An autologous stem cell transplant kurapwa kwakanyanya uko murwere anogamuchira ega masero emasero kumashure. Izvi zvakasiyana kana uchigamuchira mumwe munhu (donor) stem cells, anonzi an allogeneic stem cell transplant.
Mhedziso ye autologous stem cell transplant
Iyo autologous stem cell transplant inogona kutsanangurwa sea kununura kurapwa. Iwo autologous stem masero anopihwa seyekununura kune immune system. 'Autologous' izita repamutemo rechimwe chinhu chinobva pauri, kusiyana nechinhu chinobva kune mumwe munhu. Mune autologous stem cell transplant, masero akasimwa ndiwo masero omurwere ari kudzoserwa mukati mawo.
Chikonzero icho izwi rekununura rinogona kushandiswa kutsanangura autologous stem cell transplant, imhaka yekuti kana lymphoma isiri kupindura kurapwa, kana kuramba ichidzoka mushure mekurapa matanho akasimba anodiwa kuedza nekupedza lymphoma zvachose. Izvi zvinowanzobatanidza madosi akanyanya kwazvo e chemotherapy.
Aya madhasi akanyanya anouraya immune system (kusanganisira lymphoma). Nekudaro, mhedzisiro yekurapwa kwakanyanya kunoreva kuti immune system haizokwanise kupora yega, autologous stem masero anopa kununura kune yakakuvadzwa immune system uye kuibatsira kusimuka nekushanda.
Chinangwa che stem cell transplant
Pane zvikonzero zvinoverengeka nei varwere ve lymphoma vangangoda stem cell transplant kusanganisira:
- Kurapa varwere ve lymphoma vari mukuregererwa, asi vane 'njodzi huru' yekudzoka kwavo lymphoma
- Iyo lymphoma yakadzoka mushure mekutanga kwemaitiro ekutanga kurapwa, saka yakanyanya (yakasimba) chemotherapy inoshandiswa kuvadzosa mukuregererwa (hapana chirwere chinoonekwa)
- Iyo lymphoma inoramba (haina kunyatsopindura) kune yakajairwa yekutanga-mutsara kurapwa nechinangwa chekuwana kuregererwa.
Autologous (ake masero) stem cell transplant
Kana iyo autologous stem masero asina kupihwa, immune system ingadai isina kusimba kurwisa chero hutachiona. Zvichireva kuti kutapukira kwakapusa uko immune system isingaone, inogona kutungamira kuhutachiona hwehupenyu uye pakupedzisira kufa.
Maitiro e autologous stem cell transplant
Dr Amit Khot, chiremba weHematologist & chiremba wekuisira mwongo
Peter MacCallum Cancer Center uye Royal Melbourne Hospital
- Kugadzirira: izvi zvinosanganisira kumwe kurapwa kuderedza lymphoma (izvi zvinogona kusanganisira kusvika ku2 doses yechemotherapy). Kumwe kurapwa kunoitwa kukurudzira mwongo kuti ubudise masero akakwana ekuunganidza.
- Stem cell collection: Iyi ndiyo nzira yekukohwa stem cell, inowanzoitwa kuburikidza nemuchina weapheresis unobatsira kusefa maseru kubva muropa rinotenderera. Iwo stem maseru anoomeswa nechando uye anochengetwa kusvika zuva reinfusion.
- Conditioning treatment: iyi ndiyo chemotherapy iyo inopihwa mumazinga akanyanya kwazvo kubvisa yese lymphoma
- Reinfusion ye stem masero: kana mishonga yepamusoro yaitwa, masero emurwere pachake akanga atorwa kare, anodzoserwa muropa.
- Engraftment: Iyi ndiyo nzira iyo masero akadzoserwa anogara mumuviri uye anowedzera immune system, achiinunura kubva kune yakareba neutropenia.
A stem cell transplant inzira yakasimba yekurapa uye kune zvipatara zvakasarudzwa chete muAustralia zvinokwanisa kupa kurapwa uku. Naizvozvo, mune zvimwe zviitiko zvinogona kureva kutamira kumaguta akakura ayo chipatara chekutapurirana chirimo.
Zvinogona kutora mwedzi yakawanda uye dzimwe nguva kunyange makore kuti immune system inyatso kupora mushure mekutapurirana autologous. Vanhu vazhinji vari kuita autologous stem cell transplant vachange vari muchipatara kwemavhiki matatu kusvika matanhatu paavhareji. Ivo vanowanzo gamuchirwa muchipatara mazuva mashoma zuva reTransplant risati rasvika (zuva iro masero anodzoserwa) uye vanogara muchipatara kudzamara immune system yavo yapora kusvika padanho rakachengeteka.
Kugadzirira
Mukutungamira kusvika kune stem cell transplant, pane gadziriro dzinodiwa. Kwese kuisirwa kwakasiyana, timu yako yekudyara inofanirwa kukurongera zvese. Zvimwe zvekugadzirira zvinogona kusanganisira:
Kuiswa kwemutsara wepakati
Kana murwere asati atova nemutsara wepakati, ipapo mumwe achaiswa musati waiswa. Mutsetse wepakati unogona kunge uri PICC (peripherally inserted central catheter) kana inogona kunge iri CVL (central venous line). Chiremba achasarudza kuti ndeupi mutsara wepakati wakanakira murwere.
Mutsara wepakati unopa nzira yekuti varwere vagamuchire mishonga yakawanda yakasiyana panguva imwe chete. Varwere vanowanzoda mishonga yakasiyana-siyana uye kuongororwa ropa panguva yekuisirwa uye mutsara wepakati unobatsira vanamukoti kutarisira kutarisira kwemurwere.
Kurapwa
High dose chemotherapy inogara ichiitwa sechikamu cheiyo transplantation process. Iyo yakakwirira dose chemotherapy inonzi conditioning therapy. Kunze kweiyo yakakwira dose chemotherapy, vamwe varwere vanoda salvage chemotherapy. Salvage therapy ndiyo iyo lymphoma ine hutsinye uye inoda kuderedzwa isati yasara yekusimwa inogona kuenderera mberi. Zita salvage inobva pakuedza kuponesa muviri kubva kune lymphoma.
Kutamiswa kunorapwa
Chete zvimwe zvipatara mukati meAustralia zvinokwanisa kuita stem cell transplantation. Nekuda kweizvi, varwere vangangoda kutama kubva kumba kwavo kuenda kunzvimbo iri padyo nechipatara. Zvimwe zvipatara zvinoiswa varwere vane pekugara panogona kugara murwere nemutarisiri. Kana uine mushandi wezvekugarisana panzvimbo yekurapisa taura naye kuti uzive zvakawanda nezvesarudzo dzepekugara.
Kuchengetedza mbereko
Stem cell transplantation inogona kukanganisa kugona kuita vana. Zvakakosha kuti varwere vakurukure nezvesarudzo dziripo kuchengetedza mbereko. Kana usati wava nevana kana kuti urikuda kuenderera mberi nemhuri yako zviri nani kuti utaure nevechiremba nezvembereko kurapwa kusati kwatanga.
Steve akaonekwa kuti ane mantle cell lymphoma muna 2010. Steve akapona ne autologous uye allogeneic stem cell transplant. Iyi inyaya yaSteve.
Mazano anoshanda ekugadzirira kuisirwa
Kuve ne stem cell transplant kazhinji kunosanganisira kugara muchipatara kwenguva refu. Zvinogona kubatsira kurongedza zvimwe zveizvi zvinhu:
- Mapeya akati wandei ehembe dzakapfava, dzakapfava kana mapyjamas uye dzakawanda dzemukati
- Toothbrush (soft), toothpaste, sipo, gentle moisturiser, gentle deodorant
- Pillow (inopisa geza pillowcase uye chero magumbeze emunhu/kanda marape asati apinda muchipatara - anopisa anogeza kuti aderedze utachiona sezvo immune system yako ichange iri panjodzi huru).
- Slippers kana shangu dzakagadzikana uye akawanda emapeya emasokisi
- Zvinhu zvako zvekuvhenekera mukamuri yechipatara (mufananidzo wevaunoda)
- Varaidzo zvinhu zvakaita semabhuku, magazini, crosswords, iPad/laptop/tablet. Chipatara chinogona kufinha chose kana usina chekuita.
- Karenda yekuchengeta zuva, kubvumidzwa kwenguva refu muchipatara kunogona kudzima mazuva ese pamwechete.
Kuunganidzwa kwe stem masero
Peripheral blood stem cell collection
Peripheral stem cell collection muunganidzwa wesero kubva kurwizi rweropa.
Mukutungamira kune peripheral stem cell kuunganidzwa, varwere vazhinji vanogashira majekiseni ekukura chinhu. Zvinhu zvinokura zvinokurudzira kugadzirwa kwe stem cell. Izvi zvinobatsira stem cell kufamba kubva mumwongo, kupinda muropa, akagadzirira kuunganidzwa.
Masero e stem anounganidzwa kuburikidza nenzira inozivikanwa seapheresis. Muchina weapheresis unoshandiswa kuunganidza uye kupatsanura stem maseru kubva kune rimwe ropa rose.
Usati watora stem cell muunganidzwa unogashira chemotherapy, kuderedza kana kubvisa lymphoma isati yaunganidzwa.
Iwo akaunganidzwa stem maseru anoomeswa nechando uye anochengetwa kusvika wagadzirira kuti apinzwe zvakare kana kuisirwa. . Aya stem maseru anozonyungudutswa pakarepo asati aiswazve, kazhinji padivi pemubhedha.
Iyo apheresis inoshanda sei
Muchina weapheresis unoparadzanisa zvikamu zvakasiyana zveropa. Inoita izvi nekuparadzanisa masero akakwana anodiwa pakuisirwa. Apheresis inosanganisira kuisa cannula (tsono/catheter) mutsinga hombe muruoko kana vascath (special central line). Iyo cannula kana vascath inobatsira ropa kufamba kunze kwemuviri uye kupinda mumushini weapheresis.
Muchina uyu unozopatsanura masero e stem mubhegi rekuunganidza. Kana ropa rafamba nechikamu chekuunganidza masero. Inofamba ichidzokera mumuviri. Iyi nzira inotora maawa akawanda (anenge 2 - 4 maawa). Apheresis collection inodzokororwa kwemazuva akati wandei kusvika vhoriyamu yekuunganidza kana masero akakwana stem aunganidzwa.
Peripheral stem cell collection haikonzerese kurwadziwa kunoramba kuripo. Pane kumwe kusagadzikana kubva pane tsono (cannula kana vascath) yakaiswa mutsinga. Panogona zvakare kuve nekunyorova 'kurwadza kwebhonzo' kunowanikwa nekuda kwemajekiseni ekukura. Kurwadziwa uku kunowanzogadziriswa zvakanaka nemuromo paracetamol. Apheresis ndiyo nzira yakajairika yekuunganidza stem maseru nhasi.
Conditioning therapy
Conditioning therapy ndeyepamusoro-dose chemotherapy iyo inopihwa mumazuva anotungamira kusvika pakuisirwa. Conditioning therapy ndeye chemotherapy uye dzimwe nguva radiation therapy inopiwa pamwe chete. Zvinangwa zviviri zveconditioning therapy ndezvi:
- Kuuraya lymphoma yakawanda sezvinobvira
- Deredza stem cell huwandu
Kune akawanda akasiyana musanganiswa wechemotherapy uye radiation therapy inogona kushandiswa mukugadzirisa mamiriro. Boka rinorapa richasarudza kuti ndeipi hurumende yehutano yakanakira murwere. Izvi zvinoenderana neiyo lymphoma subtype, nhoroondo yekurapa uye zvimwe zvinhu zvakaita sezera, hutano hwese uye kusimba.
Varwere vane co-morbidities uye vari panjodzi huru yekukanganisika, kazhinji vanenge vadzikisa kurapa kwakanyanya. Izvi zvinodaidzwa kuti 'reduced-intensity conditioning regime'. Conditioning therapy inogona kuva yakakwirira-yakanyanya kana kuderedzwa-yakanyanya. Muhurumende mbiri kurapa kune hutsinye. Nekuda kweizvozvo, masero mazhinji ane hutano anofa pamwe neiyo lymphoma.
Kupinda muchipatara kazhinji kunotanga kubva pakutanga kwekurapa kweconditioning. Mamwe marapirwo ekurapa anogona kuitwa mumakiriniki ekunze asi kubvumidzwa kuchipatara kuchaitika 1-2 mazuva asati aiswa. Varwere vanogona kupihwa muchipatara kwese kwese kwemavhiki 3-6. Uyu ndiwo gwara sezvo kuisirwa kwega kwega kwakasiyana uye vamwe varwere vanozoda kurapwa kwakawanda kwenguva yakareba kupfuura mavhiki matanhatu.
Kune lymphomas, imwe yeakajairika mamiriro ekugadzirisa ndeye chemotherapy protocol inonzi BEAM:
- B - BCNU® kana BCNU kana carmustine
- E – Etoposide
- A - Ara-C kana cytarabine
- M – Melplan
BEAM inopihwa muchipatara kwemazuva matanhatu masero emurwere pachake asati adzorerwa. Mishonga inopiwa kuburikidza nemutsara wepakati.
Iko kuverengera kwekuita kuti stem masero ako adzoke kutanga kubva pazuva rekutangisa kurapwa. Zuva zero ndiro zuva rinogashirwa maseru. Semuenzaniso, kana wanga uchigamuchira BEAM protocol inoenda kwemazuva matanhatu, zuva rekutanga reiyi protocol rinonzi zuva -6 (minus 6). Inoverengera pasi zuva rega rega nezuva rechipiri rinozivikanwa sezuva -6, zvichingodaro, kusvika wasvika kuzuva 5 apo masero omurwere anodzoserwa.
Mushure mekunge murwere agamuchira stem masero kumashure, mazuva anoverengera kumusoro. Zuva rinotevera masero agamuchirwa rinonzi zuva +1 (pamwe chete), zuva rechipiri izuva +2, nezvimwewo.
Kudzoreredza stem masero
Mushure mekunge chemotherapy yakanyanya kupera, stem masero anodzoserwa. Aya masero anotanga zvishoma nezvishoma kugadzira masero eropa matsva, ane utano. Pakupedzisira, vanozogadzira masero ane hutano akakwana kuti adzorere mwongo wese, achizadza ropa rose nemasero ekudzivirira.
Kuita kuti stem masero adzorerwe inzira yakatwasuka. Izvo zvakafanana nekuwedzerwa ropa uye masero anopiwa kuburikidza nemutsara mumutsara wepakati. Zuva iro stem masero anodzoreredzwa ndiro "Zuva Zero".
Nechero nzira yekurapa, pane njodzi yekuve nekuita kune stem cell infusion. Kune varwere vazhinji hapana chekuita, asi vamwe vanogona kusangana:
- Kunzwa kurwara kana kurwara
- Kuravira kwakashata kana kunzwa kupisa mumuromo
- High blood pressure
- Allergic reaction
- Kurwara
Mune autologous (self) transplant, stem masero anoomeswa uye anochengetwa asati aiswazve. Kuomesa nechando uku kunosanganisira kusanganisa masero mune inochengetedza. Vamwe varwere vanogona kuita kune iyi inochengetedza kwete maseru stem. Chimiro chechimiro cheichi chekuchengetedza ndechekuchinja kwekufema, kunokonzera mweya kunhuhwirira kutapira.
Kubatanidzwa kwe stem masero
Engraftment ndipo apo masero matsva anotanga kutora zvishoma nezvishoma sekutanga masero. Izvi zvinowanzoitika mukati memavhiki 2-3 mushure mekuiswa kwe stem cell.
Nepo masero matsva anonyora, murwere ari panjodzi huru yekubata hutachiona. Varwere kazhinji vanofanirwa kugara muchipatara kwenguva iyi, nekuti vanogona kurwara uye vanoda kurapwa nekukurumidza.
Zvinetso zve stem cell transplants
Migumisiro yemamiriro ekugadzirisa chemotherapy
Varwere vangangosangana nemhedzisiro kubva kune yakakwira-dose chemotherapy kurapwa. Pane chikamu chakasiyana pane chakajairika migumisiro yechirwere che lymphoma, kusanganisira mazano anoshanda ekuti ungararama sei nemamwe akajairika:
- Oral Mucositis (muromo unorwadza)
- Anemia (yakaderera masero matsvuku)
- Thrombocytopenia (yakaderera platelet count)
- Nausea uye kurutsa
- Dambudziko rekudya (manyoka kana kuvimbiswa)
Ngozi yeKutapukirwa
Tumira stem cell transplant, iwo madosi epamusoro echemotherapy anenge abvisa akawanda eropa masero, kusanganisira chena sero reropa rinonzi neutrophils, rinokonzera neutropenia. Neutropenia yenguva refu inoisa varwere panjodzi huru yekuva nehutachiona. Zvirwere izvi zvinogona kurapwa, zvisinei kana zvikasakurumidza kubatwa nekurapwa nekukasika zvinogona kuisa upenyu panjodzi.
Uchiri muchipatara, nekukasika tumira stem cell transplant, boka rinorapa richange richitora matanho ekudzivirira kutapukira uye nekunyatsoongorora zviratidzo zvehutachiona. Kunyangwe kungwarira kwakawanda kuchitorwa kudzikisa njodzi yekubatira hutachiona, varwere vazhinji vane autologous stem cell transplant vanowana hutachiona.
Mazuva mashoma ekutanga mushure mekutapurirana ndipo apo varwere vanenge vari panjodzi huru yekutapukirwa nehutachiona hwakadai sehutachiona hweropa, mabayo, digestive system hutachiona kana hutachiona hweganda.
Mumwedzi mishoma iri kutevera, varwere vari panjodzi huru yekutapukirwa nehutachiona. Aya anogona kunge ari mavhairasi anga akarara mumuviri asati aisirwa uye anogona kusimuka kana immune system yadzikira. Hadzisi nguva dzose dzinokonzera zviratidzo asi nguva dzose kuongororwa kweropa mushure mekusimwa kunofanira kuona kubuda kwehutachiona hwehutachiona hunonzi cytomegalovirus (CMV). Kana kuongororwa kweropa kuchiratidza CMV iripo - kunyangwe pasina zviratidzo - murwere acharapwa nemishonga inorwisa mavhairasi.
Kuverengwa kweropa kunotanga kukwira pakati pemasvondo maviri kusvika mana mushure mekuita autologous stem cell transplant. Nekudaro, zvinogona kutora mwedzi yakawanda, kana dzimwe nguva kunyange makore, kuti immune system inyatsopora.
Varwere vanofanirwa kurairwa kana vaenda kumba kuti ndezvipi zviratidzo zvehutachiona zvekutarisa uye ndiani wekubata kana paine mukana wekutapukirwa kana chimwe chinhu chiri kunetsa murwere.
Late Effects
Mamiriro ekupedzisira matambudziko ehutano anogona kukura mwedzi kana makore mushure mekunge kurapwa kwe lymphoma kwapera. Nzvimbo zhinji dzekutapurirana dzakatsaurira nguva dzekupedzisira mhedzisiro masevhisi anopa zvirongwa zvekuongorora kuti zvione kunonoka mhedzisiro nekukurumidza sezvinobvira. Izvi zvinopa murwere mukana wakanakisa wekurapwa zvinobudirira kana paine mhedzisiro inononoka ikamuka.
Chikwata chekutapurirana chinozopa zano izvo zvinononoka zvinobata varwere vari panjodzi yekuvandudza uye zvekuita kuderedza njodzi yeiyi kukura. Kuti uwane rumwe ruzivo, ona 'Late Effects'
Varwere vanogonawo kunge vari panjodzi yekukura post-transplant lymphoproliferative disorder (PTLD) - lymphomas inogona kukura muvarwere vari kutora immunosuppressant mishonga mushure mekutapurwa. Nekudaro, PTLD haiwanzo uye varwere vazhinji vakave nekuchinjirwa havaite PTLD. Chikwata chekudyara chinokurukura chero njodzi dzemunhu uye chero zviratidzo kana zviratidzo zvekutarisira.
Kuchengeta kwekutevera
Mushure mekuisirwa stem cell, varwere vanozogara vachisangana nachiremba wavo. Kugadzwa uku kunoderera nekufamba kwenguva uye kupora kunoitika. Kutevera kunoenderera mberi kwemwedzi uye makore mushure mekurapwa, asi zvishoma uye zvishoma kazhinji nekufamba kwenguva. Pakupedzisira vanachiremba vanoisira vanhu vanozokwanisa kupa rubatsiro rwekutevera, kuna Chiremba wezvirwere zvese.
Inenge mwedzi ye3 mushure mekusimwa, PET scan, CT scan uye / kana bone marrow aspirate (BMA) inogona kurairwa kuti iongorore kuti kupora kuri kuitika sei.
Zvakajairika kuti udzokere kuchipatara kunorapwa mumavhiki nemwedzi inotevera kuisirwa asi nekufamba kwenguva, njodzi yematambudziko akakomba inoderera.
Varwere vanotapurirana vanogonawo kunge vachisangana nemhedzisiro kubva mukurapwa kwedosi yakakwira. Varwere dzimwe nguva vanganzwa vasinganzwe zvakanaka uye vakaneta zvikuru. Zvakakosha kutora nguva yekupora kubva kune stem cell transplant.
Chikwata chekurapa chinofanira kupa zano nezve zvimwe zvinhu zvekufunga nezvazvo panguva yekupora.
Chii chinoitika mushure mekuisirwa stem cell
Kupedza kurapwa inogona kuva nguva yakaoma kune vanhu vazhinji, sezvavanogadzirisa kudzokera kuhupenyu mushure mekusimwa. Vamwe vanhu vanogona kusatanga kunzwa mamwe ematambudziko kwemavhiki kusvika kumwedzi mushure mekunge kurapwa kwegomarara kwapera, sezvavanotanga kufunga nezveruzivo rwavo kana kusanzwa kuti kupora kwapera, pavanotanga kufunga nezveruzivo rwavo kana kuita. vasinganzwi kuti vari kupora nokukurumidza sezvavanofanira. Zvimwe zvezvinonetsa zvinowanzoitika zvinogona kuenderana ne:
- chisimba
- Pfungwa dzakanaka
- Utano hwepfungwa
- Relationships
- Basa, kudzidza uye zviitiko zvekugarisana nevamwe
Hutano uye kugara zvakanaka
Unogona kunge uchitova nemararamiro ane hutano, kana kuti ungashuva kuita shanduko yemararamiro akanaka mushure mekurapwa. Kuita shanduko diki sekudya uye kuwedzera kusimba kwako kunogona kuvandudza hutano hwako uye kugara zvakanaka uye kubatsira muviri wako kupora. Kune dzakawanda nzira dzekuzvitarisira izvo zvinogona kukubatsira kupora kubva mukurapwa.
