An i-allogeneic stem cell transplant ukwelashwa okujulile lapho uthola khona ukufakelwa ama-stem cells (omunye umuntu). Lokhu kuhlukile lapho isiguli sithola amaseli aso emuva, okubizwa ngokuthi i ukufakelwa kwe-autologous stem cell. Lokhu kuxoxwa kwelinye ikhasi.
Uhlolojikelele lwe-allogeneic stem cell transplants?
UDkt Amit Khot, Udokotela Wegazi kanye nodokotela wokufakelwa komnkantsha
Peter MacCallum Cancer Center kanye nesibhedlela saseRoyal Melbourne
I-allogeneic stem cell transplantation isebenzisa ama-stem cells aqoqwe kumnikeli (omunye umuntu) ukuze athathele owakho ama-stem cells. Lokhu kwenzelwa ukwelapha i-Lymphoma ephikisayo (engaphenduli ekwelashweni) noma ebuyela emuva (i-lymphoma elokhu ibuya. Abantu abaningi abane-lymphoma abadingi ukufakelwa kwe-stem cell. Ku-lymphoma, ukufakelwa kwe-allogeneic (donor) kuyivelakancane kakhulu kune-autologous (i-autologous) self) ukufakelwa.
I-Lymphoma ingumdlavuza wama-lymphocyte. Ama-Lymphocyte awuhlobo lwamangqamuzana amhlophe egazi avela kuma-stem cells. Umgomo we imiphumela emibi yokwelashwa ngamakhemikhali ukuqeda amaseli e-lymphoma nawo wonke ama-stem cells angase akhule abe yi-lymphoma. Uma amangqamuzana amabi eseqediwe, amaseli amasha angakhula abuyele emuva okungenzeka ukuthi awanawo umdlavuza.
Endabeni yabantu abaye babuyela emuva noma i-refractory lymphoma, lokhu akusebenzi - i-lymphoma eyengeziwe ilokhu ikhula naphezu kokwelashwa. Ngakho-ke, ukuqeda ama-stem cells ngemithamo ephezulu kakhulu ye-chemotherapy, bese ubuyisela ama-stem cells alowo muntu esikhundleni somunye kungaholela esimisweni sokuzivikela ezifweni esisha lapho ama-stem cells anikelayo ethatha indima yokukhiqiza amangqamuzana egazi angajiki abe i-lymphoma.
Inhloso yokufakelwa kwe-stem cell
Kunezizathu eziningi zokuthi kungani iziguli ze-lymphoma zingadinga ukufakelwa kwe-stem cell ezihlanganisa:
- Ukwelapha iziguli ze-lymphoma esezixolelwe, kodwa 'zinengozi enkulu' yokubuya kwe-lymphoma yazo
- I-lymphoma ibuyile ngemuva kokwelashwa okujwayelekile komugqa wokuqala, ngakho-ke i-chemotherapy enamandla kakhulu (enamandla) isetshenziselwa ukuyibuyisela ekuxolelweni (asikho isifo esitholakalayo)
- I-lymphoma iyaphika (ayikaphenduli ngokuphelele) ekwelashweni okujwayelekile komugqa wokuqala ngenhloso yokuthola ukuxolelwa.
I-allogeneic stem cell transplant ingase inikeze imisebenzi emibili
- Imithamo ephezulu kakhulu yokwelapha ngamakhemikhali iqeda i-lymphoma futhi amaseli amasha anikelayo anikeza indlela yokuthi amasosha omzimba alulame, anciphisa isikhathi lapho amasosha omzimba engasebenzi. Amaseli amasha anikelayo athatha indima yokusebenza kwamasosha omzimba kanye nokukhiqizwa kwamangqamuzana egazi anempilo, njengama-lymphocyte. Ama-stem cell anikelayo athatha indawo yamaseli angasebenzi esiguli.
- Umphumela we-Graft ngokumelene ne-lymphoma. Yilapho ama-stem cells anikelayo (abizwa ngokuthi i-graft) ebona noma yimaphi amaseli e-lymphoma asele futhi awahlasele, abhubhise i-lymphoma. Lona umphumela omuhle lapho ama-stem cells anikelayo esiza ekwelapheni i-lymphoma. Kubalulekile ukuqaphela ukuthi lokhu kuxhunyelelwa ngokumelene nomphumela we-lymphoma akwenzeki njalo ngale ndlela. I-lymphoma ingamelana namaseli esiqu somnikeli, noma umzimba womamukeli (obizwa ngokuthi umsingathi) ungalwa namaseli anikelayo (abizwa ngokuthi i-graft) okuholela ekutheni ukuxhunyelelwa kuqhathaniswa nesifo sokubamba (inkinga yokufakelwa kwe-allogeneic).
Inqubo yokufakelwa i-allogeneic stem cell inezigaba ezinhlanu
UDkt Amit Khot, Udokotela Wegazi kanye nodokotela wokufakelwa komnkantsha
Peter MacCallum Cancer Center kanye nesibhedlela saseRoyal Melbourne
- Ukulungiselela: lokhu kuhlanganisa ukuhlolwa kwegazi ukuthola uhlobo lwamaseli owadingayo. Kwesinye isikhathi abantu badinga ukuthola i-'salvage' chemotherapy ukuze bazame ukunciphisa i-lymphoma ngaphambi kokufakelwa.
- Iqoqo le-stem cell: lena inqubo yokuvuna ama-stem cells, ngoba ukufakelwa kwe-allogenic kuvela kumnikeli, ithimba lezokwelapha lidinga ukuthola okufanayo kokufakelwa.
- Ukwelashwa kwe-conditioning: lena i-chemotherapy, i-target therapy kanye ne-immunotherapy elawulwa ngemithamo ephezulu kakhulu ukuze kuqedwe yonke i-lymphoma.
- Ukufakwa kabusha kwama-stem cell: uma ukwelashwa kwethamo eliphezulu sekwenziwe, ama-stem cells ayeqoqwe ngaphambilini kumnikeli, ayasetshenziswa.
- I-engraftment: lena inqubo lapho ama-stem cells anikelayo ahlala khona emzimbeni futhi athathe ukusebenza kwamasosha omzimba.
Ukulungiselela ukwelashwa
Kuzoba nokulungiswa okuningi okudingekayo ekuholeni kuze kufike ekufakweni kwe-stem cell. Konke ukufakelwa kuhlukile futhi ithimba lokufakelwa kabusha kufanele lihlelele isiguli yonke into. Amanye amalungiselelo ongawalindela angabandakanya:
Ukufakwa komugqa omaphakathi
Uma isiguli singenawo umugqa omaphakathi, khona-ke uzofakwa ngaphambi kokufakelwa. Ulayini omaphakathi kungaba yi-PICC (i-catheter emaphakathi efakwe ngokuzungezile). Kungaba yi-CVL (umugqa we-venous ophakathi). Udokotela uzonquma ukuthi yimuphi umugqa ophakathi olungele isiguli.
Umugqa omaphakathi unikeza indlela yokuthola imithi eminingi ehlukene ngesikhathi esisodwa. Iziguli ngokuvamile zidinga imithi eminingi ehlukene kanye nokuhlolwa kwegazi ngesikhathi sokufakelwa futhi umugqa omaphakathi usiza abahlengikazi ukuphatha kangcono ukunakekelwa kwesiguli.
Ukwelashwa ngamakhemikhali
I-chemotherapy enedosi ephezulu ihlale ilawulwa njengengxenye yenqubo yokufakelwa kabusha. I-chemotherapy yomthamo omkhulu ibizwa ngokuthi ukwelashwa kwe-conditioning. Ngaphandle komthamo omkhulu we-chemotherapy, ezinye iziguli zidinga i-salvage chemotherapy. I-Salvage therapy yilapho i-lymphoma inolaka futhi idinga ukuncishiswa ngaphambi kokuba yonke inqubo yokufakelwa iqhubeke. Igama salvage kuvela ekuzameni ukuhlenga umzimba ku-lymphoma.
Ukuthutha ukuze uthole ukwelashwa
Izibhedlela ezithile kuphela ngaphakathi kwe-Australia ezikwazi ukwenza i-allogeneic stem cell transplantation. Ngenxa yalokhu, kungase kudingeke bathuthe ekhaya labo, baye endaweni eseduze nesibhedlela. Izibhedlela eziningi zokufakelwa kabusha zinendawo yokuhlala yesiguli isiguli kanye nomnakekeli abangahlala kuzo. Khuluma nosonhlalakahle esikhungweni sakho sokwelashwa ukuze uthole mayelana nezinketho zokuhlala.
Ukulondolozwa kokuzala
Ukufakelwa kwe-stem cell kuzoba nomthelela emandleni esiguli okuba nezingane. Kubalulekile ukuthi kuxoxwe ngezinketho ezitholakalayo zokulondoloza inzalo.
Amathiphu awusizo
Ukufakelwa i-stem cell ngokuvamile kuhilela ukuhlala isikhathi eside esibhedlela. Kungase kube usizo ukupakisha ezinye zalezi zinto:
- Amapheya amaningana ezingubo ezithambile, ezinethezekile noma amaphijama nenqwaba yezingubo zangaphansi.
- Isixubho (sithambile), umuthi wokuxubha, insipho, isikhuthazi esithambile, isiqedaphunga esithambile
- Umcamelo wakho (ushise geza umcamelo wakho kanye nanoma yiziphi izingubo zokulala/ziphonse omata ngaphambi kokungeniswa esibhedlela - ziwashe ngokushisa ukuze unciphise amagciwane njengoba amasosha akho omzimba azoba sengozini kakhulu).
- Ama-slippers noma izicathulo ezikhululekile kanye namapheya amaningi amasokisi
- Izinto zomuntu siqu zokukhanyisa igumbi lakho lasesibhedlela (isithombe sabathandekayo bakho)
- Izinto zokuzijabulisa njengezincwadi, omagazini, amagama ahlukene, i-iPad/laptop/tablet. Isibhedlela singaba nesicefe kakhulu uma ungenayo into ongayenza.
- Ikhalenda lokugcina umkhondo wedethi, ukulaliswa esibhedlela isikhathi eside kungafiphalisa zonke izinsuku ndawonye.
I-HLA kanye Nokuthayipha Kwezicubu
Lapho kunokufakelwa kwe-stem cell allogeneic (donor), umxhumanisi wokufakelwa uhlela ukusesha komnikezeli we-stem cell ofanelekile. Ukufakelwa kwe-stem cell allogeneic cishe kuzophumelela uma amaseli omnikeli ehambisana eduze nesiguli. Ukuhlola lokhu, isiguli sizohlolwa igazi esibizwa ukuthayipha kwezicubu ebheka amaprotheni ahlukene ebusweni bamaseli okuthiwa ama-antigens e-leukocyte yomuntu (HLA).
Amaseli awo wonke umuntu enza amaprotheni e-HLA ukusiza amasosha omzimba abone amaseli asemzimbeni futhi abone amaseli okungewona awawo.
Kunezinhlobo eziningi ezahlukene ze-HLA futhi ithimba lezokwelapha lizama ukuthola umnikeli onezinhlobo ze-HLA ezihambelanayo ezingabanikazi bakhe eduze ngangokunokwenzeka.
Uma kungenzeka, baphinde bazame ukwenza isiqiniseko sokuthi isiguli kanye nomnikeli bake babhekana namagciwane afanayo, nakuba lokhu kungabalulekile kunokumatanisa i-HLA.
Abafowethu noma odade kungenzeka kakhulu babe namaprotheni e-HLA afana nesiguli. Cishe umuntu ongu-1 kwaba-3 unomfowethu noma usisi ofana naye. Uma isiguli singenabo abafowethu noma odadewabo, noma uma bengafanelani kahle, ithimba lezokwelapha lizofuna umnikeli wevolontiya oluhlobo lwe-HLA olufana neziguli eduze ngangokunokwenzeka. Lokhu kwaziwa njengomnikelo ongafaniswayo ongahlobene (i-MUD) futhi izigidi zamavolontiya zibhaliswe nokubhaliswa kwe-stem cell kuzwelonke nasemhlabeni.
Uma umnikezeli ongahlobene (i-MUD) ofanayo engatholakali esigulini, kungase kwenzeke ukusebenzisa eminye imithombo yama-stem cells. Lokhu kubandakanya:
- Isihlobo esinohhafu wohlobo lwe-HLA olufana nolwakho: lokhu kwaziwa njengomnikeli we-'haploidentical'
- Igazi lenkaba elivela kumnikeli ongahlobene: igazi lenkaba akudingeki lifane eduze nohlobo lwe-HLA yakho njengeminye imithombo yama-stem cells. Kungenzeka ukuthi isetshenziselwe izingane kunabantu abadala ngoba iqukethe ama-stem cells ambalwa kuneminye imithombo. Amarejista egazi lenkaba eligciniwe ayatholakala.
Ukuqoqwa kwama-Stem Cell
Kunezindlela ezimbili umnikeli anganikela ngazo ngama-stem cell.
- Iqoqo le-peripheral stem cell
- Umnikelo we-bone marrow stem cell
Umnikelo we-peripheral stem cell
Amaseli e-stem e-peripheral aqoqwa emgudwini wegazi we-peripheral. Ekuholeleni ekuqoqweni kwe-peripheral stem cell, abantu abaningi bathola imijovo yesici sokukhula. Izici zokukhula zikhuthaza ukukhiqizwa kwe-stem cell. Lokhu kusiza ama-stem cells asuke emnkantsheni, aye egazini, alungele ukuqoqwa.
Iqoqo lenzeka ngokuhlukanisa ama-stem cells kulo lonke igazi futhi inqubo isebenzisa umshini we-apheresis. Umshini we-apheresis ungahlukanisa izingxenye ezihlukene zegazi futhi ungahlukanisa ama-stem cells. Uma igazi selihambe esigabeni sokuqoqwa kwamaseli libuyela emzimbeni. Le nqubo ithatha amahora ambalwa (cishe amahora angu-2 - 4). Umnikeli angaya ekhaya ngemva kwenqubo, nokho, angase adinge ukubuya ngakusasa uma kungaqoqwanga amaseli anele.
I-Apheresis ayihlaseli kakhulu kuneqoqo lomnkantsha wamathambo futhi lokhu kungesizathu sokuthi kungani kuyindlela ethandwayo yokuqoqwa kwe-stem cell.
Ku-allogeneic (donor) transplants, onikelayo uthola i-apheresis yomamukeli futhi leli qoqo lenzeka eduze nosuku lokufakelwa kabusha ngangokunokwenzeka. Ngoba lawa ma-stem cells azolethwa esanda kutholwa kumamukeli ngosuku lokufakelwa.
Umnikelo we-Bone Marrow stem cell
Indlela engavamile kakhulu yokuqoqa ama-stem cells isivuno somongo. Yilapho ama-stem cells ahoxiswa khona emnkantsheni ngaphansi kwe-anesthesia jikelele. Odokotela bafaka inaliti ethanjeni endaweni ye-pelvic, ebizwa ngokuthi i-iliac crest. Umnkantsha wethambo ukhishwa okhalweni, ngenaliti futhi lomnkantsha wethambo ube usuhlungwa futhi ugcinwe kuze kube usuku lokufakelwa.
Igazi lentambo umnikelo uvela ebhange lomphakathi lapho umnikelo wama-stem cell egazini elishiywe enkabeni nase-placenta ngemva kokuzalwa komntwana unikelwe futhi wagcinwa.
Isebenza kanjani i-apheresis
Ukucubungula/ukugcina ama-stem cells noma umnkantsha
Amaseli e-stem aqoqwe ukuze afakwe i-allogeneic (donor), aqoqwa ngokushesha ngaphambi kokusetshenziswa futhi angagcinwa nganoma yisiphi ubude besikhathi.
Amaseli e-stem aqoqwe ukuze afakelwe i-autologous (self), ngokuvamile agcinwa futhi agcinwe efrijini aze alungele ukusetshenziswa.
Isimo
Iziguli ezihlinzwa ziqala ukunikwa ukwelashwa okubizwa ngokuthi yi-conditioning regimen. Lokhu ukwelashwa ngethamo eliphezulu okwenziwa ezinsukwini ngaphambi kokuba kufakwe ama-stem cells. Ukwelashwa kwe-conditioning kungabandakanya ukwelashwa ngamakhemikhali futhi ngezinye izikhathi ukwelashwa ngemisebe. Izinhloso ezimbili ze-conditioning therapy yilezi:
- Ukubulala i-lymphoma eningi ngangokunokwenzeka
- Yehlisa inani lama-stem cell
Kunezinhlanganisela eziningi ezahlukene ze-chemotherapy, i-radiation therapy kanye ne-immunotherapy engasetshenziswa ezimisweni zokulungisa isimo. Kunokuqina okuhlukene kokwelashwa kwe-conditioning, yilezi:
- Ukuqina okugcwele kwe-myeloablative conditioning
- I-non-myeloablative conditioning
- Ukunciphisa izinga lokuqina
Kuzo zonke izinhlobo zemithi ukwelashwa kunamandla futhi ngenxa yalokho, amangqamuzana amaningi anempilo ayafa kanye ne-lymphoma. Ukukhethwa kwemithi kuzoncika ohlotsheni lwe-lymphoma, umlando wokwelashwa nezinye izici zomuntu ngamunye ezifana neminyaka, impilo evamile kanye nokuqina. Ithimba elelaphayo lizoxoxa nesiguli ukuthi yiluphi uhlobo lokwelapha olufanele isiguli.
Ku-transplant ye-allogeneic, iziguli zingangeniswa esibhedlela ezinsukwini eziyi-14 ngaphambi kokufakelwa. Icala ngalinye leziguli lihlukile futhi udokotela wakho uzokwazisa ukuthi uzokwamukelwa nini. Iziguli zihlala esibhedlela noma yikuphi kusukela emavikini angu-3 - 6 ngemva kokufakelwa. Lona umhlahlandlela; konke ukufakelwa kuhlukile, futhi abanye abantu badinga ukunakekelwa okwengeziwe kwezokwelapha isikhathi eside kunamaviki angu-6.
Uma ufaka i-allogeneic stem cell transplant usebenzisa ama-stem cells avela kumnikeli ongahlobene noma omkhulu ongafani, ungase udinge ukwelashwa kokuqina okuphezulu.
Ungase ube nokwelashwa okuhlukile kwe-conditioning uma ufaka i-allogeneic usebenzisa ama-stem cells asuka egazini lentambo yombilical noma ovela esihlotsheni esifaniswa nesigamu.
Ungafinyelela ulwazi oluningiliziwe mayelana nemithetho yokubeka isimo ku- Iwebhusayithi ye-Eviq.
Ukubuyisela ama-stem cells
Ngemva kokuphela kokwelashwa kwe-chemotherapy, ama-stem cells ayabuyiselwa. Lama-stem cells kancane kancane aqala ukukhiqiza amaseli egazi amasha, anempilo. Ekugcineni, azokhiqiza amangqamuzana anempilo anele ukuze agcwalise wonke umnkantsha wamathambo, agcwalise lonke igazi namangqamuzana omzimba omzimba.
Ukubuyisela ama-stem cells kuyinqubo eqondile. Kufana nokumpontshelwa igazi. Amaseli anikezwa ngomugqa emgqeni omaphakathi. Ngosuku lapho ama-stem cells abuyiselwa khona abizwa ngokuthi “Day Zero”.
Nganoma iyiphi inqubo yezokwelapha, kunengozi yokuba nokusabela ekufakweni kwe-stem cell. Kubantu abaningi akukho ukusabela, kodwa abanye bangase bahlangabezane:
- Ukuzizwa ugula noma ukugula
- Ukunambitheka okubi noma umuzwa ovuthayo emlonyeni wakho
- Umfutho wegazi ophezulu
- Ukusabela okweqile
- Ukutheleleka
Ku-allogeneic stem cell transplants, njengoba lawa maseli anikelwe ebamba (noma e-engraft) kumamukeli (isiguli). Baqala ukusebenza njengengxenye yamasosha omzimba futhi bangase bahlasele amangqamuzana e-lymphoma. Lokhu kubizwa ngokuthi umphumela we-graft-versus lymphoma.
Kwezinye izimo, ngemva kokufakelwa kwe-allogeneic, amaseli anikelayo aphinde ahlasele amaseli anempilo esiguli. Lokhu kubizwa i-graft-versus-host disease (GVHD).
Ukufakwa kwama-stem cell akho
I-Engraftment yilapho ama-stem cells amasha eqala ukuthatha kancane kancane njengama-primary stem cell. Lokhu ngokuvamile kwenzeka cishe emavikini angu-2 - 3 ngemva kokufakwa kwama-stem cells kodwa kungathatha isikhathi eside, ikakhulukazi uma ama-stem cells amasha ephuma egazini lenkaba.
Ngenkathi ama-stem cells amasha ehlelwa, usengozini enkulu yokuthola ukutheleleka. Ngokuvamile abantu kufanele bahlale esibhedlela ngalesi sikhathi, ngoba bangagula futhi badinge ukuthola ukwelashwa ngokushesha.
Ngenkathi usalinde ukuthi izibalo zakho zegazi zithuthuke, ungase ube nokunye kokwelashwa okulandelayo ukusekela ukululama kwakho:
- Ukumpontshelwa igazi - ngenani eliphansi lamaseli abomvu egazi (i-anemia)
- Ukumpontshelwa kweplatelet - kumazinga aphansi eplatelet (thrombocytopenia)
- Ama-antibiotics - ukutheleleka kwebhaktheriya
- Imithi ye-antiviral - yezifo ezibangelwa amagciwane
- Imithi ye-anti-fungal - yezifo ze-fungal
I-Engraftment syndrome
Ngemva kokuthola ama-stem cells amasha, abanye abantu baba nalezi zimpawu ezilandelayo emasontweni angu-2-3 kamuva, ngokuvamile phakathi nesikhathi sokufakwa kweseli:
- Ukushisa: izinga lokushisa eliphakeme lama-38 degrees noma ngaphezulu
- Ukuqubuka okubomvu
- Uhudo
- Ukugcinwa kwe-Fluid
Lokhu kubizwa ngokuthi 'ingraftment syndrome'. Kuvame kakhulu ngemva kokufakelwa kwe-stem cell (okuzenzakalelayo) kunokufakelwa kwe-stem cell donor (allogeneic).
Kungumphumela ovamile oseceleni wokufakelwa futhi welashwa ngama-steroid. Lezi zimpawu zingabangelwa ezinye izici, okuhlanganisa ukwelashwa ngamakhemikhali, futhi kungase kungabi uphawu lwe-engraftment syndrome.
Amanye amaphrothokholi ajwayelekile esibhedlela ngesikhathi sokufakelwa ahlanganisa:
- Ngokuvamile uhlala wedwa ekamelweni lasesibhedlela ngesikhathi sokuhlala kwakho
- Igumbi lasesibhedlela lihlanzwa njalo futhi amashidi nama-pillowcase ashintshwa nsuku zonke
- Awukwazi ukuba nezitshalo eziphilayo noma izimbali ekamelweni lakho
- Izisebenzi zasesibhedlela nezivakashi kufanele zigeze izandla ngaphambi kokungena ekamelweni lakho
- Kwesinye isikhathi izivakashi nabasebenzi basesibhedlela bangase badinge ukuthi bagqoke amagilavu, izingubo zokugqoka noma amaphinifa, namamaski obuso lapho bakuvakashele.
Abantu akufanele bakuvakashele uma bengaphilile - Izingane ezingaphansi kweminyaka ethile zingase zingavunyelwe nhlobo ukuvakasha - nakuba ezinye izibhedlela zibavumela ukuba benze kanjalo uma izingane ziphilile
Uma izilinganiso zegazi lakho seziluleme futhi isiguli sesiluleme ngokwanele, singabuyela ekhaya. Ngemva kwalesi sikhathi, bazolandelwa eduze ithimba lezokwelapha.
Izinkinga ezivela ku-stem cell transplantation
I-Graft Versus Host Disease (GvHD)
I-Graft-versus-host disease (GvHD) iyinkinga evamile yokufakelwa kwe-stem cell allogeneic. Kwenzeka uma:
- Ama-T-cells (aphinde abizwe ngokuthi 'i-graft') abona ama-antigen kwamanye amaseli emzimbeni womamukeli (obizwa ngokuthi 'umsingathi') njengangaphandle.
- Ngemva kokubona lawa ma-antigen, ama-T-cell anikelayo abe esehlasela amaseli omsingathi wawo omusha.
Lo mphumela ungaba usizo lapho ama-T-cell amasha anikelayo ehlasela amaseli e-lymphoma asele (abizwa ngokuthi i-graft versus lymphoma effect). Ngeshwa, ama-T-cell anikelayo angahlasela izicubu ezinempilo. Lokhu kungabangela imiphumela emibi kakhulu.
Isikhathi esiningi i-GvHD idala izimpawu ezimaphakathi ukuya kwezimaphakathi, kodwa ngezikhathi ezithile, ingaba nzima futhi ibeke impilo engcupheni. Ngaphambi nangemuva kokufakelwa, iziguli zinikezwa ukwelashwa ukunciphisa ingozi yokuba ne-GvHD. Ithimba lokufakelwa liqapha isiguli eduze ukuze libone noma yiziphi izimpawu ze-GvHD ukuze likwazi ukuyelapha ngokushesha ngangokunokwenzeka, uma kwenzeka.
I-GvHD ihlelwa ngokuthi 'acute' noma 'ehlala njalo' kuye ngezimpawu nezimpawu.
Ingozi Yokutheleleka
Ngemuva kokufakelwa kwe-stem cell, imithamo ephezulu ye-chemotherapy izobe iqede amangqamuzana egazi amhlophe amaningi, okuhlanganisa nengqamuzana elimhlophe legazi elibizwa ngokuthi ama-neutrophils. Izinga eliphansi lama-neutrophils laziwa ngokuthi i-neutropenia. I-neutropenia ende ibeka umuntu engcupheni enkulu kakhulu yokuthola ukutheleleka. Izifo zingelapheka, kodwa uma zingabanjwanga kusenesikhathi futhi zelashwe ngokushesha zingaba yingozi empilweni.
Ngesikhathi ngisesibhedlela, ngokushesha ngemva kokufakelwa kwe-stem cell, ithimba elelaphayo lizobe lithatha izinyathelo zokuphepha ukuvimbela izifo kanye nokuqapha ngokucophelela izimpawu zokutheleleka. Nakuba kuthathwa izinyathelo eziningi zokuvikela ukunciphisa ingozi yokuthola ukutheleleka, iziguli eziningi ezinokufakelwa kwe-allogeneic stem cell zizothola ukutheleleka.
Emasontweni ambalwa okuqala ngemva kokufakelwa, iziguli zisengozini enkulu yokutheleleka ngegciwane. Izifo ezinjalo zihlanganisa, izifo zegazi, inyumoniya, izifo zesimiso sokugaya ukudla noma izifo zesikhumba.
Ezinyangeni ezimbalwa ezizayo, iziguli zisengozini enkulu yokuthola izifo ezibangelwa amagciwane futhi lawa kungase kube amagciwane ayelele elele emzimbeni ngaphambi kokufakelwa futhi angase aqubuke lapho amasosha omzimba ephansi. Azibangeli izimpawu ngaso sonke isikhathi. Ukuhlolwa kwegazi okuvamile ngemva kokufakelwa kuzokwenziwa ukuze kuqinisekiswe ukuthi ukuqubuka kwegciwane elibizwa ngokuthi i-cytomegalovirus (CMV) kutholakala kusenesikhathi. Uma ukuhlolwa kwegazi kubonisa ukuthi i-CMV ikhona - ngisho noma ingenazo izimpawu - isiguli sizothola ukwelashwa ngemithi elwa namagciwane. Kungase kudingeke inkambo yokwelashwa engaphezu kweyodwa futhi lokhu kwelashwa kungandisa isikhathi sokuhlala esibhedlela.
Izibalo zegazi ziqala ukukhuphuka phakathi kwamaviki ama-2 kuya kwamane ngemva kokufakelwa i-allogeneic stem cell. Nokho, kungathatha izinyanga eziningi, noma ngezinye izikhathi ngisho neminyaka, ukuze amasosha omzimba alulame ngokugcwele.
Lapho bephuma esibhedlela ithimba lezokwelapha kufanele litshele ukuthi yiziphi izimpawu zokutheleleka okufanele zibhekwe nokuthi ubani okufanele axhumane naye uma kungenzeka kube khona ukutheleleka noma yini enye engase ikhathaze isiguli.
Imiphumela engemihle yomthamo omkhulu kakhulu we-chemotherapy
Iziguli kungenzeka zithole imiphumela engemihle evela ekwelashweni kwethamo eliphezulu lokulwa nomdlavuza. Imiphumela emibi elandelayo ingase ibe yinto evamile futhi ulwazi olwengeziwe luku okuqhamuka uma udla imishanguzo ingxenye
- I-Oral Mucositis (umlomo obuhlungu)
- I-anemia (isibalo esiphansi samaseli abomvu)
- I-Thrombocytopenia (inani eliphansi leplatelet)
- I-nausea nokuhlanza
- Izinkinga zokugaya ukudla (isifo sohudo noma ukuqunjelwa)
Ukuhluleka kwe-graft
Ukuhluleka kwe-graft kwenzeka uma ama-stem cells atshalwe kabusha ehluleka ukuhlala emnkantsheni futhi enze amaseli egazi amasha. Lokhu kusho ukuthi isibalo segazi asilulali, noma siqala ukululama kodwa bese sehla futhi.
Ukwehluleka kwegraft kubi kakhulu kodwa akuvamile ngemva kokufakelwa kwe-allogeneic stem cell, ikakhulukazi uma onikelayo efanelana kahle.
Ithimba lezokwelapha lizoqapha ngokucophelela izibalo zegazi futhi uma i-stem cell entsha iqala ukwehluleka, isiguli singase selashwe ekuqaleni ngama-hormone factor. Lokhu kungakhuthaza ama-stem cells emnkantsheni ukuze akhiqize amaseli amaningi.
Uma ama-stem cells anikelayo engabhalwanga, isiguli singase sidinge ukufakelwa kwe-stem cell yesibili. Lokhu kufakelwa kwesibili kungase kuvele kumnikeli we-stem cell noma ohlukile.
Imiphumela yakamuva
Imiphumela yakamuva yizinkinga zempilo ezingase zikhule izinyanga noma iminyaka ngemuva kokwelashwa kwe-lymphoma. Izikhungo eziningi zokufakelwa kabusha zinikezele ngezinsizakalo zemiphumela yakamuva ezinikezela ngezinhlelo zokuhlola ukuze kutholwe imiphumela yakamuva ngokushesha okukhulu. Lokhu kunikeza isiguli ithuba elihle kakhulu lokwelashwa ngempumelelo uma siba nemiphumela ephuzile.
Iziguli zingase futhi zibe sengozini yokuthola i-Post-Transplant Lymphoproliferative Disorder (PTLD) - i-lymphomas engakhula kubantu abasebenzisa izidakamizwa ezivimbela ukuzivikela komzimba ngemva kokufakelwa. Nokho, i-PTLD ayivamile. Iziguli eziningi ezike zafakwa ukufakelwa aziyikhi i-PTLD.
Ukunakekelwa kokulandelela
Ngemuva kokufakelwa kwe-stem cell, kuzoba nokuqokwa okujwayelekile (isonto ngalinye) nodokotela. Ukulandelela kuzoqhubeka izinyanga neminyaka ngemva kokwelashwa, kodwa kancane kancane njengoba isikhathi sihamba. Ekugcineni odokotela bokufakelwa bazokwazi ukunikeza ukunakekelwa kokulandelela, kudokotela weziguli.
Cishe izinyanga ezi-3 ngemuva kokufakelwa kabusha, a Iskena se-PET, CT scan futhi / noma I-bone marrow aspirate (BMA) ingase ihlelelwe ukuhlola ukuthi ukululama kuhamba kanjani.
Kujwayelekile ukuthi ubuyele esibhedlela ukuze uyokwelashwa emasontweni nasezinyangeni ezilandela ukufakelwa kodwa ngokuhamba kwesikhathi, ingozi yezinkinga ezinkulu iyancipha.
Iziguli kungenzeka futhi zibe nemiphumela engemihle yokwelashwa ngethamo eliphezulu futhi zingase zizwe zingaphilile futhi zikhathele kakhulu. Kodwa-ke, ngokuvamile kuthatha isikhathi esingangonyaka ukuze silulame ekufakweni kwe-stem cell.
ITHIMBA lodokotela kufanele leluleke ngezinye izinto okufanele zibhekwe ngesikhathi sokululama. I-Lymphoma Australia inekhasi le-Facebook eliyimfihlo eliku-inthanethi, i-Lymphoma Down Under lapho ungabuza khona imibuzo futhi uthole ukwesekwa kwabanye abantu abathintwe yi-lymphoma noma ukufakelwa kwe-stem cell.
Kwenzekani ngemva kokufakelwa i-stem cell?
Ukuqeda ukwelashwa kungaba isikhathi esiyinselele ezigulini eziningi, njengoba zibuyela ekuphileni ngemva kokufakelwa. Okunye okukhathazayo okuvamile kungahlotshaniswa nalokhu:
- Physical
- Ukuphila kwengqondo
- Impilo engokomzwelo
- Relationships
- Umsebenzi, ukufunda kanye nemisebenzi yomphakathi
Ulwazi olunzulu
USteve kwatholakala ukuthi une-mantle cell lymphoma ngo-2010. U-Steve uye wasinda ekufakweni kwe-autologous kanye ne-allogeneic stem cell. Lena indaba kaSteve.
UDkt Nada Hamad, Udokotela Wegazi kanye nodokotela wokufakelwa komnkantsha
Isibhedlela iSt Vincent's, eSydney
UDkt Amit Khot, Udokotela Wegazi kanye nodokotela wokufakelwa komnkantsha
Peter MacCallum Cancer Center kanye nesibhedlela saseRoyal Melbourne
UDkt Amit Khot, Udokotela Wegazi kanye nodokotela wokufakelwa komnkantsha
Peter MacCallum Cancer Center kanye nesibhedlela saseRoyal Melbourne
UDkt Amit Khot, Udokotela Wegazi kanye nodokotela wokufakelwa komnkantsha
Peter MacCallum Cancer Center kanye nesibhedlela saseRoyal Melbourne
UDkt Amit Khot, Udokotela Wegazi kanye nodokotela wokufakelwa komnkantsha
Peter MacCallum Cancer Center kanye nesibhedlela saseRoyal Melbourne
