Ama-B-cell lymphocyte e-Diffuse Large B-cell Lymphoma (DLBCL)
Ukuze uqonde i-DLBCL udinga ukwazi kancane ngama-B-Cell lymphocyte akho.
I-B-Cell lymphocyte:
- Ziwuhlobo lwamangqamuzana amhlophe egazi
- Yilwa nezifo kanye nezifo ukuze uhlale unempilo.
- Khumbula izifo obunazo esikhathini esidlule, ngakho-ke uma uthola ukutheleleka okufanayo futhi, amasosha omzimba wakho angalwa nakho ngempumelelo nangokushesha.
- Zenziwe emnkantsheni wakho (ingxenye yesiponji phakathi kwamathambo akho), kodwa ngokuvamile zihlala ku-spleen yakho kanye nama-lymph nodes akho. Abanye bahlala ku-thymus yakho nasegazini futhi.
- Ungahamba ngohlelo lwakho lwe-lymphatic, uye kunoma iyiphi ingxenye yomzimba wakho ukuze ulwe nokutheleleka noma izifo.
I-DLBCL iqala lapho amanye ama-B-cell akho eba nomdlavuza. Zikhula ngokungalawuleki, azijwayelekile, futhi azifi lapho kufanele.
Uma une-DLBCL ama-lymphocyte akho anomdlavuza we-B-cell:
- Ngeke isebenze ngempumelelo ukulwa nezifo kanye nezifo.
- Angaba makhulu kunalokho okufanele futhi abukeke ahlukile kuma-B-cell akho anempilo.
- Kungabangela ukuthi i-lymphoma ikhule futhi ikhule kunoma iyiphi ingxenye yomzimba wakho.
- Zisabalele (zihlakazeke) kunokuba zihlanganiswe ndawonye.
Nakuba i-DLBCL ivame ukukhula ngokushesha (i-aggressive) lymphoma, abantu abaningi abane-DLBCL bangelapheka ngokwelashwa, ngisho noma kutholakala ukuthi unesigaba esithuthukile. Isigaba esithuthukile se-lymphoma sehluke kakhulu kunezigaba ezithuthukile zeminye imidlavuza engelapheki.
Izimbangela Zokusabalalisa I-Large B-cell Lymphoma (DLBCL)
Asazi ukuthi yini ebangela i-DLBCL, kodwa kucatshangelwa izici ezihlukile zobungozi ezingandisa ubungozi bakho bokuyithola. Ezinye, izici zobungozi ze-DLBCL kucatshangwa ukuthi zihlanganisa okulandelayo uma:
- Yiba nesimo esithinta amasosha akho omzimba njenge-human immunodeficiency virus (HIV).
- Uthatha imithi ecindezela amasosha omzimba, njengaleyo ethathwe ngemva kokufakelwa isitho somzimba.
- Yiba nelungu lomndeni eline-lymphoma.
- Yiba ne-hepatitis C - igciwane elithinta isibindi sakho.
- Babekhuluphele njengengane.
*Kubalulekile ukuqaphela, akubona bonke abantu abanalezi zici zobungozi abazoba ne-DLBCL, futhi abanye abantu abangenazo zalezo zici zobungozi bangakwazi ukuthuthukisa i-DLBCL.
Ukuze uthole umbono we-DLBCL owethulwe udokotela wegazi uMichael Dickinson sicela ubukele ividiyo engezansi.
Izimpawu ze-Diffuse Large B-cell Lymphoma (DLBCL)
Uphawu lokuqala noma uphawu lwe-DLBCL olutholayo kungase kube isigaxa, noma izigaxa ezimbalwa eziqhubeka nokukhula. Ungase uzizwe noma uzibone entanyeni yakho, ekhwapheni noma enqeni. Lezi zigaxa ziyi-lymph nodes (izindlala), ezivuvukele ngokuba nama-B-cell amaningi anomdlavuza akhula kuzo.
Zivame ukuqala engxenyeni eyodwa yomzimba wakho, bese zisakazeka ohlelweni lwakho lwe-lymphatic nakwezinye izingxenye zomzimba wakho kuhlanganise neyakho:
- ipeni
- i-thymus
- amaphaphu
- isibindi
- amathambo
- umkantsha
- isimiso sezinzwa esiyinhloko (CNS)
- ezinye izitho
Izitho zesistimu yakho ye-lymphatic - i-Spleen ne-thymus
Ubende lwakho yisitho esihluza igazi lakho futhi siligcine liphilile. Kuphinde kube isitho sakho se-lymphatic system lapho ama-B-cell lymphocyte akho ehlala khona futhi akhiqize amasosha omzimba ukulwa nokutheleleka. Isohlangothini lwesobunxele lwesisu sakho esingaphezulu ngaphansi kwamaphaphu akho naseduze kwesisu sakho (isisu).
Uma ubunde bakho buba bukhulu kakhulu, bungase bucindezele isisu sakho futhi bukwenze uzizwe usuthe, ngisho noma ungakadli kakhulu.
I-thymus yakho nayo iyingxenye yesistimu yakho ye-lymphatic. Kuyisitho esimise okwevemvane esihlala ngemuva kwethambo lakho lesifuba ngaphambili kwesifuba sakho. Amanye ama-B-cell nawo aphila futhi adlule ku-thymus yakho.
Kuya ngokuthi i-DLBCL ikhulela kuphi ungase ube nezimpawu ezihlukene njengoba zibalwe ngezansi.
Izimpawu ze-DLBCL (Ithebula lokuqala)
Indawo ethintekile | Izimpawu |
Gut - okuhlanganisa isisu sakho namathumbu | Isicanucanu lapho uphalaza noma ungaphalazi (ukuzizwa ugula esiswini noma ukuphalaza). Uhudo noma ukuqunjelwa (indle elimanzi noma eliqinile). Igazi uma uya endlini encane. Ukuzizwa usuthi noma ungadlanga kakhulu. |
Isimiso sezinzwa esimaphakathi (CNS) – okuhlanganisa ubuchopho bakho nomgogodla | Ukudideka noma izinguquko zenkumbulo. Ubuntu bushintsha. Ukuquleka. Ubuthakathaka, ukuba ndikindiki, ukuvutha noma izikhonkwane nezinaliti ezingalweni nasemilenzeni yakho. |
Chest | Ukuphelelwa umoya ubuhlungu besifuba Ukukhwehlela okomile |
Umkantsha | Izibalo zegazi eziphansi ezihlanganisa amaseli abomvu, amaseli amhlophe namaplatelet okuholela ku: o Ukuphelelwa umoya. o Amagciwane ajulile abuyayo noma okunzima ukuwaqeda. o Ukopha okungajwayelekile noma imihuzuko. |
Skin | Ukuqubuka okubukeka okubomvu noma okunsomi. Amaqhubu namaqhuqhuva esikhumbeni sakho okungenzeka kube nombala wesikhumba noma obomvu noma onsomi. Ukulunywa. |
Izimpawu ezijwayelekile ze-lymphoma
Izimpawu ezijwayelekile ze-lymphoma zingabandakanya:
- B-izimpawu - bheka isithombe ngezansi
- ukuvuvukala kwama-lymph nodes (izindlala)
- ukuzizwa ukhathele ngendlela engavamile (ukhathele)
- ezwa ephelelwa umoya
- isikhumba esilumayo
- izifo ezingapheli noma ezilokhu zibuya
- izinguquko ekuhlolweni kwegazi lakho
- amangqamuzana abomvu aphansi namaplatelet
- ama-lymphocyte amaningi kanye/noma ama-lymphocyte angasebenzi kahle
- amaseli amhlophe ehlile (kuhlanganise nama-neutrophils)
- high lactic acid dehydrogenase (LDH) – uhlobo lweprotheyini esetshenziselwa ukwenza amandla. Uma amangqamuzana akho onakaliswe i-lymphoma yakho, i-LDH ingachitheka emangqamuzaneni akho futhi iye egazini lakho
- i-beta-2 microglobulin ephezulu – uhlobo lwamaprotheni olwenziwa amaseli e-lymphoma. Ingatholakala egazini lakho, emchameni noma oketshezini lomgogodla wobuchopho
Uzoxhumana nini nodokotela wakho
Kufanele uxhumane nodokotela wakho uma:
- unama-lymph nodes avuvukele angasuki, noma uma emakhulu kunalokho obungakulindela ekuthelelekeni
- uvame ukuphelelwa umoya ngaphandle kwesizathu
- ukhathele kakhulu kunokujwayelekile futhi akubi ngcono ngokuphumula noma ukulala
- ubona ukopha okungajwayelekile noma imihuzuko (kuhlanganise nendle, emakhaleni noma ezinsinini)
- uba nokuqubuka okungajwayelekile (ukuqubuka okunsomi kwamabala abomvu kungasho ukuthi unokopha okuthile ngaphansi kwesikhumba sakho)
- isikhumba sakho siyaluma kunokujwayelekile
- uba nokukhwehlela okusha okomile
- uba nezimpawu ze-B
Kubalulekile ukuqaphela ukuthi eziningi zezimpawu nezimpawu ze-DLBCL zingahlotshaniswa nezimbangela ngaphandle komdlavuza. Isibonelo, ama-lymph nodes avuvukele angenzeka uma unokutheleleka. Nokho, ngokuvamile, uma unokutheleleka, izimpawu zizoba ngcono futhi ama-lymph nodes azobuyela kusayizi ojwayelekile emasontweni ambalwa.
Nge-lymphoma, lezi zimpawu ngeke ziphele. Zingase zibe zimbi nakakhulu.
Itholakala kanjani i-Diffuse Large B-cell Lymphoma (DLBCL)?
Ukuxilonga i-DLBCL ngezinye izikhathi kungase kube nzima futhi kungathatha amasonto ambalwa.
Uma udokotela wakho ecabanga ukuthi ungase ube ne-lymphoma, uzodinga ukuhlela inani lokuhlolwa okubalulekile. Lezi zivivinyo ziyadingeka ukuze uqinisekise noma ukhiphe i-lymphoma njengembangela yezimpawu zakho. Ngoba kunezinhlobo ezimbalwa ezihlukene ze-DLBCL, ungase ube nezivivinyo ezengeziwe ukuze uthole ukuthi iyiphi onayo. Lokhu kubalulekile ngoba ukuphathwa nokuphathwa kohlobo lwakho oluncane kungase kwehluke kwezinye izinhlobo ezincane ze-DLBCL.
Biopsy
Ukuze uhlole i-DLBCL uzodinga i-biopsy. I-biopsy iyinqubo yokukhipha ingxenye, noma yonke i-lymph node ethintekile kanye/noma isampula yomnkantsha. I-biopsy ibe isihlolwa ososayensi elabhorethri ukuze babone ukuthi azikho yini izinguquko ezisiza udokotela ahlonze i-DLBCL.
Uma wenza i-biopsy, ungase ube ne-anesthesia yendawo noma evamile. Lokhu kuzoncika ohlotsheni lwe-biopsy nokuthi ithathwe kuyiphi ingxenye yomzimba wakho. Kunezinhlobo ezahlukene ze-biopsies futhi ungase udinge ezingaphezu kweyodwa ukuze uthole isampula engcono kakhulu.
I-Core or fine inaliti biopsy
I-core or finele biopsies yenaliti ithathwa ukuze kukhishwe isampula ye-lymph node evuvukele noma isimila ukuze kuhlolwe izimpawu ze-DLBCL.
Udokotela wakho ngokuvamile uzosebenzisa isibulali-zinzwa sendawo ukuze enze indawo ibe ndikindiki ukuze ungezwa zinhlungu phakathi nenqubo, kodwa uzobe uphapheme phakathi nalokhu biopsy. Bazobe sebefaka inaliti ku-lymph node evuvukele noma isigaxa bese bekhipha isampula lesicubu.
Uma i-lymph node yakho evuvukele noma isigaxa sijule ngaphakathi emzimbeni wakho i-biopsy ingenziwa ngosizo lwe-ultrasound noma i-x-ray ekhethekile (imaging).
Ungase ube nesibulali-zinzwa esivamile salokhu (okukwenza ulale isikhashana). Ungase futhi ube nezitishi ezimbalwa kamuva.
I-Core Need biopsy ithatha isampula enkulu kune-finenes biopsy.
I-Excisional node biopsy
Ama-excisional node biopsies enziwa lapho i-lymph node yakho evuvukele noma isimila sijule kakhulu emzimbeni wakho ukuthi singafinyelelwa ngomongo noma ngenaliti ecolekile. Uzothola isibulali-zinzwa esivamile esizokulalisa isikhashana ukuze uhlale unganyakazi, futhi ungezwa buhlungu.
Phakathi nale nqubo, udokotela ohlinzayo uzokhipha yonke i-lymph node noma isigaxa futhi ayithumele ku-pathology ukuze ihlolwe.
Uzoba nenxeba elincane elinemithungo embalwa, kanye nengubo ngaphezulu.
Imithungo ivamise ukuhlala izinsuku eziyisi-7-10, kodwa udokotela noma unesi wakho uzokunikeza imiyalelo yokuthi unakekele ukugqokwa, nokuthi ubuya nini ukuyokhipha imithungo.
Ukuhlolwa kwegazi
Ukuhlolwa kwegazi kuthathwa uma uzama ukuxilonga i-lymphoma yakho, kodwa futhi kukho konke ukwelashwa kwakho ukuze uqiniseke ukuthi izitho zakho zisebenza kahle futhi zingakwazi ukubhekana nokwelashwa kwethu.
Imiphumela
Uma udokotela wakho esethole imiphumela ekuhlolweni kwegazi kanye nama-biopsies uzokwazi ukukutshela uma une-DLBCL futhi angase akwazi ukukutshela ukuthi yiluphi uhlobo oluncane lwe-DLBCL onalo. Bazobe sebefuna ukwenza izivivinyo ezengeziwe esiteji futhi balinganise i-DLBCL yakho
Isiteji kanye Nokugreda Diffuse Large B-cell Lymphoma (DLBCL)
Uma usutholwe ukuthi une-DLBCL, udokotela wakho uzoba nemibuzo eminingi mayelana ne-lymphoma yakho. Lokhu kuzobandakanya:
- Isiphi isigaba se-lymphoma yakho?
- Ingakanani i-lymphoma yakho?
- Iluphi uhlobo oluncane lwe-DLBCL onalo?
Chofoza izihloko ezingezansi ukuze ufunde kabanzi mayelana nesiteji kanye nokugreda.
Isiteji sisho ukuthi ungakanani umzimba wakho othintwa i-lymphoma yakho - noma ukuthi isisabalele kangakanani lapho iqale khona.
Ama-B-cell angahamba aye kunoma iyiphi ingxenye yomzimba wakho. Lokhu kusho ukuthi amaseli e-lymphoma (ama-B-cell anomdlavuza), angaphinde ahambe kunoma iyiphi ingxenye yomzimba wakho. Kuzodingeka wenze izivivinyo ezengeziwe ukuze uthole lolu lwazi. Lezi zivivinyo zibizwa ngokuthi yi-staging test futhi uma uthola imiphumela, uzothola ukuthi unesigaba sokuqala (I), isigaba sesibili (II), isigaba sesithathu (III) noma isigaba sesine (IV) DLBCL.
Isigaba sakho se-DLBCL sizoncika kulokhu:
- Zingaki izindawo zomzimba wakho ezine-lymphoma
- Lapho i-lymphoma ihlanganisa uma ingaphezulu, ngezansi noma ezinhlangothini zombili ze-diaphragm yakho (umsipha omkhulu, omise okwedome ngaphansi kwezimbambo zakho ezihlukanisa isifuba sakho nesisu sakho)
- Kungakhathaliseki ukuthi i-lymphoma isisabalele kumnkantsha wakho wethambo noma ezinye izitho ezifana nesibindi sakho, amaphaphu, isikhumba noma ithambo.
Izigaba I no-II zibizwa ngokuthi 'isigaba sokuqala noma esilinganiselwe' (okubandakanya indawo elinganiselwe yomzimba wakho).
Izigaba III kanye ne-IV zibizwa ngokuthi 'isiteji esithuthukisiwe' (sabalale kakhulu).
1 internship | Indawo eyodwa ye-lymph node iyathinteka, noma ngaphezulu noma ngaphansi kwe-diaphragm*. |
2 internship | Izindawo ezimbili noma ngaphezulu zama-lymph node ziyathinteka ohlangothini olulodwa lwe-diaphragm*. |
3 internship | Okungenani indawo eyodwa ye-lymph node ngaphezulu kanye ne-lymph node eyodwa engaphansi kwe-diaphragm* iyathinteka. |
4 internship | I-Lymphoma itholakala kuma-lymph nodes amaningi futhi isisakazekele kwezinye izingxenye zomzimba (isb. amathambo, amaphaphu, isibindi). |
Ulwazi lwesiteji olwengeziwe
Udokotela wakho angase futhi akhulume ngesiteji sakho esebenzisa incwadi, efana no-A,B, E, X noma S. Lezi zincwadi zinikeza ulwazi olwengeziwe mayelana nezimpawu onazo noma ukuthi umzimba wakho uthinteka kanjani i-lymphoma. Lonke lolu lwazi lusiza udokotela wakho ukuthi akutholele uhlelo olungcono kakhulu lwezokwelapha.
Incwadi | Okusho | Ukubaluleka |
A noma B |
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E & X |
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S |
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(Ubende lwakho luyisitho ohlelweni lwakho lwe-lymphatic oluhluza futhi luhlanze igazi lakho, futhi luyindawo lapho ama-B-cell akho aphumula khona futhi enze amasosha omzimba) |
Ukuhlolwa kwesiteji
Ukuze uthole ukuthi yisiphi isigaba onaso, ungacelwa ukuthi wenze ezinye zalezi zivivinyo ezilandelayo:
Icwecwe le-computer tomography (CT)
Lezi zithwebuli zithatha izithombe zengaphakathi lesifuba sakho, isisu noma i-pelvis. Banikeza izithombe ezinemininingwane enikeza ulwazi olwengeziwe kune-X-ray evamile.
Ukuskena kwe-Positron emission tomography (PET)
Lesi iskena esithatha izithombe zengaphakathi lomzimba wakho wonke. Uzonikezwa futhi ufake inaliti ngomuthi othile othathwa amaseli anomdlavuza - njengamaseli e-lymphoma. Umuthi osiza ukuskena kwe-PET ukukhomba lapho i-lymphoma ikuphi kanye nosayizi nokuma ngokugqamisa izindawo ezinamaseli e-lymphoma. Lezi zindawo ngezinye izikhathi zibizwa ngokuthi "ezishisayo".
Ukukhishwa kwe-Lumbar
Ukubhoboza i-lumbar kuyinqubo eyenziwa ukuhlola ukuthi unayo yini i-lymphoma endaweni yakho isimiso sezinzwa esiyinhloko (CNS), okuhlanganisa ubuchopho bakho, umgogodla kanye nendawo ezungeze amehlo akho. Kuzodingeka uhlale unganyakazi phakathi nenqubo, ngakho izingane kanye nezingane zingase zibe ne-anesthetic evamile ukuze zilalise isikhashana lapho inqubo yenziwa. Abantu abadala abaningi bazodinga kuphela umuthi obulala izinzwa wasendaweni ukuze inqubo iqede indawo.
Udokotela wakho uzokufaka inaliti emhlane wakho, futhi akhiphe uketshezi oluncane olubizwa ngokuthi “uketshezi lwe-cerebral spinal” (CSF) kusuka eduze komgogodla wakho. I-CSF iwuketshezi olusebenza kancane njengesibambisi sokwethuka ku-CNS yakho. Iphinde ithwale amaprotheni ahlukene kanye nokutheleleka okulwa namaseli omzimba afana ne-lymphocyte ukuvikela ubuchopho bakho nomgogodla. I-CSF ingasiza futhi ukukhipha noma iluphi uketshezi olwengeziwe okungenzeka unalo ebuchosheni bakho noma eduze komgogodla wakho ukuvimbela ukuvuvukala kulezo zindawo.
Isampula ye-CSF izobe isithunyelwa ku-pathology futhi ihlolwe noma yiziphi izimpawu ze-lymphoma.
I-bone yomnkantsha i-biopsy
- I-Bone marrow aspirate (BMA): lokhu kuhlola kuthatha inani elincane loketshezi olutholakala endaweni yomnkantsha.
- I-Bone marrow aspirate trephine (BMAT): lokhu kuhlola kuthatha isampula elincane lomnkantsha wethambo.
Amasampula abe esethunyelwa ku-pathology lapho ehlolelwa khona izimpawu ze-lymphoma.
Inqubo ye-biopsies yomnkantsha ingahluka kuye ngokuthi ulashwa kuphi, kodwa ngokuvamile izofaka isibulali-zinzwa sasendaweni ukuze ndikindiki indawo.
Kwezinye izibhedlela, ungase unikezwe i-sedation elula ekusiza ukuthi uphumule futhi ingakuvimba ekukhumbuleni inqubo. Nokho abantu abaningi abakudingi lokhu futhi esikhundleni salokho bangase babe “nempempe eluhlaza” abangayincela. Le nlozi eluhlaza inomuthi obulala izinhlungu kuwo (obizwa ngePenthrox noma i-methoxyflurane), owusebenzisa njengoba kudingeka kuyo yonke inqubo.
Qiniseka ukuthi ubuza udokotela wakho ukuthi yini etholakalayo ukuze ukhululeke kakhudlwana phakathi nenqubo, futhi ukhulume nabo ngalokho ocabanga ukuthi kuyoba inketho engcono kakhulu kuwe.
Ulwazi olwengeziwe mayelana nama-biopsies omnkantsha lungatholakala ekhasini lethu lewebhu lapha.
Amaseli akho e-lymphoma anephethini yokukhula ehlukile, futhi abukeka ehlukile kumaseli avamile. Ibanga le-lymphoma yakho yindlela amaseli akho e-lymphoma akhula ngayo ngokushesha, okuthinta indlela yokubukeka ngaphansi kwe-microscope. Amabanga amabanga 1-4 (aphansi, aphakathi nendawo, aphezulu). Uma une-lymphoma yebanga eliphakeme, amaseli akho e-lymphoma azobukeka ehluke kakhulu kumaseli avamile, ngoba akhula ngokushesha kakhulu ukuze athuthuke kahle. Uhlolojikelele lwamabanga angezansi.
- I-G1 – ibanga eliphansi – amaseli akho abukeka esondele kokujwayelekile, futhi akhula futhi asakazeke kancane.
- I-G2 - ibanga eliphakathi nendawo - amaseli akho aqala ukubukeka ehlukile kodwa amanye amaseli avamile akhona, futhi akhula futhi asakazeke ngesilinganiso esimaphakathi.
- I-G3 - ibanga eliphezulu - amaseli akho abukeka ehluke kakhulu ngamaseli ambalwa avamile, futhi akhula futhi asakazeke ngokushesha.
- I-G4 – ibanga eliphezulu – amaseli akho abukeka ehluke kakhulu kokujwayelekile, futhi akhula futhi asakazeke ngokushesha.
Lonke lolu lwazi lwengeza kuso sonke isithombe esakha udokotela wakho ukusiza ukunquma uhlobo olungcono kakhulu lokwelashwa kwakho.
Kubalulekile ukuthi ukhulume nodokotela wakho mayelana nezici zakho eziyingozi ukuze ube nombono ocacile wokuthi yini ongayilindela ekwelashweni kwakho.
Izinhlobo ezingaphansi ze-Diffuse Large B-cell Lymphoma (DLBCL)
Kunezinhlobo ezingaphansi eziningi ze-DLBCL. Lezi zinhlobo ezimbili eziyinhloko ziqanjwe ngokusekelwe kuseli ethize i-lymphoma yakho eqale ukukhula kuyo. Okuvame kakhulu ukuthi “Activated B-cell (ABC)”, cishe uhhafu wazo zonke iziguli ezine-DLBCL ezinalolu hlobo oluncane. Olunye uhlobo oluncane oluncane lwe-DLBCL yi-“Germinal Cell B-cell (GCB)”, cishe abantu abathathu kwabayi-3 abane-DLBCL abanalolu hlobo oluncane.
Udokotela wakho angakutshela ukuthi unayo yini i-GCB noma i-ABC subtype ngokubheka amaseli akho e-lymphoma ku-pathology. Ama-subtypes amabili abukeka ehlukile ngokuba namaprotheni ahlukene ebusweni bamaseli, kanye nokuguqulwa kofuzo okuhlukile.
Uma udokotela wakho nethimba elelaphayo sebazi ukuthi unayo i-GCB noma i-ABC, bangase benze ukuhlolwa okwengeziwe kwe-cytogenetic kumaseli akho e-lymphoma. Lokhu kuhlola kubheka ezinye izinguquko zofuzo kuma-chromosome akho nezakhi zofuzo (okubizwa ngokuthi ukuhlela kabusha). Ungathola ulwazi olwengeziwe kulokhu ngezansi kuleli khasi ngaphansi kwesihloko esithi “Understanding your lymphoma genetics”.
I-DLBCL ingabuye ibizwe ngokuthi i-nodal noma i-extra-nodal. I-Nodal isho ukuthi iqale kuma-lymph nodes akho, kanti i-extra-nodal isho ukuthi yaqala ngaphandle kwesistimu yakho ye-lymphatic. Ezinye izindawo ezingase ziqale i-DLBCL zihlanganisa isikhumba sakho, amabele, amasende, isibindi, amaphaphu, ithambo, ubuchopho, isisu noma amathumbu.
Chofoza izibhengezo ezingezansi uma ungathanda ukufunda kabanzi mayelana nezinye izinhlobo ezincane ze-DLBCL ezakha amacala asele.
I-Primary mediastinal B-cell lymphoma (PMBCL) iwuhlobo olungavamile olunolaka (olukhula ngokushesha) lwe-non-Hodgkin Lymphoma. Yayikade ihlukaniswa njengohlobo oluncane lwe-DLBCL, kodwa manje isiphinde yahlelwa yiNhlangano Yezempilo Yomhlaba njengohlobo oluncane iyodwa.
Ukuze uthole ulwazi olwengeziwe nge-PMBCL, sicela ubheke i-Primary Mediastinal B – cell lymphoma (PMBCL) ikhasi lewebhu lapha, noma yethu ishidi lamaqiniso lapha.
I-T-cell/histiocyte rich B-cell lymphoma (T/HRBCL) iwuhlobo oluncane olungavamile lwe-DLBCL okungaba nzima kakhulu kudokotela wakho ukuthi aluxilonge. Kunzima ukuxilonga ngoba kubukeka kufana nezinye izinhlobo ezimbili ze-lymphoma. Ngalesi sizathu, abanye abantu abane-T/HRBCL bangathola ukuxilongwa okungalungile kwe-Hodgkin's lymphoma noma i-peripheral T-cell lymphoma, ngaphambi kokuthola ukuxilongwa okufanele. Uzodinga ukuhlolwa okukhethekile ukuze uthole i-T/HRBCL ebizwa ngokuthi i-immunohistochemistry test. Lokhu ukuhlolwa okukhethekile okwenziwe kuma-biopsies akho ukuze udokotela wakho afunde okwengeziwe nge-lymphoma yakho.
Ama-T-cell angolunye uhlobo lweseli ye-lymphocyte olusiza amasosha akho omzimba akhumbule izifo oke waba nazo esikhathini esidlule. Zisiza ukugcina amasosha akho omzimba eqinile ukuze angasebenzi ngokuzikhandla, futhi asekela namanye amaseli amasosha akho omzimba ukuze asebenze ngempumelelo. I-Histiocyte nayo iwuhlobo noma i-immune cell ebizwa ngokuthi i-phagocyte. Ama-phagocyte asiza ukukuvikela ekuthelelekeni nasezifweni ngoba abona amaseli amabi futhi awadle.
Uma une-T/HRBCL – unama-T-cell nama-histiocyte amaningi kakhulu (yingakho ibizwa ngokuthi “rich” – T/HR) kuyilapho futhi enama-B-cell lymphocyte (BCL) anomdlavuza.
Ukwelashwa okujwayelekile kwe-T/HRBCL kuyafana nezinye izinhlobo ezincane ze-B-cell lymphoma (DLBCL) enkulu esabalele, okuxoxwe ngayo kamuva kuleli khasi lewebhu.
I-EBV-positive DLBCL ayicaciswanga ngenye indlela uhlobo oluncane lwe-DLBCL olungenzeka kubantu abasha, kodwa ngokuvamile luhlasela abantu abangaphezu kweminyaka engama-50 ubudala. Kwenzeka kwabanye abantu abaye baba negciwane elibizwa nge-Epstein-Barr virus (EBV), elihlasela ama-B-cell. I-EBV ibangela imfiva yezindlala (ebizwa nangokuthi “mono” noma isifo sokuqabula). Nokho, inani elincane kakhulu labantu abaye baba ne-EBV abaqhubeka nokuthuthukisa i-EBV-positive DLBCL. Ngeshwa okwamanje asinayo indlela yokwazi ukuthi ubani ozothuthukisa le lymphoma ngemva kokutheleleka nge-EBV.
Izimpawu zizoxhomeka lapho i-lymphoma yakho ikhula khona. Ngokuvamile iqala kuma-lymph nodes akho (okuthiwa i-nodal lymphoma) engabangela ukuba kuvele isigaxa esisha. Lokhu kuvame ukuba sentanyeni, ekhwapheni, enqeni noma esiswini, kodwa kungaba noma yikuphi emzimbeni wakho.
Ezinye izindawo engakhula futhi izimpawu ezihambisana nayo ziyefana nalezi ezibalwe ngenhla kuthebula lokuqala.
Ukwelashwa okujwayelekile kwe-intravascular lymphoma enkulu ye-B-cell kuyafana nezinye izinhlobo ezincane ze-B-cell lymphoma (DLBCL) enkulu esabalele, okuxoxwe ngayo kamuva kuleli khasi lewebhu.
I-ALK-positive B-cell lymphoma enkulu iwuhlobo oluncane olungavamile kakhulu lwe-DLBCL. Ingahlasela abantu banoma ibuphi ubudala futhi ivame kakhulu emadodeni. Amaseli e-lymphoma anokuguqulwa kofuzo okwenza iphrotheni ebusweni bamaseli awo e-B-Lymphocyte abizwa nge-'anaplastic big-cell kinase' (ALK).
Izinhlobo ezingaphansi eziningi ze-DLBCL zinephrotheni kumaseli e-lymphoma okuthiwa i-CD20. Nokho, i-ALK positive B-cell lymphomas enkulu ngokuvamile ayinawo amaprotheni e-CD20. Ngalesi sizathu, ukwelashwa kuzohluka kancane kwezinye izinhlobo ezincane ze-DLBCL. Nakuba imithi eminingi izofana, uma unalolu hlobo oluncane, wena ngeke athole umuthi we-monoclonal antibody obizwa nge-rituximab. I-Rituximab isebenza kuphela lapho i-CD20 itholakala kumaseli e-lymphoma. Ngakho-ke, uma uzibuza ukuthi kungani ungase ungayitholi imithi eyengeziwe etholwa ezinye iziguli….lokhu kungase kube isizathu.
I-ALK-positive enkulu ye-B-cell lymphoma ngokuvamile iqala kuma-lymph nodes akho, ngakho-ke uphawu oluvamile ongase ube nalo ukuvuvuka kwama-lymph nodes.
Kodwa-ke, kungase futhi kuqale ezindaweni ezingaphandle kwesistimu yakho ye-lymphatic, kuhlanganise neyakho:
- nolimi
- i-nasopharynx (indawo engemuva kwekhala nomlomo wakho)
- amaqanda
- isibindi
- amabele
- amathambo
- isisu
- ubuchopho noma isikhala se-epidural (indawo ezungeze umgogodla wakho)
Izimpawu zakho zizohlobana nalapho i-lymphoma ikhula khona.
I-Intravascular B-cell lymphoma enkulu iwuhlobo olungavamile lwe-DLBCL ye-extra-nodal. Sihlasela kakhulu abantu abadala asebekhulile abaphakathi kweminyaka engama-50-70 ubudala. Le subtype yenzeka ngokulinganayo kubo bobabili abesilisa nabesifazane. Amaseli e-lymphoma atholakala ngaphakathi kolwelwesi lwangaphakathi lwemithambo yakho yegazi emincane. Le mithambo yegazi emincane ibizwa ngokuthi ama-capillaries.
I-intravascular big B-cell lymphoma ngokuvamile ayibangeli ama-lymph nodes akhulisiwe. Kungase kuthinte imithambo yegazi emincane esikhumbeni sakho noma ebuchosheni bakho. Ungase ube nezimpawu zesistimu yezinzwa ezimaphakathi (CNS). Isimiso sakho sezinzwa esimaphakathi sihlanganisa ubuchopho bakho nomgogodla, ngakho izimpawu ohlangabezana nazo zingase zihlanganisa:
- ukudideka
- ukuhlukunyezwa
- isiyezi
- ebuthakathakeni
Ezinye izimpawu ongase ube nazo eziqondene ne-subtype yakho zihlanganisa:
- amabala abomvu noma izigaxa esikhumbeni sakho
- isibindi esikhulisiwe kanye/noma ubende
Lezi zimpawu zingaphezu kwezimpawu ze-lymphoma ezibalwe ngenhla.
Ukwelashwa okujwayelekile kwe-intravascular lymphoma enkulu ye-B-cell kuyafana nezinye izinhlobo ezincane ze-B-cell lymphoma (DLBCL) enkulu esabalele, okuxoxwe ngayo kamuva kuleli khasi lewebhu.
*I-Extra-nodal isho i-lymphoma yakho eyakhiwe ngaphandle kwama-lymph nodes akho.
I-Primary Central Nervous System Lymphoma (PCNSL) iwuhlobo oluncane olungajwayelekile lwe-DLBCL oluthathwa njengolaka ngoba lukhula ngokushesha. Kuvame kakhulu kubantu abaneminyaka ephakathi kuka-50 no-60 ubudala, kodwa kungenzeka kunoma iyiphi iminyaka yobudala.
Uma une-PCNSL kungenzeka ukuthi i-lymphoma yakho yaqala ohlelweni lwakho lwezinzwa oluphakathi, oluhlanganisa ubuchopho bakho nomgogodla.
Kubantu abangaphezu kwe-9 kwabayi-10 abane-PCNSL i-lymphoma ikhula ebuchosheni, umgogodla, iso noma i-leptomeninges (ama-membrane amabili angaphakathi azungeze ubuchopho nomgogodla).
Indawo evame kakhulu isebuchosheni.
Uma i-lymphoma yakho iqale kwezinye izingxenye zomzimba wakho kuqala bese kuthi esigabeni esithile isisakazekele ebuchosheni noma emgogodleni, ibizwa ngokuthi 'secondaryI-CNS lymphoma (SCNSL).
Ukwelashwa nokuphathwa kwe-PCNSL kuhlukile kwezinye izinhlobo ezincane ze-DLBCL njengoba izindlela zokwelapha ezijwayelekile zingakwazi ukufinyelela ebuchosheni bakho kanye nentambo yomgogodla. Ungafunda kabanzi mayelana nokwelashwa kwe-PCNSL kamuva ekhasini lewebhu ngaphansi kwesihloko esithi Treatments.
Isikhumba (isikhumba) B-cell i-lymphoma iwuhlobo oluncane oluyivelakancane lwe-DLBCL oluvela kuma-B-cell esikhumbeni sakho. Ngaphansi ko-1 kwabayi-100 abantu abane-NHL bazotholakala benalolu hlobo oluncane.
Ukuze wena udokotela akuxilonge ukuthi unalolu hlobo oluncane, i-lymphoma idinga ukuthi ithinte isikhumba sakho kuphela.
Ngenxa yokuthi le lymphoma iqala esikhumbeni sakho, izimpawu eziyinhloko ongase uziqaphele zihlanganisa izigaxa, ama-patches noma ama-rash noma yikuphi esikhumbeni sakho.
Njengoba ama-B-cell lymphoma e-cutaneous ephathwa ngendlela ehlukile kwezinye izinhlobo ezincane ze-DLBCL, sinikezele ikhasi lewebhu elihlukile kulezi zinhlobo ezincane.
Ungathola ulwazi oluthe xaxa mayelana ne-cutaneous B-cell lymphoma lapha.
Sicela uqaphele ukuthi uma kutholakale ukuthi unolunye uhlobo oluncane lwe-DLBCL futhi isisakazekele esikhumbeni sakho, kufanele uqhubeke nokubheka ulwazi lwalolo hlobo lokuqala oluncane. Uma i-lymphoma isakazeke esikhumbeni sakho ngemva kokuqala kwenye indawo, ibhekwa njenge-secondary cutaneous lymphoma. I-lymphoma ye-cutaneous eyinhloko neyesibili iphathwa ngendlela ehlukile.
Ukwengeza, uma une-T-cell lymphoma ye-cutaneous, lokhu kuhlukile futhi.
Ungathola ulwazi olwengeziwe nge-cutaneous T-cell lymphoma lapha.
Ukuqonda i-lymphoma genetics yakho
Ukuhlolwa kwe-Cytogenetic kwenziwa ukuhlola ukuhlukahluka kofuzo okungenzeka kuhileleke esifweni sakho. Ukuze uthole ulwazi olwengeziwe ngalokhu sicela ubheke isigaba sethu sokuqonda i-lymphoma genetics ngokuqhubekayo kuleli khasi. Ukuhlola okusetshenziselwa ukuhlola noma yikuphi ukuguqulwa kofuzo kubizwa ngokuthi ukuhlola kwe-cytogenetic. Lokhu kuhlola kubheka ukubona ukuthi awunakho yini okushintshile kuma-chromosome nakuzakhi zofuzo.
Sivame ukuba namapheya angu-23 ama-chromosome, futhi abalwa ngokobukhulu bawo. Uma une-DLBCL, ama-chromosome akho angase abukeke ehluke kancane.
Ayini izakhi zofuzo nama-chromosomes
Ingqamuzana ngalinye elakha umzimba wethu linenucleus, futhi ngaphakathi ku-nucleus kunamapheya angu-23 ama-chromosome. Ichromosome ngayinye yenziwe ngemicu emide ye-DNA (deoxyribonucleic acid) equkethe izakhi zethu zofuzo. Izakhi zofuzo zethu zinikeza ikhodi edingekayo ukuze kwenziwe wonke amangqamuzana namaprotheni asemzimbeni wethu, futhi ibatshela ukuthi kufanele babukeke noma benze kanjani.
Uma kunoshintsho (ukuhlukahluka) kulawa ma-chromosome noma izakhi zofuzo, amaprotheni namaseli akho ngeke asebenze kahle.
Ama-lymphocyte angaba amaseli e-lymphoma ngenxa yezinguquko zofuzo (okuthiwa ukuguqulwa noma ukuhluka) ngaphakathi kwamaseli. I-lymphoma biopsy yakho ingase ibhekwe udokotela wezifo ezithile ukuze abone ukuthi awunazo yini izinguquko zofuzo.
Ukuguqulwa kwe-Double Hit kanye ne-Triple Hit ku-DLBCL
Abanye abantu abane-DLBCL bangase babe nokuguqulwa kwezakhi zofuzo eziqondile ezi-2 noma ezi-3 okwenza i-lymphoma ibe nolaka kune-DLBCL ngaphandle kokuguqulwa. Lezi zinguquko zibizwa ngokuthi ukuhlela kabusha. Izakhi zofuzo ezihilelekile zihlala zibandakanya isakhi sofuzo esibizwa nge-MYC, kanye nofuzo olubizwa nge-BCL2 kanye/noma i-BCL6.
I-Double Expressor
Kwezinye izimo, ungase ungabi nokuhlela kabusha ezakhini zakho zofuzo, kodwa amaprotheni okulawula izakhi zofuzo angase adluliselwe kumaseli akho e-lymphoma. Lokhu kusho ukuthi unamaprotheni amaningi e-MYC noma e-BCL kumaseli akho, okungenza kube nzima kakhulu ukuwelapha.
Ukuhlelwa kabusha nokubonakaliswa kwamaprotheni ku-Double & Triple Hit, kanye ne-Double Expressor Lymphomas |
||||
Ukuhlelwa kabusha kwe-MYC |
Ukuhlelwa kabusha kwe-BCL2 |
Ukuhlelwa kabusha kwe-BCL6 |
Ukuvezwa ngokweqile kwamaprotheni e-MYC ne-BCL |
|
I-Double Hit |
YEBO |
YEBO |
Cha |
Ngokuvamile, kodwa hhayi njalo |
Hit Kathathu |
YEBO |
YEBO |
YEBO |
Ngokuvamile, kodwa hhayi njalo |
I-Double Expressor |
Cha |
Cha |
Cha |
YEBO |
Cela udokotela wakho ukuthi akuchazele ngoshintsho ngalunye nokuthi lokhu kungase kube nomthelela kanjani ekwelashweni kwakho. |
||||
Izakhi zofuzo ezijwayelekile ze-MYC ne-BCL zisiza ekwenzeni amaprotheni abe yizidingo zamaseli akho ukuthi akhule futhi athuthuke ngendlela efanele. Uma unokuhlelwa kabusha kulezi zakhi zofuzo, iphrotheni ayikwazi ukusekela ukukhula kwamangqamuzana okunempilo futhi i-lymphoma ingakhula. I-DLBCL nalokhu kuhlelwa kabusha kubizwa ngokuthi yi-double hit lymphoma (DHL) noma i-triple hit lymphoma (THL). Ngezinye izikhathi zibizwa nge-high-grade B-cell lymphoma (HGBL).
Ukuhlola ukuguqulwa kwezakhi zofuzo
Uma une-lymphoma yezinga eliphezulu udokotela wakho angase afise ukwenza ezinye izivivinyo kuma-biopsies akho ukuze abone ukuthi awunakho yini ukuhlela kabusha kofuzo noma amaprotheni aveza kabili. Ukuhlolwa kubizwa I-Flourescence In Situ Hybridization (INHLANZI) futhi ibheka izimpawu zofuzo ezihlukene kumasampula akho e-biopsy.
Kodwa-ke, lokhu kuhlolwa akumboziwe uhlelo lwezinzuzo ze-Medicare ngakho ngokuvamile kwenziwa ngezindleko ezengeziwe ezigulini, okusho ukuthi kuzodingeka ukhokhele ukuhlolwa. Kungabiza kakhulu, futhi izindleko zingahluka kuye ngokuthi ukwenzele kuphi. Ngokuvamile, ukwelashwa ngeke kushintshe, kodwa kwezinye izimo kungase kushintshe. Uma ukwelashwa kungashintsha uma ubunalokhu kuhluka, ungacabanga ukwenza ukuhlolwa, noma ungathanda ukwazi nje ngenxa yenzuzo.
Uma ukhetha ukungakuhloli usazoba nokunakekelwa okuhle kanye nezindlela zokwelashwa.
Okunye ukuguqulwa okutholwe ku-DLBCL
Olunye ushintsho lwezakhi zofuzo olungenzeka ku-DLBCL "i-double expressor". Lokhu kwehlukile ku hit kabili i-DLBCL ngoba esikhundleni sokuhlela kabusha izakhi zofuzo, izakhi zofuzo zisendaweni efanele kodwa zichazwe ngokweqile, okusho ukuthi ziningi kakhulu izakhi zofuzo ezimbili.
Kubalulekile futhi ukuthi udokotela wakho azi ukuthi yimaphi amaprotheni (noma ama-receptors) kumaseli akho e-lymphoma. Ngenkathi i-chemoUkwelapha kusebenza ngokubulala amaseli akhula ngokushesha, eminye imithi isebenza ngokukhomba iphrotheni ethile ku-lymphoma iseli.
Ngakho-ke uma unama-receptors athile, ungathola i-chemotherapy kanye neyodwa yamasosha omzimba ahlosiwe we-monoclonal. Ngokwesibonelo:
- Uma unamaprotheni abizwa I-CD20 kumaseli akho e-lymphoma, ungathola umuthi we-monoclonal antibody oqondise ku-CD20, njenge-rituximab (i-Mabthera noma i-Rituxan), i-obinutuzumab noma i-ofatumumab. Umuthi owengeziwe oqondise ku-CD20, otholakala kuphela ezivivinyweni zomtholampilo i-mosunetuzumab.
- Uma uneprotheni ebizwa CD79b kumaseli akho e-lymphoma ungathola umuthi oqondise kuleyo phrotheni, ebizwa ngokuthi i-polatuzumab vedotin.
Njengoba ubona, ukuqonda ezinye zezakhi zofuzo ze-lymphoma yakho kubalulekile ukuqonda izinketho zakho zokwelapha. Sicela uhlale ucela udokotela wakho ukuthi akuchazele ngemiphumela yakho nokuthi le miphumela ithinta kanjani izinketho zakho.
Ukwelashwa kwe-Diffuse B-cell lymphoma enkulu (DLBCL)
Uma yonke imiphumela yakho evela ku-biopsy, ukuhlolwa kwe-cytogenetic kanye nezikena zesiteji sekuqediwe, udokotela uzobuyekeza lokhu ukuze anqumele indlela yokwelashwa engcono kakhulu. Kwezinye izikhungo zomdlavuza, udokotela uzophinde ahlangane nethimba lochwepheshe ukuze kudingidwe indlela yokwelapha engcono kakhulu. Lokhu kubizwa ngokuthi a ithimba le-multidisciplinary (MDT) umhlangano.
Udokotela wakho uzocabangela izici eziningi mayelana ne-DLBCL yakho. Izinqumo zokuthi udinga nini ukuqala nokuthi ikuphi ukwelashwa okungcono kakhulu zisekelwe kulokho kwakho:
- isigaba ngasinye se-lymphoma, izinguquko zofuzo kanye nezimpawu
- ubudala, umlando wezokwelapha odlule kanye nempilo jikelele
- ukuphila kahle ngokomzimba nangokwengqondo kwamanje kanye nezintandokazi zesiguli.
Ukuhlolwa okwengeziwe kungase ku-odwe ngaphambi kokuba uqale ukwelashwa ukuze uqiniseke ukuthi inhliziyo yakho, amaphaphu nezinso ziyakwazi ukubhekana nokwelashwa. Lokhu kungase kuhlanganise i-ECG (i-electrocardiogram), ukuhlolwa kokusebenza kwamaphaphu noma ukuqoqwa komchamo wamahora angu-24.
Udokotela wakho noma umhlengikazi womdlavuza angakuchazela ngohlelo lwakho lokwelapha kanye nemiphumela engemihle engase ibe khona kuwe, futhi ukhona ukuphendula noma yimuphi umbuzo ongase ube nawo. Kubalulekile ukuthi ubuze udokotela wakho kanye/noma unesi womdlavuza imibuzo nganoma yini ongayiqondi.
Ungaphinda ushayele ucingo noma uthumele i-imeyili ku-Lymphoma Australia Nurse Helpline ngemibuzo yakho futhi singakusiza ukuthi uthole ulwazi olulungile.
Inombolo yocingo yomhlengikazi we-Lymphoma:
Ifoni: 1800 953 081
Email: nurse@lymphoma.org.au
Imibuzo okufanele uyibuze udokotela wakho ngaphambi kokuba uqale ukwelashwa kwe-DLBCL
Kungaba nzima ukwazi ukuthi yimiphi imibuzo okufanele uyibuze lapho uqala ukwelashwa. Uma ungazi, ongakwazi, ungazi kanjani ukuthi yini okufanele uyibuze?
Ukuba nolwazi olufanele kungakusiza uzizwe uqiniseka futhi wazi ukuthi yini ongayilindela. Kungakusiza nokuthi uhlele kusengaphambili lokho ongase ukudinge.
Sihlanganisa uhlu lwemibuzo ongayithola iwusizo. Yiqiniso, isimo sawo wonke umuntu sihlukile, ngakho le mibuzo ayihlanganisi yonke into, kodwa inikeza isiqalo esihle.
Chofoza isixhumanisi esingezansi ukuze udawunilode i-PDF ephrintekayo yemibuzo kadokotela wakho.
Izinhlobo zokwelapha umdlavuza we-Diffuse big-cell lymphoma (DLBCL)
Kukhona izindlela zokwelapha ezihlukene ezitholakalayo ze-Diffuse Large B cell lymphoma futhi zingahluka kuye ngohlobo lwakho oluthile oluthile. Ukwelashwa okungcono kakhulu kwakho kuzoncika ezintweni eziningi ezihlanganisa neyakho:
- uhlobo oluncane lwe-DLBCL
- isigaba kanye nebanga le-DLBCL yakho
- age
- impilo jikelele
- ezinye izindlela zokwelapha onazo, kungaba eze-DLBCL noma ezinye izifo
- okuthandayo uma udokotela wakho esekuchazele izinketho.
Uma uke wathola ukwelashwa kwe-lymphoma yakho esikhathini esidlule, udokotela wakho uzocabangela ukuthi ikusebenzele kahle kangakanani, nokuthi imiphi imiphumela emibi ibe mibi kangakanani kuwe. Udokotela wakho uzokwazi ukukunikeza izindlela zokwelapha ezingcono kakhulu. Uma ungenaso isiqiniseko sokuthi kungani udokotela ethathe izinqumo azenzile, sicela uqiniseke ukuthi umcela ukuthi akuchazele - bakhona ukuze bakusize.
Ezinye zezinhlobo ezahlukene zokwelapha ongase unikezwe zona zibalwe ngezansi. Chofoza izihloko ukuze ufunde kabanzi mayelana nohlobo lokwelashwa onentshisekelo kulo.
Ukunakekelwa okusekelayo kunikezwa iziguli kanye nemindeni ebhekene nokugula okubi kakhulu. Ukunakekelwa okusekelayo kungasiza iziguli zibe nezimpawu ezimbalwa, futhi empeleni zibe ngcono ngokushesha ngokunaka lezo zici zokunakekela kwazo.
Kwabanye benu abane-DLBCL, amangqamuzana akho e-leukemic angase akhule ngokungalawuleki futhi aminyene umnkantsha, igazi, ama-lymph nodes, isibindi noma ubende. Ngenxa yokuthi umnkantsha ugcwele amaseli e-DLBCL mancane kakhulu ukuthi angasebenza kahle, amaseli akho egazi ajwayelekile azothinteka. Ukwelashwa okusekelayo kungase kuhlanganise izinto ezifana nokuthi umpontshelwa igazi noma i-platelet ewodini noma endaweni yokufakwa emthanjeni esibhedlela. Ungase ube nama-antibiotics ukuvimbela noma ukwelapha izifo.
Kungase kuhlanganise ukubonisana nethimba labanakekeli abakhethekile noma ngisho nokunakekelwa kwe-palliative. Kungase futhi kube nezingxoxo mayelana nokunakekelwa kwesikhathi esizayo, okubizwa ngokuthi Ukuhlelwa Kokunakekelwa Okuthuthukile. Lezi zinto ziyingxenye yokuphathwa kwe-lymphoma ye-multidisciplinary.
Ukunakekelwa okusekelayo kungabandakanya ukunakekelwa kwe-palliative okusiza ukuthuthukisa izimpawu zakho kanye nemiphumela emibi, kanye nokuphela kokunakekelwa kwempilo uma kudingeka.
Kubalulekile ukwazi ukuthi ithimba Lokunakekela I-Palliative Care lingabizwa noma nini phakathi nendlela yakho yokwelashwa hhayi nje ekupheleni kwempilo. Bangasiza ukulawula nokulawula izimpawu (njengokunzima ukulawula ubuhlungu nesicanucanu) okungenzeka ukuthi unakho ngenxa yesifo sakho noma ukwelashwa kwaso.
Uma wena nodokotela wakho ninquma ukusebenzisa ukunakekelwa okusekelayo noma ukuyeka ukwelashwa kwe-lymphoma yakho, izinto eziningi zingenziwa ukuze zikusize uhlale unempilo futhi unethezekile ngangokunokwenzeka isikhathi esithile.
I-radiation therapy yindlela yokwelapha umdlavuza esebenzisa imithamo ephezulu yemisebe ukubulala amangqamuzana e-lymphoma futhi ashwabene nezimila. Ngaphambi kokuba ube nemisebe, uzoba neseshini yokuhlela. Lesi seshini sibalulekile kubelaphi bemisebe ukuthi bahlele ukuthi bangaqondisa kanjani emisebeni ku-lymphoma, futhi bagweme ukulimaza amaseli anempilo. Ukwelashwa ngemisebe ngokuvamile kuthatha phakathi kwamaviki angu-2-4. Ngalesi sikhathi, uzodinga ukuya esikhungweni semisebe nsuku zonke (ngoMsombuluko-uLwesihlanu) ukuze uthole ukwelashwa.
*Uma uhlala kude nesikhungo se-radiation futhi udinga usizo ngendawo yokuhlala ngesikhathi sokwelashwa, sicela ukhulume nodokotela noma unesi wakho mayelana nokuthi yiluphi usizo ongaluthola. Ungakwazi futhi ukuthintana neCancer Council noma i-Leukemia Foundation esifundeni sakho futhi ubone ukuthi bangasiza yini ngendawo yokuhlala.
Ungase ube le mithi njengethebhulethi futhi/noma unikezwe njengethonsi (ukufakwa) emithanjeni yakho (emgudwini wegazi lakho) emtholampilo womdlavuza noma esibhedlela. Imithi eminingana ehlukene ye-chemo ingase ihlanganiswe nomuthi we-immunotherapy. I-Chemo ibulala amaseli akhula ngokushesha ngakho-ke ingathinta namanye amaseli akho amahle akhula ngokushesha abangele imiphumela engemihle.
Ungase ube ne-MAB infusion emtholampilo womdlavuza noma esibhedlela. Ama-MAB anamathela kuseli ye-lymphoma futhi ahehe ezinye izifo ezilwa namaseli amhlophe egazi namaprotheni kumdlavuza ukuze amasosha akho omzimba akwazi ukulwa ne-DLBCL.
I-MABS izosebenza kuphela uma unamaprotheni athile noma izimpawu kumaseli akho e-lymphoma. Umaka ojwayelekile ku-DLBCL yi-CD20. Uma unalo maka ungase uzuze ekwelashweni nge-MAB.
Ama-immune checkpoint inhibitors (ICIs) awuhlobo olusha lwe-monoclonal antibody (MAB) futhi asebenza ngokuhlukile kancane kwamanye ama-MABS.
Ama-ICI asebenza lapho amaseli wakho wesimila eba “nezindawo zokuhlola amasosha omzimba” kuwo avame ukutholakala kumaseli akho anempilo kuphela. Indawo yokuhlola izivikeli mzimba itshela amasosha akho omzimba ukuthi ingqamuzana liphilile futhi livamile, ngakho amasosha akho omzimba alishiya lodwa.
Ama-ICI asebenza ngokuvimbela i-immune checkpoint ukuze amaseli akho e-lymphoma angabe esakwazi ukuzenzisa anempilo, amaseli avamile. Lokhu kuvumela amasosha akho omzimba ukuthi awabone njengomdlavuza, futhi aqale ukuwahlasela.
I-Chemotherapy ehlanganiswe ne-MAB (isibonelo, i-rituximab).
Ungathatha lezi njengethebhulethi noma ukumnika emithanjeni yakho. Izindlela zokwelapha eziphuzwayo zingase zithathwe ekhaya, nakuba ezinye zizodinga ukuhlala isikhashana esibhedlela. Uma unomuthi, ungawuthola emtholampilo wansuku zonke noma esibhedlela. Izindlela zokwelapha ezihlosiwe zinamathisela kuseli ye-lymphoma futhi zivimbe izimpawu ezidinga ukukhula futhi zikhiqize amaseli amaningi. Lokhu kuvimbela umdlavuza ukuthi ungakhuli futhi kubangela ukuthi amangqamuzana e-lymphoma afe.
I-stem cell noma ukufakelwa komnkantsha wethambo kwenziwa ukuze esikhundleni somnkantsha wakho ogulayo kube namaseli amasha angakhula abe amaseli egazi amasha anempilo. Ukufakelwa komnkantsha ngokuvamile kwenziwa kuphela ezinganeni ezine-DLBCL, kuyilapho ukufakelwa kwe-stem cell kwenziwa kuzo zombili izingane ezindala.
Ekufakweni komnkantsha, ama-stem cells asuswa ngokuqondile emnkantsheni, lapho njengokufakelwa kwe-stem cell, ama-stem cells asuswa egazini.
Ama-stem cells angase akhishwe kumnikeli noma aqoqwe kuwe ngemva kokwelashwa ngamakhemikhali.
Uma wena ama-stem cell avela kumnikeli, kubizwa ngokuthi i- i-allogeneic stem cell transplant.
Uma ama-stem cells akho eqoqwa, kubizwa ngokuthi i- ukufakelwa kwe-autologous stem cell.
Ama-stem cells aqoqwa ngenqubo ebizwa ngokuthi i-apheresis. Wena (noma umnikezeli wakho) uzoxhunywa emshinini we-apheresis futhi igazi lakho lizokhishwa, ama-stem cells ahlukaniswe futhi aqoqwe esikhwameni, bese lonke igazi lakho libuyiselwa kuwe.
Ngaphambi kwenqubo, uzothola i-chemotherapy yomthamo omkhulu noma i-radiotherapy yomzimba ogcwele ukuze ubulale wonke amaseli akho e-lymphoma. Kodwa-ke lokhu kwelashwa ngethamo eliphezulu kuzophinde kubulale wonke amaseli omnkantsha wakho. Ngakho-ke ama-stem cells aqoqiwe azobe esebuyiselwa kuwe (atshalwe kabusha). Lokhu kwenzeka ngendlela efanayo naleyo yokumpontshelwa igazi, ngokusebenzisa i-drip emthanjeni wakho.
I-CAR T-cell therapy ukwelashwa okusha okuzonikezwa kuphela uma usuvele unezinye izindlela zokwelapha okungenani ezimbili ze-DLBCL yakho.
Kwezinye izimo, ungase ukwazi ukufinyelela ekwelashweni kwe-CAR T-cell ngokujoyina isilingo somtholampilo.
Ukwelashwa kwe-CAR T-cell kuhilela inqubo yokuqala efana nokufakelwa kwe-stem cell, lapho i-T-cell lymphocyte yakho ikhishwa egazini lakho ngesikhathi senqubo ye-apheresis. Njengawe-B-cell lymphocyte, ama-T-cell ayingxenye yamasosha akho omzimba futhi asebenza nama-B-cell akho ukuze akuvikele ezifweni nasekuguleni.
Uma ama-T-cell ekhishwa, athunyelwa elabhorethri lapho enziwa kabusha khona. Lokhu kwenzeka ngokujoyina i-T-cell ku-antigen eyisiza ukuthi ibone i-lymphoma ngokucacile futhi ilwe ngokuphumelelayo.
I-Chimeric isho ukuba nezingxenye ezinemvelaphi ehlukile ukuze ukuhlangana kwe-antigen ku-T-cell kuyenze ibe yi-chimeric.
Uma ama-T-cell esenziwe kabusha azobuyiselwa kuwe ukuze aqale ukulwa ne-lymphoma.
Ukwelashwa komugqa wokuqala - Ukwelashwa kokuqala
Ukuqala Ukwelapha
Kuzodingeka ukuthi uqale ukwelashwa ngokushesha ngemva kokubuya kwayo yonke imiphumela yokuhlolwa. Kwezinye izimo, ungaqala ngaphambi kokuthi yonke imiphumela ingene.
Kungaba nzima kakhulu uma uqala ukwelashwa. Ungase ube nemicabango eminingi mayelana nokuthi uzobhekana kanjani nesimo, indlela yokuphatha ekhaya, noma ukuthi ungase ugule kanjani.
Yazisa ithimba lakho labelaphi uma unomuzwa wokuthi ungase udinga ukwesekwa okwengeziwe. Bangakwazi ukukusiza ngokukuthumela ukuthi uyobonana nosonhlalakahle noma omunye uchwepheshe wezempilo ukuze akusize ulungise izinselele zokuphila zansuku zonke ongase ubhekane nazo. Ungakwazi futhi ukufinyelela kubahlengikazi abanakekela i-Lymphoma ngokuchofoza inkinobho ethi "Xhumana nathi" ezansi kwaleli khasi.
Uma uqala ukwelashwa okokuqala, kubizwa ngokuthi ukwelashwa komugqa wokuqala. Ungase ube nemithi engaphezu kowodwa, futhi lokhu kungase kuhlanganise ukwelashwa ngamakhemikhali, i-monoclonal antibody noma ukwelashwa okuhlosiwe. Kwezinye izimo ungase welashwe ngemisebe noma uhlinzwe futhi, noma esikhundleni semithi.
Imijikelezo yokwelashwa namaphrothokholi
Uma unalezi zindlela zokwelapha, uzoba nazo ngemijikelezo. Lokho kusho ukuthi uzothola ukwelashwa, bese uthola ikhefu, bese kuba omunye umzuliswano (umjikelezo) wokwelashwa. Kubantu abaningi abane-DLBCL, i-chemoimmunotherapy iyasebenza ukuze kuzuzwe ukuxolelwa (akukho zimpawu zomdlavuza).
Okunye ukuphazamiseka kwezakhi zofuzo kungase kusho ukuthi izindlela zokwelapha ezihlosiwe zizokusebenzela kangcono, kanti okunye ukungahambi kahle kofuzo - noma ufuzo oluvamile lungasho ukuthi i-chemoimmunotherapy izosebenza kangcono kakhulu.
Ezinye izibonelo ze-chemoimmunotherapy ongazithola uma une-DLBCL zihlanganisa:
I-R-CHOP
Inhlanganisela ejwayelekile ye-rituximab (a MAB) enemithi ye-chemo i-cyclophosphamide, i-doxorubicin, i-vincristine kanye ne-steroid ebizwa ngokuthi i-prednisolone. Imvamisa inikezwa ngosuku olulodwa njalo ezinsukwini eziyi-14 noma ezingama-21. Ngo-4th ngosuku ngemva kokwelashwa, uzophinde ube nomjovo esiswini sakho ukusiza amangqamuzana egazi amhlophe akhule abuye ngokushesha.
I-R-mini-CHOP
Ifana ne-R-CHOP ngenhla kodwa umthamo omncane. Ingasetshenziswa uma usukhulile noma udokotela wakho ekhathazekile ngokuthi ungase ungakubekezeleli umthamo ogcwele.
I-DA-R-EPOCH
Inhlanganisela yemithi efanayo ne-R-CHOP kodwa ngokungezwa kwenye i-chemotherapy ebizwa ngokuthi i-etoposide. Le nqubo yomthetho inikezwa ngemithamo ehlukene kuye ngesimo sakho ngasinye. I-DA egameni lisho ukuthi "umthamo ulungisiwe". Inikezwa isikhathi sezinsuku ezi-5 njalo ezinsukwini ezingama-21. Ngosuku lwesithupha, uzophinde ube nomjovo esiswini sakho ukusiza amangqamuzana egazi amhlophe akhule ngokushesha. Le phrothokholi inganikezwa uma une:
- I-high grade hit double (DH), i-triple hit (TH) noma i-double expressor (DEL)
- Noma, uma une-HIV ehambisana ne-lymphoma
I-SMARTE-R-CHOP14
Ifana ne-R-CHOP ngenhla, kodwa ngemithi ye-rituximab enikezwa ngezinsuku ezihlukene. Le nqubo yomthetho ingase inikezwe uma ungaphezu kweminyaka engama-60 ubudala, futhi amaseli akho e-DLBCL anomaka CD20 kuwo.
I-Hyper CVAD
Le nqubo yomthetho ngokuvamile izonikezwa wena kuphela uma unokuguquguquka kokushaya kathathu (ukuhlelwa kabusha kofuzo lwakho lwe-MYC kanye nofuzo lwakho lwe-BCL2 ne-BCL 6). IHyper CVAD inikezwa izingxenye ezimbili - IHyper CVAD ingxenye A kanye neHyper CVAD ingxenye B.
- Ingxenye A ihlanganisa i-steroid ebizwa ngokuthi i-dexamethasone, kanye nemithi yokwelapha ngamakhemikhali i-cyclophosphamide kabili ngosuku izinsuku ezintathu, i-doxorubicin ngosuku lwesine kanye ne-vincristine ngezinsuku ezingu-4 no-11 zephrothokholi. Uzoba nomunye umuthi obizwa nge-Mesna ngenkathi une-cyclophosphamide ukusiza ukuvikela esinyeni sakho. Ngosuku lwesi-5, uzoba nomjovo esiswini sakho obizwa nge-pegfilgratim ukuze usize umzimba wakho udale amangqamuzana egazi amhlophe engeziwe ukuze akuvikele ekuthelelekeni.
- Ingxenye B kuhlanganisa ukwelashwa ngamakhemikhali okubizwa ngokuthi i-methotrexate ne-cytarabine. I-methotrexate inikezwa ngosuku loku-1 kulandelwa umuthi obizwa nge-calcium folinate (leucovorin) esiza umzimba wakho ukuthi ukhiphe i-methotrexate eyeqile ukuze uvimbele imiphumela emibi kakhulu. Lokhu kuzobe sekulandelwa yi-cytarabine ezinsukwini 2 no-3 kanye nomjovo we-pegfilgratim ngosuku lwesi-4.
*Sicela uqaphele, uma une-ALK positive B-cell lymphoma enkulu, ungase ube nokwelashwa okufanayo nalokhu, kodwa ngeke abe nemithi ye-rituximab. Lokhu kungenxa yokuthi amaseli e-lymphoma ku-ALK positive B-cell lymphoma enkulu awanayo i-CD20 marker kuwo, edingekayo ukuze umuthi usebenze.
- Ungase futhi ufaneleke ukubamba iqhaza ocwaningweni lomtholampilo.
Isistimu yezinzwa emaphakathi (CNS) prophylaxis (ukuvimbela)
Cishe oyedwa kwabangu-20 abantu abane-DLBCL angaba ne-lymphoma yabo ibuye ngemva kokwelashwa ku-CNS yabo. Phambilini bekucatshangwa ukuthi ngokunikeza umthamo ophezulu we-methotrexate ngemuva kwe-chemo-immunotherapy yakho yomugqa wokuqala ingozi ye-lymphoma ebuya ku-CNS yakho izoncipha.
Kodwa-ke, ucwaningo olubonise kakhulu ukuthi amazinga esifo se-CNS anengozi efanayo kulabo abaye bathola umthamo ophezulu we-methotrexate nalabo abangazange babe ne-methotrexate ephezulu yomthamo. Ngalesi sizathu, izikhungo eziningi zokunakekela umdlavuza azisanikezi le nketho yokwelashwa, njengoba ubungozi budlula izinzuzo.
Ukwelashwa komugqa wesibili (Ngemva kokuphinda noma isifo esingamahlalakhona)
Ngemva kokwelashwa iningi lenu lizongena eshweni. Ukuxolelwa yinkathi yesikhathi lapho ungenazo khona izimpawu ze-DLBCL ezisele emzimbeni wakho, noma lapho i-DLBCL ilawulwa futhi ingadingi ukwelashwa. Nokho, ngezinye izikhathi i-DLBCL ingaphindela emuva (ibuye) bese kunikezwa ukwelashwa okuhlukile.
Bambalwa kini abangase bangakutholi ukuthethelelwa ngokwelashwa kwakho komugqa wokuqala. Uma lokhu kwenzeka, i-DLBCL yakho ibizwa ngokuthi “i-refractory”. Uma une-DLBCL ephikisayo udokotela wakho cishe uzofuna ukuzama imithi ehlukile.
Ukwelashwa okutholayo uma une-DLBCL ephikisayo noma ngemva kokuphinda ugule kubizwa ngokuthi ukwelashwa komugqa wesibili. Umgomo wokwelashwa komugqa wesibili uwukukufaka ekwephuleni futhi.
Uma unokunye ukuthethelelwa, bese uphinda futhi uthola ukwelashwa okwengeziwe, lokhu kwelashwa okulandelayo kubizwa ngokuthi ukwelashwa komugqa wesithathu, ukwelashwa komugqa wesine nokunye.
Ungase udinge izinhlobo ezimbalwa zokwelapha ze-DLBCL yakho. Ochwepheshe bathola izindlela zokwelapha ezintsha nezisebenza ngempumelelo ezikhulisa ubude bokukhululwa. Uma i-DLBCL yakho ingasabeli kahle ekwelashweni noma kuba khona ukuphindeka ngokushesha ngemva kokwelashwa (ezinyangeni eziyisithupha) lokhu kwaziwa ngokuthi i-DLBCL ephikisayo futhi kuzodingeka uhlobo oluhlukile lokwelapha.
I-DLBCL ebuyelwe kabusha futhi ephikisayo isengafakwa ekuxolelweni noma yelashwe ngokwelashwa okwengeziwe, nokho kubantu abambalwa abambalwa i-DLBCL ingaba nolaka kakhulu. Buza udokotela wakho mayelana nezici zakho eziyingozi kanye nomgomo wokwelashwa kwakho. Bazokwazisa uma ungalindela ukuxolelwa, ukwelashwa, noma ukuthi yini ongayilindela uma ukwelashwa kwamanje kungasebenzi.
Ukuthi ukwelashwa kwakho komugqa wesibili kunqunywa kanjani
Ngesikhathi sokubuyela emuva, ukukhetha ukwelashwa kuzoncika ezintweni eziningana ezihlanganisa.
- Isikhathi esingakanani uxolelwe
- Impilo yakho jikelele kanye neminyaka yakho
- Ikuphi ukwelashwa/ukwelashwa kwe-DLBCL okuthole esikhathini esidlule
- Izintandokazi zakho.
Le phethini ingase iziphindaphinde eminyakeni eminingi. Izindlela zokwelapha ezintsha ezihlosiwe manje seziyatholakala ezifweni eziphindelelayo noma ezinganambitheki kanye nezinye izindlela zokwelapha ezivamile ze-DLBCL ebuyelile.
Ukwelashwa komugqa wesibili okuvamile kwe-DLBCL
I-DHAP – iphrothokholi yokwelashwa ngamakhemikhali yomugqa wesibili kusetshenziswa isteroid ebizwa nge-dexamethasone kanye nemithi yokwelapha ngamakhemikhali ebizwa ngokuthi i-carboplatin ne-cytarabine.
ICE – lena i-chemotherapy protocol eqinile, futhi ihlanganisa nemithi yokwelapha ngamakhemikhali ebizwa ngokuthi i-ifosphamide, i-carboplatin ne-etoposide. Omunye umuthi obizwa nge-Mesna nawo unikezwa ukuvikela esinyeni sakho.
ESHAP – lena futhi iphrothokholi ye-chemotherapy eqinile ehlanganisa i-steroid ebizwa ngokuthi i-methylprednisolone kanye ne-chemotherapies etoposide, i-cytarabine ne-cisplatin. Le nqubo yomthetho ingase inikezwe uma ubuyele esimweni, noma uma uhlela ukufakelwa i-stem cell.
I-GDP - Le nqubo ingase inikezwe uma ubuyela emuva noma uhlela ukufakelwa kwe-stem cell. Kuhlanganisa i-steroid ebizwa ngokuthi i-dexamethasone kanye ne-chemotherapies i-gemcitabine ne-cisplatin.
I-Polatuzumab vedotin – umuthi omusha futhi uyi-conjugated monoclonal antibody. Unganikezwa lo muthi uma unomaka we-CD79b kumaseli akho e-lymphoma. Ngokuvamile i-giev nenye i-monoclonal antibody ebizwa ngokuthi i-rituximab (uma futhi unomaka we-CD20 kumaseli akho e-lymphoma) kanye nokwelapha ngamakhemikhali okuthiwa i-bendamustine. Lokhu kuvame ukusetshenziswa uma ungahlelelwe ukufakelwa kwe-stem cell.
Ukufakelwa kwe-stem cell - ingase inikezwe abantu abathile abane-DLBCL asebephindele kulo mkhuba, nokho akuyona into efanelekile kuwo wonke umuntu. Wena dokotela uzocabangela izinto ezimbalwa ngaphambi kokunquma ukuthi lena inketho yokwelashwa enhle yini kuwe. Lokhu kuzobandakanya:
- iminyaka yakho
- noma yiziphi ezinye izifo (comorbidities) ongase ube nazo
- ukuthi uphendule kahle kangakanani ekwelashweni esikhathini esidlule.
Ukwelashwa komugqa wesithathu
Kwabanye abantu, ukwelashwa komugqa wesithathu noma wesine kungase kudingeke.
Udokotela wakho uzocabangela izimo zakho ngazinye lapho enquma ngenketho yokwelashwa engcono kakhulu kuwe. Ungase unikezwe imithi efanayo naleyo ebhalwe ngaphansi komugqa wokuqala nowesibili.
Inketho entsha ebizwa nge-CAR T-cell therapy nayo igunyazelwe abantu abaye baba nezinye izinhlobo zokwelapha okungenani ezimbili. Uma usomugqa wakho wesithathu noma wesine wokwelashwa futhi udokotela ungakayisho i-CAR T-cell therapy sincoma ukuthi ubabuze ngakho. Kodwa-ke, njengokufakelwa kwe-stem cell, ukwelashwa kwe-CAR T-cell akufanele wonke umuntu.
Izivivinyo zemitholampilo
Kunconywa ukuthi noma nini lapho udinga ukuqala ukwelashwa okusha ubuze udokotela wakho mayelana nezivivinyo zomtholampilo ongase ukufanelekele.
Izivivinyo zomtholampilo zibalulekile ukuthola imithi emisha, noma izinhlanganisela zemithi ukuthuthukisa ukwelashwa kwayo I-DLBCL esikhathini esizayo.
Bangakunikeza nethuba lokuzama umuthi omusha, inhlanganisela yemithi noma ezinye izindlela zokwelapha ongeke ukwazi ukuzithola ngaphandle kohlolo. Uma ungathanda ukubamba iqhaza esivivinyweni somtholampilo, buza udokotela wakho ukuthi yiziphi izivivinyo zomtholampilo okufanelekela kuzo.
Kukhona izindlela zokwelapha eziningi nezinhlanganisela ezintsha zokwelapha okwamanje ezihlolwayo ezivivinyweni zemitholampilo emhlabeni wonke ezigulini ezisanda kuxilongwa nezibuye zabuyela emuva. I-DLBCL.
I-prognosis ye-DLBCL - nokuthi kwenzekani lapho ukwelashwa kuphela
I-prognosis yigama elisetshenziselwa ukuchaza indlela okungenzeka yesifo sakho, ukuthi sizosabela kanjani ekwelashweni nokuthi uzokwenza kanjani phakathi nangemuva kokwelashwa.
Kunezici eziningi ezinomthelela ekubikezeleni kwakho futhi akunakwenzeka ukunikeza isitatimende esiphelele mayelana nokubikezela. Nokho, i-DLBCL ivamise ukusabela kahle kakhulu ekwelashweni futhi iziguli eziningi ezinalo mdlavuza zingelapheka – okusho ukuthi ngemva kokwelashwa, alukho uphawu lwe-DLBCL emzimbeni wakho.
Izinto ezingaba nomthelela ku-prognosis
Ezinye izici ezingase zibe nomthelela ekubikezelweni kwakho zihlanganisa:
- Uneminyaka yobudala kanye nempilo yonke ngesikhathi sokuxilongwa.
- Indlela osabela ngayo ekwelashweni.
- Kuthiwani uma kukhona ukuguqulwa kofuzo onakho.
- Uhlobo oluncane lwe-DLBCL onalo.
Uma ungathanda ukwazi okwengeziwe nge-prognosis yakho siqu, sicela ukhulume nochwepheshe wakho we-hematologist noma i-oncologist. Bazokwazi ukukuchazela izici zakho zobungozi kanye ne-prognosis kuwe.
Ukusinda - Ukuphila nomdlavuza, nangemva kwalokho
Indlela yokuphila enempilo, noma ezinye izinguquko ezinhle zokuphila ngemva kokwelashwa zingaba usizo olukhulu ekululameni kwakho. Ziningi izinto ongazenza ukuze uphile kahle nazo I-DLBCL.
Abantu abaningi bathola ukuthi ngemva kokuxilongwa umdlavuza, noma ukwelashwa, ukuthi izinhloso zabo nezinto eziza kuqala ekuphileni ziyashintsha. Ukwazi ukuthi kuyini 'okujwayelekile kwakho okusha' kungase kuthathe isikhathi futhi kukhungathekise. Okulindelekile komndeni wakho nabangane kungase kwehluke kokwakho. Ungase uzizwe uhlukanisiwe, ukhathele noma iyiphi imizwa ehlukene engashintsha usuku ngalunye.
Imigomo eyinhloko ngemva kokwelashwa kwakho I-DLBCL wukubuyela ekuphileni futhi:
- khuthala ngangokunokwenzeka emsebenzini wakho, emndenini, nakwezinye izindima zempilo
- nciphisa imiphumela emibi kanye nezimpawu zomdlavuza kanye nokwelashwa kwawo
- khomba futhi ulawule noma yimiphi imiphumela emibi ngemva kwesikhathi
- ukusiza ukugcina uzimele ngangokunokwenzeka
- ngcono izinga lakho lempilo futhi ugcine impilo enhle yengqondo
Izinhlobo ezahlukene zokuvuselela umdlavuza zinganconywa kuwe. Lokhu kungasho noma yiluphi uhlobo olubanzi yezinkonzo ezifana nalezi:
- ukwelashwa ngokomzimba, ukuphathwa kobuhlungu
- ukuhlela okunomsoco nokuzivocavoca
- ukwelulekwa ngokomzwelo, kwezemisebenzi nakwezezimali.
