofunikira kuti apeze mankhwala atsopano, kapena osakanizidwa amankhwala kuti apititse patsogolo chithandizo cha CLL/SLL mtsogolo.
Atha kukupatsaninso mwayi woyesera mankhwala atsopano, kuphatikiza mankhwala, kapena mankhwala ena omwe simungathe kupita nawo kunja kwa mayeso. Ngati mukufuna kutenga nawo mbali pamayesero azachipatala, funsani dokotala kuti ndi mayesero ati azachipatala omwe mukuyenera nawo.
Mankhwala ena akuyesedwa a CLL / SLL
Pali mankhwala ambiri komanso kuphatikiza kwatsopano kwamankhwala komwe akuyesedwa pano m'mayesero azachipatala padziko lonse lapansi kwa odwala omwe ali ndi CLL yomwe yangopezeka kumene komanso yoyambiranso. Njira zina zochiritsira zomwe zikufufuzidwa ndi;
- Venetoclax kuphatikiza mankhwala - kugwiritsa ntchito venetoclax ndi mitundu ina ya chithandizo
- Zanubrutinib - kapisozi yemwe ndi mankhwala omwe amayang'aniridwa (BTK inhibitor)
- Chimeric antigen receptor T-cell therapy (CAR T-cell therapy)
Mutha kuwerenganso zathu 'Kumvetsetsa Mayesero Achipatala ' pepala kapena pitani kwathu tsamba la webu kuti mudziwe zambiri za mayesero azachipatala
Kuneneratu kwa CLL / SLL - ndi zomwe zimachitika mankhwala akatha
Kuneneratu kumayang'ana zomwe zikuyembekezeka zotsatira za CLL / SLL yanu, komanso zomwe zingakhudze chithandizo chanu.
CLL / SLL sichiritsika ndi mankhwala omwe alipo. Izi zikutanthauza kuti mukapezeka ndi matenda, mudzakhala ndi CLL / SLL kwa moyo wanu wonse….Koma, anthu ambiri amakhalabe ndi moyo wautali komanso wathanzi ndi CLL / SLL. Cholinga, kapena cholinga cha chithandizo ndikusunga CLL / SLL kuti ikhale yoyenera ndikuwonetsetsa kuti mulibe zizindikiro zomwe zimakhudza moyo wanu.
Aliyense yemwe ali ndi CLL / SLL ali ndi ziwopsezo zosiyanasiyana kuphatikiza zaka, mbiri yachipatala ndi majini. Choncho, n’kovuta kwambiri kulankhula za kulosera mwachisawawa. Ndibwino kuti muyankhule ndi dokotala wanu zazomwe zimayambitsa chiopsezo chanu, komanso momwe izi zingakhudzire momwe mukudziwira.
Kupulumuka - Kukhala ndi khansa
Kukhala ndi moyo wathanzi, kapena kusintha kwa moyo wabwino mukalandira chithandizo kungathandize kwambiri kuti muchiritsidwe. Pali zinthu zambiri zomwe mungachite kuti mukhale ndi moyo wabwino ndi CLL / SLL.
Anthu ambiri amapeza kuti atapezeka ndi khansa, kapena kulandira chithandizo, zolinga zawo ndi zomwe amaika patsogolo pamoyo wawo zimasintha. Kudziwa ‘zachilendo’ zanu kungatenge nthawi komanso kukukhumudwitsani. Zoyembekeza za banja lanu ndi anzanu zingakhale zosiyana ndi zanu. Mutha kudzimva kukhala osungulumwa, kutopa kapena kuchuluka kwa malingaliro osiyanasiyana omwe angasinthe tsiku lililonse. Zolinga zazikulu mukalandira chithandizo cha CLL / SLL yanu ndikubwerera kumoyo ndi:
- khalani okangalika momwe mungathere pantchito yanu, banja lanu, ndi maudindo ena amoyo wanu
- kuchepetsa zotsatira ndi zizindikiro za khansa ndi chithandizo chake
- zindikirani ndikuwongolera zovuta zilizonse mochedwa
- kukuthandizani kuti mukhale odziyimira pawokha momwe mungathere
- sinthani moyo wanu komanso kukhala ndi thanzi labwino
Kukonzanso Khansa
Mitundu yosiyanasiyana ya kukonzanso khansa ikhoza kulangizidwa kwa inu. Izi zitha kutanthauza mitundu ingapo ya mautumiki monga:
- chithandizo chamankhwala, kusamalira ululu
- kukonza zakudya ndi masewera olimbitsa thupi
- uphungu wamalingaliro, ntchito ndi zachuma
Tili ndi malangizo abwino kwambiri patsamba lathu pansipa:
- Kuopa kuyambiranso kwa khansa ndikuwunika nkhawa
- Kusamalira tulo ndi lymphoma
- Kuchita masewera olimbitsa thupi ndi lymphoma
- Kutopa ndi lymphoma
- Kugonana ndi ubwenzi
- Zotsatira zamaganizo za matenda a lymphoma ndi chithandizo
- Kukhudzidwa kwamalingaliro okhala ndi lymphoma
- Kukhudza kwamtima kwa lymphoma pambuyo pomaliza chithandizo cha lymphoma
- Kusamalira munthu yemwe ali ndi Lymphoma
- Zotsatira zamaganizo za kubwereranso kapena refractory lymphoma
- Chithandizo chothandizira ndi njira zina: Lymphoma
- Kudzisamalira ndi Lymphoma
- Nutrition ndi Lymphoma
Kusintha kwa Lymphoma (kusintha kwa Richter)
Kodi kusinthika ndi chiyani?
Lymphoma yosinthidwa ndi lymphoma yomwe poyamba inapezeka kuti ndi yosasamala (kukula pang'onopang'ono) koma yasintha kukhala matenda achiwawa (akukula mofulumira).
Kusintha sikochitika, koma kumatha kuchitika ngati majini a indolent lymphoma cell awonongeka pakapita nthawi. Izi zikhoza kuchitika mwachibadwa, kapena chifukwa cha mankhwala ena, zomwe zimapangitsa kuti maselo akule mofulumira. Izi zikachitika mu CLL/SLL zimatchedwa Richter's Syndrome (RS).
Izi zikachitika, CLL / SLL yanu imatha kusintha kukhala mtundu wa Lymphoma wotchedwa Diffuse Large B-cell Lymphoma (DLBCL) kapena osakhala T-cell Lymphoma.
Kuti mumve zambiri za Transformed Lymphoma chonde onani wathu mfundo apa.
