Cutar sankarar bargo ba daya cuta ba, amma mutane da yawa. Masana kimiyya sun fara fahimtar yadda ko da guda ɗaya, musamman irin cutar sankarar bargo yana da subtypes wanda ya bambanta a hanyoyi masu muhimmanci.
Magungunan cutar sankara guda hudu suna dogara ne akan ko suna da mawuyacin hali ko ciwon kwaɗayi, da kuma myeloid ko leukemias na lymphocytic, kuma waɗannan mahimman sunaye sune:
- Na'urar myeloid (ko myelogenous) cutar sankarar bargo (CML)
- Lymphocytic m (ko lymphoblastic) leukemia (ALL)
- Likitan cutar ciwon sankarar lymphocytic na zamani (CLL)
Game da AML
Murawon cutar sankarar mutelogenous mai cututtuka shine ciwon daji na kasusuwa na kasusuwan ciki-waxanda suke cike da kasusuwa, inda ake yin jini - kuma yana da ciwon daji na jini.
AML ana dauke da cutar sankarar "m" saboda yana cigaba da sauri. Sashen ɓangaren sunaye na daga cikin kwayoyin myeloid - rukuni na kwayoyin da ke ci gaba da zama a cikin nau'ukan jini daban-daban, irin su suturar jini, da jini mai launin jini da kuma platelets.
AML yana da sunayen da yawa: Murakimin sankarar myelogenous mai maƙwabtaka kuma ana san shi da cutar mukakken cutar myeloid m, da myeloblastic cutar sankarar bargo, m cutar cutar sankarar ƙanƙarar granulocytic da kuma rashin gandur da cutar sankarar nonlymphocytic.
AML zai iya shafar mutane daga dukan zamanai. Shirin GLOBOCAN na 2012 na Lafiya ta Duniya ya nuna kimanin mutane 352,000 a duniya da AML, kuma cutar ta zama mafi girma a matsayin yawancin shekarun.
Alamomi da alamun bayyanar AML sun hada da:
- Fever
- Kuna ciwo
- Sohargy da gajiya
- Rawancin numfashi
- Pale fata
- Kwayoyin cuta masu yawa
- Ƙarfafawa mai sauki
- Zubar da jini marar yalwa, irin su yawancin hanci da zub da jinin jini
Subtypes
Ana rarraba samfurin AML dangane da siffar microscopic kwayoyin cutar kanjamau, ko kwayoyin halittar jiki, ta hanyar sabon binciken game da canjin yanayi ko maye gurbin da ke cikin nau'o'i daban-daban na wannan mummunan.
Masu bincike a Cibiyar Wellcome Trust Sanger Cibiyar da masu haɗin gwiwar kwanan nan sun kara da su a cikin ilimin ilimin, suna bada rahoto game da maye gurbin kwayoyin halitta wanda ke taimakawa wajen fahimtar fahimtar AML-kara canza yanayin da ake nufi da AML daga wannan cuta guda daya zuwa daya tare da akalla iri iri daban daban malignancy , tare da bambance-bambance wanda zai iya taimakawa wajen bayyana saurin sauye sauye tsakanin matasa da AML.
Masu binciken sun wallafa nazarin su a kan jinsunan AML a cikin watan Yuni na shekarar 2016 na "New England Journal of Medicine," kuma masana sun gaskata cewa wannan binciken zai iya inganta gwaji na asibitoci da kuma tasiri kan yadda ake bincikar marasa lafiya da AML a nan gaba.
Nazarin NEJM
Masu bincike sunyi nazarin marasa lafiya 1,540 tare da AML wadanda aka sanya su cikin gwaji. Sun bincika fiye da 100 kwayoyin da aka sani da cutar da cutar sankarar jini tare da manufar gano "jinsin jinsin" bayan ci gaba da cutar.
Sun gano cewa marasa lafiya tare da AML zasu iya rarraba zuwa akalla 11 kungiyoyi masu girma, kowannensu yana da nau'i daban-daban na canjin yanayi da bambancin halaye da fasali. Bisa ga binciken, mafi yawan marasa lafiya sun haɗu da halayen kwayoyin cutar da ke cutar da cutar sankarar bargo, wanda zai iya taimakawa wajen bayyana dalilin da ya sa AML ta nuna irin wannan canji a cikin yawan rayuwa.
Abubuwa
Sanin yadda kwayoyin cutar sankarar marasa lafiya suka yi amfani da kwayoyin halitta zai iya inganta ikon yin hango ko hasken magani zai kasance mai tasiri. Ana iya amfani da irin wannan bayanin don tsara sababbin gwaje-gwaje na asibiti don samar da mafi kyawun maganin kowane ɗayan shafe na AML; kuma a ƙarshe, ƙarin gwajin kwayoyin cutar AML a ganewar asiri zai iya zama mafi mahimmanci.
A cikin shekarar 2008 na tsarin kula da lafiyar duniya (WHO), masana kimiyya sun riga sun fara rarraba tsohuwar AML zuwa "kungiyoyin kwayoyin" daban-daban, "ciki har da wasu canji na kwayoyin ko kuma raunin da ya faru ga chromosomes da aka ƙaddara kamar haka: t (15; 17), t (8; 21; ), inv (16) -t (16, 16), t (6; 9), inv (3) -t (3; 3), MLL fusion jinsin, da kuma dacewa, CEBPA ko NPM1 maye gurbin.
Duk da haka, kamar yadda aka kwatanta a cikin binciken NEJM na kwanan nan, WHO na ƙaddamar da kwayoyin halitta ba ya aiki sosai ga yawancin lambobin AML. A cikin binciken, 736 marasa lafiya tare da AML, ko kashi 48 cikin su, ba za a ƙayyade su ba bisa ga ƙungiyoyi kwayoyin WHO, ko da yake 96 bisa dari na marasa lafiya, sun kasance suna da alamar motar direbobi-canjin yanayi wanda ya haifar da malignancy.
Gano sababbin cutar kwayar cutar sankarar bargo, ƙwayoyin motsawa da yawa tare da haƙuri, da kuma dabi'un maye gurbi sun sa masu binciken su sake nazarin tsarin lissafin AML daga farkon.
Ana ba da shawara na AML da kuma Ƙididdiga, bisa ga Tsarin Halitta
Sabili da haka, masu bincike suka koma cikin zane-zane don kokarin kokarin samar da wani sabon tsari don rarraba AML wanda ke yin amfani da bayanan da ke faruwa.
Kaddamar da jinsin da aka fi sani da AML yayi amfani da ladaran WHO - ciki har da wadanda ake kira cytogenetic raunuka-alal misali t (15; 17) - tare da NPM1, FLT3ITD, da CEBP, kamar yadda aka lissafa a sama.
Bisa ga sabon binciken, marubuta sun bada shawarar cewa, a cikin gajeren lokaci, TP53, SRSF2, ASXL1, DNMT3A, da kuma IDH2 ya kamata a yi la'akari da sanyawa cikin ka'idojin gwaji saboda suna da kowa kuma suna da tasiri mai karfi akan sakamako na asibiti.
Don AML tsarawa, kimantawa da "kwayoyin halitta" RUNX1, ASXL1, da kuma MLLPTD a ganewar asali zasu gano marasa lafiya a cikin "ƙungiyar chromatin-spliceosome". Wannan shi ne karo na biyu mafi girma na marasa lafiya AML a cikin binciken, kuma ya bambanta da Kwayoyin WHO na AML, babu wata kwayar halitta da ta bayyana wannan rukuni.
Yin amfani da wannan tsarin da aka tsara, 1,236 na marasa lafiya 1,540 tare da direbobi masu kamfani zasu iya rarraba su a cikin ƙungiya guda guda, kuma mambobi 56 sun hadu da ma'auni don ƙungiya biyu ko fiye. Kusan 166 marasa lafiya tare da direbobi direbobi sun kasance ba tare da sun kasance ba.
Bayanin Tsarin Tsarin Gida
AML ba a daidaita kamar sauran cututtuka ba. Gabatarwa ga mutum tare da AML ya dogara a kan wasu bayanan, irin su subtype kamar yadda aka tsara ta gwaje-gwajen gwaje-gwaje, da shekarun mai haƙuri, da kuma sauran gwajin gwaji.
Ƙididdiga na AML suna iya danganta da yanayin lafiyar mutum da kuma kyakkyawan magani. Alal misali, ƙuƙwalwar cutar sankarar bargo (APL) mai tsanani wanda aka saba amfani da su ta amfani da kwayoyi da suka bambanta da waɗanda aka yi amfani da wasu subtypes na AML.
Biyu daga cikin manyan tsare-tsaren da aka yi amfani da su don rarraba AML a cikin subtypes sune jinsin Faransanci da Birtaniya (FAB) da kuma sabon tsarin kiwon lafiya na duniya (WHO).
Faransanci na Faransanci da Ingila (FAB) na AML
A cikin shekarun 1970s, wani rukuni na Faransanci, Amurka, da Birtaniya kan cutar sankarar bargo sun raba AML zuwa subtypes, M0 ta hanyar M7, bisa ga irin kwayar halitta wadda cutar tawon ciwon yaro ta tasowa da kuma yadda tsofaffin kwayoyin halitta suke da girma. Wannan ya dogara ne akan yadda kwayoyin cutar sankarar bargo ke kallo a ƙarƙashin microscope bayan da ake amfani da su.
FAB Subtype Name
M0 Ba tare da wata sanadiyar cutar sankarar bargo ba
M1 Myeloglastic cutar sankarar bargo tare da kadan maturation
M2 Myeloblastic cutar sankarar bargo tare da maturation
M3 Murasar cutar sankarar mota mai wuya (APL)
M4 Murar cutar sankarar myelomonocytic m
M4 eos Murawon cutar sankarar mikiya mai karfin zuciya tare da eosinophilia
M5 Murar cutar sankarar mota guda daya
M6 Maturan cutar sankarar bargo
M7 Maƙarƙashin cutar sankarar bargo mai sauƙi
Ƙididdiga M0 ta hanyar M5 duk farawa ne a cikin nau'in jini mai tsabta. M6 AML farawa ne a cikin jinsunan jini maras kyau, yayin da M7 AML farawa a cikin nau'in kwayoyin halitta wanda ke yin plalets.
Kungiyar Lafiya ta Duniya (WHO) ta ƙunshi AML
Tsarin tsarawa na FAB yana da amfani kuma har yanzu ana amfani da su don hada AML cikin subtypes, duk da haka ilmi ya ci gaba da nunawa da kuma hangen zaman gaba ga nau'o'in AML, kuma wasu daga cikin wadannan ci gaba sun nuna a cikin tsarin kula da lafiya na duniya (WHO) 2008.
Hukumar WHO ta raba AML zuwa kungiyoyi masu yawa:
AML tare da wasu ƙwayoyin cuta
- AML tare da fassarar tsakanin chromosomes 8 da 21
- AML tare da fassarar ko inversion a cikin chromosome 16
- AML tare da fassarar tsakanin chromosomes 9 da 11
- APL (M3) tare da fassarar tsakanin chromosomes 15 da 17
- AML tare da fassarar tsakanin chromosomes 6 da 9
- AML tare da fassarar ko inversion a chromosome 3
- AML (megakaryoblastic) tare da fassarar tsakanin chromosomes 1 da 22
AML tare da canje-canje na myelodysplasia
AML dangane da cutar rigakafi ko radiation
AML ba a kayyade shi ba (AML wanda ba ya fada cikin ɗayan kungiyoyin da aka sama kuma an haɗa shi kamar abin da aka aikata a tsarin FAB):
- AML tare da ƙananan bambancin (M0)
- AML ba tare da maturation (M1)
- AML tare da maturation (M2)
- Murawon cutar sankarar mutelomonocytic (M4)
- Murar cutar sankarar mota mai tsanani (M5)
- Ƙananan cutar sankarar bargo erythroid (M6)
- Maƙarƙin cutar sankarar mikiya mai ƙwayar cuta (M7)
- Murar cutar sankarar ƙananan basophilic
- Ƙananan panmyelosis tare da fibrosis
Sarcoma myeloid (wanda aka sani da sarcoma granulocytic ko chloroma)
Maganin ƙwayoyin cuta da aka danganta da Down syndrome
Undifferentiated da biphenotypic m leukemias :
Wadannan su ne leukemias wadanda ke da siffofin lymphocytic da myeloid. Wani lokaci ana kira DUK tare da alamomi mai suna, AML tare da alamar lymphoid, ko kuma leukemias mai zurfi.
A sama da Kwayoyin WHO an daidaita su daga Cibiyar Cancer na Amurka.
Sources:
Papaemmanuil E, Gerstung M, et al. Tsarin halittu da ƙwarewa a cikin cutar cutar sankarar myeloid m. N Engl J Med . 2016; 374 (23): 2209-21.
Wellcome Trust Sanger Cibiyar. Kwayar cutar sankarar myeloid mai miki ne akalla 11 cututtuka daban-daban. Samun shiga Yuni 2016.
Cibiyar Cancer na Amurka. Yaya aka kirkiro cutar cutar sankarar myeloid mai tsanani? Samun shiga Yuni 2016.