An i-allogeneic stem cell transplant lunyango olumandla apho ufumana uqhaqho-fakelo lwe-donor (yomnye umntu) iiseli zesiqu. Oku kwahlukile xa isigulane sifumana iiseli zaso emva, ezibizwa ngokuba yi- i-autologous stem cell transplant. Oku kuxutyushwa kwelinye iphepha.
Isishwankathelo sofakelo lwe-allogeneic stem cell?
UGq Amit Khot, ugqirha weHaematologist kunye nogqirha wofakelo lomongo wethambo
Peter MacCallum Cancer Centre kunye nesibhedlele saseRoyal Melbourne
I-allogeneic stem cell transplantation isebenzisa iiseli ze-stem eziqokelelwe kumnikeli (omnye umntu) ukuze zibuyisele iiseli zakho. Oku kwenziwa ukunyanga i-Lymphoma ephikisayo (engaphenduliyo kunyango) okanye ibuyele (i-lymphoma ehlala ibuya. Abantu abaninzi abane-lymphoma abayifuni i-stem cell transplant. Kwi-lymphoma, i-allogeneic (donor) transplants inqabile kakhulu kune-autologous. self) uqhaqho.
I-Lymphoma ngumhlaza we-lymphocytes. I-Lymphocytes luhlobo lweeseli ezimhlophe zegazi ezikhula kwiiseli ze-stem. Injongo ye chemotherapy kukuphelisa iiseli ze-lymphoma kunye nazo zonke iiseli ezinokuthi zikhule zibe yi-lymphoma. Nje ukuba iiseli ezimbi zipheliswe, iiseli ezintsha zinokuphinda zikhule kwaye ngethemba lokuba azinamhlaza.
Kwimeko yabantu abaye babuyela kwi-lymphoma okanye i-refractory lymphoma, oku akusebenzi - i-lymphoma eninzi iqhubeka ikhula nangona unyango. Ngoko ke, ukuphelisa iiseli ze-stem kunye needosi eziphezulu kakhulu ze-chemotherapy, emva koko ukubuyisela iiseli ze-stem zaloo mntu kunye nomnye umntu kunokukhokelela kwi-immune system apho iiseli ze-stem zomnikeli zithatha indima yokuvelisa iiseli zegazi ezingajikiyo zibe yi-lymphoma.
Injongo yokutshintshwa kwe-stem cell
Kukho izizathu ezininzi zokuba izigulane ze-lymphoma zingadinga ukutshintshwa kweeseli ze-stem ezibandakanya:
- Ukunyanga izigulane ze-lymphoma ezixolelweyo, kodwa 'zinomngcipheko omkhulu' wokubuya kwe-lymphoma
- I-lymphoma ibuyile emva konyango lokuqala olusemgangathweni, ngoko ke ichemotherapy eqatha (eyomelele) isetyenziselwa ukubabuyisela kuxolelo (akukho sifo sibonwayo)
- I-lymphoma i-refractory (ayikaphenduli ngokupheleleyo) kunyango oluqhelekileyo lodidi lokuqala ngenjongo yokufumana uxolelo.
I-allogeneic stem cell transplant inokubonelela ngemisebenzi emibini
- Amanani aphezulu kakhulu e-chemotherapy aphelisa i-lymphoma kwaye iiseli ezintsha ezinikezelayo zibonelela ngendlela yokuba amajoni omzimba aphinde aphile, ukunciphisa ixesha apho amajoni omzimba angasebenzi. Iiseli ezintsha zabanikezeli zithatha indima yenkqubo yomzimba yokuzikhusela kunye nokuveliswa kweeseli zegazi ezinempilo, ezifana ne-lymphocytes. Iiseli ze-stem ezinikezelayo zithatha indawo yeeseli ezingasebenziyo zesigulana.
- I-Graft versus lymphoma effect. Oku kuxa iiseli ze-stem zomnikeli (ezibizwa ngokuba yi-graft) ziqaphela naziphi na iiseli ze-lymphoma eziseleyo kwaye zihlasele, zitshabalalise i-lymphoma. Esi sisiphumo esihle apho iiseli ze-donor stem zinceda ukunyanga i-lymphoma. Kubalulekile ukuqaphela ukuba le mpembelelo ye-graft versus lymphoma ayisoloko isenzeka ngolu hlobo. I-lymphoma inokumelana neeseli ze-donor stem, okanye umzimba womamkeli (obizwa ngokuba ngumgcini) unokulwa neeseli zabaxhasi (ezibizwa ngokuba yi-graft) okukhokelela ekubeni Ukudibanisa ngokuchasene nesifo somamkeli (ingxaki yokufakelwa kwe-allogeneic).
Inkqubo ye-allogeneic stem cell transplant inezigaba ezihlanu
UGq Amit Khot, ugqirha weHaematologist kunye nogqirha wofakelo lomongo wethambo
Peter MacCallum Cancer Centre kunye nesibhedlele saseRoyal Melbourne
- Ukulungiselela: oku kuquka uvavanyo lwegazi ukufumanisa uhlobo lweeseli ozifunayo. Ngamanye amaxesha abantu kufuneka babe nechemotherapy 'yokusindisa' ukuzama nokunciphisa i-lymphoma phambi kokutshintshwa.
- Ukuqokelelwa kweeseli zesiqu: le yinkqubo yokuvuna iiseli ze-stem, kuba i-allogenic transplant ivela kumnikeli, iqela lezonyango kufuneka lifumane umdlalo wokufakelwa.
- Unyango lokulungisa: le yichemotherapy, unyango ekujoliswe kulo kunye nonyango logonyo olulawulwa ngamaxabiso aphezulu kakhulu ukuphelisa yonke i-lymphoma.
- Ukuvuselelwa kweeseli ze-stem: emva kokuba unyango lwedosi ephezulu lulawulwe, iiseli ze-stem ebeziqokelelwe ngaphambili kumnikeli, ziyalawulwa.
- Engraftment: le yinkqubo apho iiseli ze-donor stem zihlala emzimbeni kwaye zithatha ukusebenza kwe-immune system.
Ukulungiselela unyango
Kuya kubakho ukulungiswa okuninzi okufunekayo ekukhokelela kwi-stem cell transplant. Lonke uqhaqho-fakelo lwahlukile kwaye iqela lofakelo-gazi kufuneka lilungiselele yonke into yesigulana. Amanye amalungiselelo anokulindela anokuquka:
Ukufakwa komgca osembindini
Ukuba isigulane asinalo umgca ophakathi, ngoko ke umntu uya kufakwa ngaphambi kokutshintshwa. Umgca osembindini unokuba nokuba yiPICC (icatheter ephakathi efakwe kwiperipheral). Inokuba yi-CVL (umgca we-venous ophakathi). Ugqirha uya kuthatha isigqibo sokuba yeyiphi umgca ophakathi olungele isigulane.
Umgca ophakathi unika indlela yokufumana amayeza amaninzi ahlukeneyo ngexesha elinye. Izigulana ngokubanzi zifuna amayeza amaninzi ahlukeneyo kunye novavanyo lwegazi ngexesha lokutshintshwa kwaye umgca osembindini unceda abongikazi ukulawula ngcono ukhathalelo lwesigulana.
Chemotherapy
I-chemotherapy yedosi ephezulu ihlala ilawulwa njengenxalenye yenkqubo yokutshintshwa. Idosi ephezulu yechemotherapy ibizwa ngokuba unyango lokulungisa. Ngaphandle kwedosi ephezulu yechemotherapy, ezinye izigulana zidinga ichemotherapy yokuhlangula. Unyango lwe-Salvage xa i-lymphoma inobudlova kwaye idinga ukuncitshiswa ngaphambi kokuba yonke inkqubo yokutshintshwa iqhube phambili. Igama kunqanda ivela ekuzameni ukuhlenga umzimba kwi-lymphoma.
Ukufuduswa kunyango
Zizibhedlele ezithile kuphela ngaphakathi eOstreliya ezikwaziyo ukwenza i-allogeneic stem cell transplantation. Ngenxa yoko, kusenokufuneka bafuduke kwikhaya labo, baye kwindawo ekufutshane nesibhedlele. Uninzi lwezibhedlele zoqhaqho-fakelo lunendawo yokuhlala yezigulane esinokuhlala kuyo isigulana kunye nomkhathaleli. Thetha nonontlalontle kwiziko lakho lonyango ukuze wazi malunga nokukhetha indawo yokuhlala.
Ukugcinwa kokuchuma
Utyando lwe-stem cell luya kuba nefuthe kwisakhono sesigulana sokuba nabantwana. Kubalulekile ukuba ukhetho olukhoyo lokulondoloza ukuchuma kuxoxwe ngalo.
Iingcebiso eziluncedo
Ukuba ne-stem cell transplant kudla ngokubandakanya ukuhlala ixesha elide esibhedlele. Kunokuba luncedo ukupakisha ezinye zezi zinto:
- Izibini ezininzi zeempahla ezithambileyo, ezitofotofo okanye zokulala kunye nempahla yangaphantsi eninzi.
- Ibhrashi yamazinyo (ethambileyo), intlama yamazinyo, isepha, isiqholo esithambileyo, isiqhumiso esithambileyo
- Umqamelo wakho (uhlambe ushushu umqamelo wakho kunye naziphi na iingubo zobuqu/uziphose iiragi phambi kokuba ulaliswe esibhedlele - zihlambe zishushu ukunciphisa iintsholongwane njengoko amajoni akho omzimba aya kuba sesichengeni kakhulu).
- I-Slippers okanye izicathulo ezikhululekile kunye neninzi yeeperesi zeekawusi
- Izinto zobuqu zokuqaqambisa igumbi lakho lasesibhedlele (ifoto yabantu obathandayo)
- Izinto zokuzonwabisa njengeencwadi, iimagazini, amagama anqamlezayo, i-iPad/laptop/tablet. Isibhedlele sinokudika kakhulu ukuba awunanto yokwenza.
- Ikhalenda yokugcina umkhondo womhla, ukulaliswa esibhedlele ixesha elide kunokuphazamisa yonke imihla kunye.
I-HLA kunye ne-Tissue Typing
Xa une-allogeneic (donor) stem cell transplant, umnxibelelanisi wofakelo-gazi uququzelela ukukhangela umnikeli we-stem cell ofanelekileyo. Ufakelo lwe-allogeneic stem cell lunokwenzeka ukuba luphumelele ukuba iiseli zomnikeli zihambelana ngokusondeleyo nesigulana. Ukujonga oku, isigulane siya kuba novavanyo lwegazi lwenziwe olubizwa ukuchwetheza kwethishu ejonga iiproteni ezahlukeneyo kumphezulu weeseli ezibizwa i-antigens ye-leukocyte yabantu (HLA).
Iiseli zomntu wonke zenza iiproteni ze-HLA ukunceda amajoni omzimba ukuba abone iiseli ezisemzimbeni kwaye aqaphele iiseli ezingezizo ezakhe.
Zininzi iindidi ezahlukeneyo ze-HLA kwaye iqela lezonyango lizama ukufumana umxhasi oneentlobo ze-HLA ezihambelana ngokusondeleyo kangangoko kunokwenzeka.
Ukuba kunokwenzeka, baphinde bazame ukuqinisekisa ukuba isigulane kunye nomnikezeli baye bafumana iintsholongwane ezifanayo, nangona oku kungabalulekanga ngaphantsi kweHLA-matching.
Abazalwana okanye oodade badla ngokuba neeproteni ze-HLA ezifanayo nesigulana. Malunga nomntu om-1 kwaba-3 unomntakwabo okanye udade ohambelana kakuhle. Ukuba isigulana asinabo nabaphi na oobhuti okanye oodade, okanye abahambelani kakuhle, iqela lezonyango liyakukhangela umxhasi olivolontiya oluhlobo lwe-HLA oluhambelana nezigulana ngokusondeleyo kangangoko. Oku kwaziwa njengomnikelo ohambelanayo onganxulumananga (MUD) kwaye izigidi zamavolontiya zibhaliswe kubhaliso lweeseli zesizwe kunye nehlabathi jikelele.
Ukuba umxhasi onganxulumananga (i-MUD) akafumaneki kwisigulana, kusenokwenzeka ukuba kusetyenziswe eminye imithombo yeeseli zesiqu. Ezi ziquka:
- Isihlobo esinohlobo lwe-HLA olukwisiqingatha esihambelana nesakho: oku kwaziwa njengomnikeli 'wehaploidentical'
- Igazi le-Umbilical cord elivela kumnikeli onganxulumananga: igazi lenkaba akufuneki lihambelane ngokusondeleyo nohlobo lwe-HLA njengeminye imithombo yeeseli ezisisiqu. Kulindeleke ukuba isetyenziswe kubantwana kunabantu abadala kuba iqulethe iiseli ze-stem ezimbalwa kuneminye imithombo. Iirejista zegazi eligciniweyo le-umbilical cord ziyafumaneka.
Ukuqokelelwa kweeseli zeStem
Zimbini iindlela umntu anokuthi anikele ngazo ngeeseli ze-stem.
- Ukuqokelelwa kweeseli zegazi zeperipheral
- Ukunikezelwa kweeseli zomongo wethambo
Ukunikezelwa kweeseli zegazi zeperipheral
Iiseli ze-peripheral stem ziqokelelwa kumsinga wegazi we-peripheral. Ukukhokelela ekuqokeleleni i-peripheral stem cell, abantu abaninzi bafumana iinaliti zezinto zokukhula. Izinto zokukhula zikhuthaza ukuveliswa kweeseli ze-stem. Oku kunceda ii-stem cells zihambe ukusuka kumongo wethambo, ziye egazini, zilungele ukuqokelelwa.
Uqokelelo lwenzeka ngokwahlula iiseli ze-stem kulo lonke igazi kwaye inkqubo isebenzisa umatshini we-apheresis. Umatshini we-apheresis unokohlula amacandelo ahlukeneyo egazi kwaye unokwahlula iiseli ze-stem. Emva kokuba igazi lihambile kwisigaba sokuqokelelwa kweeseli libuyela emzimbeni. Le nkqubo ithatha iiyure ezininzi (malunga ne-2 - 4 iiyure). Umnikeli unokugoduka emva kwenkqubo, nangona kunjalo, unokufuna ukubuya ngosuku olulandelayo ukuba akukho seli zaneleyo eziqokelelweyo.
I-Apheresis ayingeneleli kangako kunokuqokelela umongo wamathambo kwaye oku kungenxa yokuba iyeyona ndlela ikhethwayo yokuqokelela i-stem cell.
Kwi-allogeneic (donor) transplants, umnikezeli ufumana i-apheresis yommkeli kwaye olu qokelelo lwenzeka ngokusondeleyo kumhla wokutshintshwa ngokusemandleni. Kuba ezi seli stem ziya kuziswa zintsha kumamkeli ngosuku lokutshintshwa.
Ukunikezelwa kweeseli zeBone Marrow
Indlela engaxhaphakanga kakhulu yokuqokelela iiseli ze-stem kukuvuna umongo wamathambo. Kulapho iiseli ze-stem zihoxiswa kumongo wethambo phantsi kwe-anesthesia jikelele. Oogqirha bafaka inaliti kwithambo kwingingqi ye-pelvic, ebizwa ngokuba yi-iliac crest. Umongo wethambo uhoxiswa kwi-pelvis, ngenaliti kwaye lo umongo wethambo uyahluzwa kwaye ugcinwe kude kube yimini yokutshintshwa.
Igazi lentambo Umnikelo uvela kwibhanki yentambo yoluntu apho umnikelo weeseli ze-stem eziphuma kwigazi elishiywe kwi-umbilical cord kunye ne-placenta emva kokuzalwa komntwana uye wagcinwa.
Isebenza njani i-apheresis
Ukulungiswa / ukugcinwa kweeseli ze-stem okanye umongo wethambo
Iiseli ze-Stem eziqokelelwe kwi-allogeneic (donor) transplant, ziqokelelwa ngokukhawuleza ngaphambi kokusetyenziswa kwaye azigcinwanga naluphi na ubude bexesha.
Iiseli ze-Stem eziqokelelwe ukutshintshwa kwe-autologous (self), zigcinwa ngokubanzi kwaye zigcinwe kwisikhenkcisi de zilungele ukusetyenziswa.
Isimo
Izigulana ezenza uqhaqho-fakelo kuqala zinikwa unyango olubizwa ngokuba yirejimeni yolungiselelo. Olu lunyango lwedosi ephezulu olulawulwa kwiintsuku phambi kokuba kufakwe iiseli ze-stem. Ukunyangwa konyango kunokubandakanya ichemotherapy kwaye ngamanye amaxesha unyango lweradiation. Iinjongo ezimbini zonyango lwemeko zezi:
- Ukubulala i-lymphoma eninzi kangangoko kunokwenzeka
- Ukunciphisa inani le-stem cell
Kukho indibaniselwano ezininzi ezahlukeneyo zechemotherapy, unyango lweradiation kunye ne-immunotherapy enokuthi isetyenziswe kwiinkqubo zokumisela. Kukho ubunzulu obahlukeneyo bokunyangwa kwemeko, zezi:
- Ubunzulu obugcweleyo bemeko ye-myeloablative
- Ukulungiswa kwe-myeloablative
- Ukunciphisa imeko yokuqina
Kuzo zonke iirejimeni unyango lunzulu kwaye ngenxa yoko, iiseli ezininzi ezinempilo ziyafa kunye ne-lymphoma. Ukukhethwa kwerejimeni kuya kuxhomekeka kuhlobo lwe-lymphoma, imbali yonyango kunye nezinye izinto ezizimeleyo ezifana nobudala, impilo jikelele kunye nokufaneleka. Iqela elinyangayo liya kuxoxa nesigulane ukuba yeyiphi i-conditioning regimen efanelekileyo kwisigulane.
Kwi-allogeneic transplant, izigulane zinokungeniswa esibhedlele kwangeentsuku ezili-14 ngaphambi kokutshintshwa. Imeko yesigulana ngasinye yahlukile kwaye ugqirha wakho uya kukwazisa ukuba wamkelwa nini na. Izigulana zihlala esibhedlele naphi na ukusuka kwiiveki ezi-3 ukuya kwezi-6 emva koqhaqho. Esi sisikhokelo; Ufakelo ngalunye lwahlukile, kwaye abanye abantu bafuna ukhathalelo lwezonyango ngaphezulu kweeveki ezi-6.
Ukuba une-allogeneic stem cell transplant usebenzisa iiseli ze-stem ezivela kumnikezeli onganxulumananga okanye omkhulu ongahambelaniyo, unokufuna unyango oluphezulu lwemeko.
Unokuba nonyango olwahlukileyo lwemeko ukuba unokufakelwa kwe-allogeneic usebenzisa iiseli ze-stem ezisuka kwi-umbilical cord blood okanye kwisalamane esihambelana nesiqingatha.
Ungafikelela kulwazi oluneenkcukacha malunga neerejimeni zokumisela kwi Iwebhusayithi ye-Eviq.
Ukubuyisela iiseli ze-stem
Emva kokuba i-chemotherapy conditioning enzulu igqityiwe, iiseli ze-stem zibuyiselwa kwakhona. Ezi stem cells ziqala kancinci ukuvelisa iiseli zegazi ezintsha nezisempilweni. Ekugqibeleni, baya kuvelisa iiseli ezaneleyo ezinempilo ukuze ziphinde zizalise umnkantsha wethambo, zizalise lonke igazi kunye neeseli zomzimba.
Ukubuyiselwa kweeseli ze-stem yinkqubo ethe ngqo. Kuyafana notofelo-gazi. Iiseli zinikwa ngomgca kumgca osembindini. Mhla ii-stem cells ziphinda zafakwa zibizwa ngokuba yi “Day Zero”.
Ngayo nayiphi na inkqubo yonyango, kukho umngcipheko wokusabela kwi-stem cell infusion. Kubantu abaninzi akukho kusabela, kodwa abanye banokufumana:
- Ukuziva ugula okanye ugula
- Incasa embi okanye imvakalelo evuthayo emlonyeni wakho
- Igazi elonyukayo
- Ukuphendula ngokuchaseneyo
- Sulelo
Kwi-allogeneic stem cell transplants, njengoko ezi seli ezinikezelweyo zibamba (okanye i-engraft) kumamkeli (isigulane). Baqala ukusebenza njengenxalenye yesistim somzimba kwaye banokuhlasela iiseli ze-lymphoma. Oku kubizwa ngokuba i-graft-versus lymphoma effect.
Kwezinye iimeko, emva kokufakelwa kwe-allogeneic, iiseli ezinikezelayo zihlasela iiseli eziphilileyo zesigulana. Oku kubizwa I-graft-versus-host disease (GVHD).
Ukwenziwa kweeseli zakho ze-stem
Ukungena kuxa iiseli ze-stem ezintsha ziqala ngokuthe ngcembe ukuthatha indawo njengee-primary stem cells. Oku kwenzeka ngokubanzi malunga neeveki ezi-2 ukuya kwezi-3 emva kokufakwa kweeseli ze-stem kodwa kunokuthatha ixesha elide, ngakumbi ukuba iiseli ezitsha ziphuma kwigazi lenkaba.
Ngelixa iiseli ze-stem ezintsha zikrolwa, usemngciphekweni omkhulu wokufumana usulelo. Abantu ngokubanzi kufuneka bahlale esibhedlele ngeli xesha, kuba banokugula kwaye kufuneka bakwazi ukufumana unyango kwangoko.
Ngelixa usalinde ukuba amanani egazi lakho aphucuke, unokuba nolu nyango lulandelayo ukuxhasa ukuchacha kwakho:
- Utofelo-gazi – kubalo olusezantsi lweeseli ezibomvu zegazi (i-anemia)
- Utofelo-gazi lweplatelet - kumanqanaba asezantsi eplatelet (thrombocytopenia)
- I-Antibiotics - yosulelo lwebhaktheriya
- Iyeza le-Antiviral - ngenxa yosulelo lwentsholongwane
- Iyeza elichasayo lokungunda - losulelo lomngundo
Engraftment syndrome
Emva kokufumana iiseli ezitsha ze-stem, abanye abantu bahlakulela ezi mpawu zilandelayo kwiiveki ezi-2-3 kamva, ngokubanzi malunga nexesha lokufakwa kweeseli:
- Umkhuhlane: ubushushu obuphezulu be-38 degrees okanye ngaphezulu
- Irhashalala ebomvu
- Uhudo
- Ukugcinwa kwamanzi
Oku kubizwa ngokuba 'yi-engraftment syndrome'. Ixhaphake kakhulu emva kofakelo lwe-self (autologous) ye-stem cell kunomxhasi (allogeneic) wofakelo lwe-stem cell.
Yimpembelelo yecala eqhelekileyo yokutshintshwa kwaye iphathwa nge-steroids. Ezi mpawu zisenokubangelwa zezinye izinto, kuquka ichemotherapy, kwaye isenokungabi luphawu lwe-engraftment syndrome.
Ezinye iiprothokholi zesibhedlele eziqhelekileyo ngexesha lokutshintshwa ziquka:
- Ngokuqhelekileyo uhlala kwigumbi lasesibhedlele ngokwakho ngexesha lokuhlala kwakho
- Igumbi lasesibhedlele licocwa rhoqo kwaye amashiti kunye neepillowcases zitshintshwa yonke imihla
- Awukwazi ukuba nezityalo eziphilayo okanye iintyatyambo kwigumbi lakho
- Abasebenzi basesibhedlele kunye neendwendwe kufuneka bahlambe izandla zabo ngaphambi kokungena kwigumbi lakho
- Ngamanye amaxesha abatyeleli kunye nabasebenzi basesibhedlele banokufuna ukunxiba iiglavu, iigawuni okanye iifaskoti, kunye nemaski yobuso xa bekundwendwela.
Abantu akufuneki bakundwendwele ukuba abaphilanga - Abantwana abangaphantsi kweminyaka ethile banokungavunyelwa kwaphela ukuba batyelele – nangona ezinye izibhedlele zibavumela ukuba benze njalo ukuba abantwana baphile qete
Nje ukuba amanani akho egazi sele echachile kwaye nesigulana siphile ngokwaneleyo, banokugoduka. Emva kweli xesha, baya kulandelwa ngokusondeleyo liqela lezonyango.
Iingxaki ezivela kwi-stem cell transplantation
I-Graft Versus Host Disease (GvHD)
I-Graft-versus-host disease (GvHD) yingxaki eqhelekileyo yofakelo lwe-allogeneic stem cell. Kwenzeka xa:
- Umxhasi we-T-seli (ekwabizwa ngokuba 'yi-graft') ibona ii-antigens kwezinye iiseli kumzimba womamkeli (ebizwa ngokuba 'yinginginya') njengeyangaphandle.
- Emva kokuqaphela ezi antigens, iiseli ze-T zomnikeli emva koko zihlasele iiseli zomkhosi wazo omtsha.
Esi siphumo sinokuba luncedo xa umxhasi omtsha we-T-seli ehlasela iiseli ze-lymphoma ezisele (ezibizwa ngokuba yi-graft versus lymphoma effect). Ngelishwa, iiseli ze-T ezinikezelayo zinokuhlasela izicubu ezinempilo. Oku kunokubangela iziphumo ebezingalindelekanga ezimandundu.
Amaxesha amaninzi i-GvHD ibangela iimpawu ezisezantsi ukuya kweziphakathi, kodwa ngamanye amaxesha, inokuba nzima kwaye ibeke ubomi esichengeni. Ngaphambi nasemva kofakelo, izigulane zinikwa unyango lokunciphisa umngcipheko wokuba ne-GvHD. Iqela lofakelo lofakelo lijonga isigulana ngokusondeleyo naziphi na iimpawu ze-GvHD ukuze bakwazi ukuyinyanga kwangethuba, ukuba iyavela.
I-GvHD ihlelwa njenge 'acute' okanye 'engapheliyo' ngokuxhomekeke kwiimpawu kunye neempawu.
Umngcipheko Wosulelo
Ukulandela ukutshintshwa kweeseli ze-stem, iidosi eziphezulu ze-chemotherapy ziya kube ziphelise uninzi lweeseli ezimhlophe zegazi, kubandakanya iseli emhlophe yegazi ebizwa ngokuba yi-neutrophils. Izinga eliphantsi le-neutrophils laziwa ngokuba yi-neutropenia. I-neutropenia yexesha elide ibeka umntu emngciphekweni ophezulu kakhulu wokufumana usulelo. Usulelo lunokunyangwa, kodwa ukuba alubanjwanga kwangoko kwaye lunyangwe ngokukhawuleza lunokubeka ubomi esichengeni.
Ngelixa esibhedlele, ngokukhawuleza emva kofakelo lwe-stem cell, iqela elinyangayo liya kuthatha amanyathelo okuthintela ukukhula kosulelo kunye nokubeka iliso elibukhali kwiimpawu zosulelo. Nangona amanyathelo amaninzi athatyathwa ukunciphisa umngcipheko wokufumana usulelo, izigulane ezininzi ezine-allogeneic stem cell transplant ziya kufumana usulelo.
Kwiiveki ezimbalwa zokuqala emva kokutshintshwa, izigulane zisengozini enkulu yokuphuhlisa usulelo lwebhaktheriya. Usulelo olunjalo lubandakanya, usulelo lwegazi, inyumoniya, usulelo lwenkqubo yokwetyisa okanye usulelo lwesikhumba.
Kwiinyanga ezimbalwa ezizayo, abaguli basemngciphekweni omkhulu wokufumana usulelo lwentsholongwane kwaye ezi inokuba ziintsholongwane ebezilele umzimba wonke phambi koqhaqho kwaye zinokugqabhuka xa amajoni omzimba esezantsi. Azisoloko zibangela iimpawu. Uvavanyo lwegazi rhoqo emva kofakelo luya kwenziwa ukuqinisekisa ukugqabhuka kosulelo lwentsholongwane ebizwa ngokuba yi-cytomegalovirus (CMV) lubhaqwe kwangethuba. Ukuba uvavanyo lwegazi lubonisa ukuba i-CMV ikhona - nokuba ingenazo iimpawu - isigulane siya kuba nonyango ngamachiza e-antiviral. Ngaphezulu kwekhosi enye yonyango inokufuneka kwaye olu nyango lunokwandisa ixesha lokuhlala esibhedlele.
Ubalo lwegazi luqala ukunyuka phakathi kweeveki ezi-2 ukuya kwezi-4 emva kofakelo lwe-allogeneic stem cell. Nangona kunjalo, kunokuthatha iinyanga ezininzi, okanye ngamanye amaxesha kwaneminyaka, ukuze amajoni omzimba aphinde aphile ngokupheleleyo.
Xa ekhutshwa esibhedlele iqela lezonyango kufuneka licebise ukuba zeziphi iimpawu zosulelo ekufuneka zijongwe kwaye ngubani omawuqhagamshelane naye ukuba kukho usulelo olunokwenzeka okanye nayiphi na enye into enokuba yinkxalabo kumguli.
Iziphumo ebezingalindelekanga zedosi ephezulu yechemotherapy
Izigulane kusenokwenzeka ukuba zibe neziphumo ebezingalindelekanga ezivela kunyango lwedosi ephezulu yokulwa nomhlaza. Ezi ziphumo bezingalindelekanga zilandelayo zinokuba zixhaphakile kwaye ulwazi oluninzi lukwi imiphumela icandelo
- Oral Mucositis (umlomo obuhlungu)
- I-anemia (isibalo esisezantsi seeseli ezibomvu)
- I-Thrombocytopenia (inani eliphantsi leplatelet)
- Isihlunu kunye nokuhlanza
- Iingxaki zendlela yokwetyisa (urhudo okanye ukuqhina)
Ukusilela kwegrafti
Ukungaphumeleli kwe-graft kwenzeka ukuba iiseli ze-stem ezitshintshiweyo zisilela ukuzinza kumongo wethambo kwaye zenze iiseli zegazi ezintsha. Oku kuthetha ukuba amanani egazi awachacha, okanye aqale achache kodwa ehle kwakhona.
Ukungaphumeleli kwe-graft kunzulu kodwa kunqabile emva kokufakelwa kwe-allogeneic stem cell, ngakumbi ukuba umnikeli uhambelana kakuhle.
Iqela lezonyango liya kubeka iliso kumanani egazi ngokusondeleyo kwaye ukuba iseli entsha ye-stem iqala ukusilela, isigulana sinokunyangwa ekuqaleni ngeehomoni zokukhula. Ezi zinokukhuthaza iiseli ze-stem kumongo wethambo ukuvelisa iiseli ezininzi.
Ukuba iiseli ze-stem zomnikeli azikrolwanga, isigulane sinokufuna ukutshintshwa kweseli yesibini. Olu fakelo lwesibini lunokuba luvela kumnikezeli weseli ye-stem okanye eyahlukileyo.
Iziphumo zamva
Iziphumo zamva ziingxaki zempilo ezinokuthi ziphuhlise iinyanga okanye iminyaka emva konyango lwe-lymphoma. Uninzi lwamaziko anikezela ngeenkonzo zeziphumo emva kwexesha ezibonelela ngeenkqubo zokujonga iziphumo zasemva kwexesha kwangoko. Oku kunika isigulana elona thuba lilungileyo lokunyangwa ngempumelelo ukuba ngaba siphuhlisa naziphi na iziphumo zasemva kwexesha.
Izigulane zinokuba semngciphekweni wokuphuhlisa i-Post-Transplant Lymphoproliferative Disorder (PTLD) - i-lymphomas enokuthi iphuhliswe kubantu abathatha iziyobisi ze-immunosuppressant emva kokutshintshwa. Nangona kunjalo, i-PTLD inqabile. Uninzi lwezigulana eziye zafumana uqhaqho aluphuhlisi i-PTLD.
Ukhathalelo lokulandela
Emva kokutshintshwa kwe-stem cell, kuya kubakho ukuqeshwa rhoqo (ngeveki) kunye nogqirha. Ukulandelela kuya kuqhubeka iinyanga kunye neminyaka emva konyango, kodwa ngaphantsi nangaphantsi rhoqo njengoko ixesha lihamba. Ekugqibeleni oogqirha bofakelo-mzimba baya kuba nakho ukunikezela ngokhathalelo lokulandelela, kwi-GP yezigulane.
Malunga neenyanga ezi-3 emva kofakelo, a PET yokuhlola, CT scan kunye / okanye ibone marrow aspirate (BMA) kunokucwangciswa ukuvavanya ukuba kuqhubeka njani ukuchacha.
Kuqhelekile ukuba ubuyele esibhedlele ukuze ufumane unyango kwiiveki kunye neenyanga ezilandela ukutshintshwa kodwa njengoko ixesha lihamba, umngcipheko weengxaki ezinzulu ziyancipha.
Izigulane kusenokwenzeka ukuba zibe neziphumo ebezingalindelekanga ezivela kunyango lwedosi ephezulu kwaye zinokuziva zingaphilanga kwaye zidiniwe kakhulu. Nangona kunjalo, ihlala ithatha unyaka ukuchacha kwi-stem cell transplant.
IQELA lezonyango kufuneka licebise ngezinye izinto ekufuneka ziqwalaselwe ngexesha lokuchacha. I-Lymphoma Australia inekhasi le-Facebook labucala le-intanethi, i-Lymphoma Phantsi Ngaphantsi apho unokubuza imibuzo kwaye ufumane inkxaso kwabanye abantu abachaphazelekayo nge-lymphoma okanye i-stem cell transplant.
Kwenzeka ntoni emva kofakelo lwe-stem cell?
Ukugqiba unyango inokuba lixesha elinzima kwizigulane ezininzi, njengoko zibuyela ebomini emva kokutshintshwa. Ezinye zeenkxalabo eziqhelekileyo zinokunxulumana noku:
- Zemvelo
- Ukuphila kwengqondo
- Impilo ngokweemvakalelo
- ubudlelwane
- Umsebenzi, ukufunda kunye nemisebenzi yentlalo
Inkcukacha ezithe vetshe
USteve wafunyaniswa ene-mantle cell lymphoma ngo-2010. USteve uye wasinda kwi-autologous kunye ne-allogeneic stem cell transplant. Eli libali likaSteve.
UGqr Nada Hamad, ugqirha weHaematologist kunye nogqirha wofakelo lomongo wethambo
Isibhedlele saseSt Vincent, eSydney
UGq Amit Khot, ugqirha weHaematologist kunye nogqirha wofakelo lomongo wethambo
Peter MacCallum Cancer Centre kunye nesibhedlele saseRoyal Melbourne
UGq Amit Khot, ugqirha weHaematologist kunye nogqirha wofakelo lomongo wethambo
Peter MacCallum Cancer Centre kunye nesibhedlele saseRoyal Melbourne
UGq Amit Khot, ugqirha weHaematologist kunye nogqirha wofakelo lomongo wethambo
Peter MacCallum Cancer Centre kunye nesibhedlele saseRoyal Melbourne
UGq Amit Khot, ugqirha weHaematologist kunye nogqirha wofakelo lomongo wethambo
Peter MacCallum Cancer Centre kunye nesibhedlele saseRoyal Melbourne
