Wadanne sakamako ne zai likita likita?
Kamar kowane farfadowa, akwai juye da raguwa. Hanya ita ce an yi amfani da immunotherapy don inganta ƙwarewar wasu irin ciwon daji irin su ciwon daji marasa ciwon ƙwayar cutar, ciwon daji, ƙwayar cutar ciwon jini, da lymphoma na Hodgkin. A wasu kalmomi, ana ba wa mutane damar zama na biyu a rayuwa mafi tsawo kuma sun fi rayuwa mai dadi-wani abu wanda yake canza yanayin ciwon daji.
Babu shakka, hanyar shiga cikin rigakafi na fara kawai, kuma wannan matsala ne da ke da matukar farin ciki a binciken bincike da ciwon daji a yanzu.
Tare da wannan, yayinda ake bi da mutane da yawa tare da immunotherapy, musamman masu hana masu bincike (ipilimumab, nivolumab, da pembrolizumab), likitoci suna lura da matsalolin da zasu iya haifar da sakamakon sabbin sababbin kwayoyi.
Bayani na Masu Bayar da Bincike
Domin fahimtar tasirin mummunan tasiri ko mawuyacin masu hana masu binciken , yana da muhimmanci a gane yadda irin wannan aikin immunotherapy ke aiki.
A takaice dai, shafukan dubawa na yau da kullum suna kwance a kan tsarin kwayoyin halitta (wanda ake kira T). Wadannan kwayoyin binciken sunyi aiki ta hanyar hanyar sigina mai ƙyama don dakatar da kwayar T ta mutum daga kai hare-hare kan kwayoyin lafiya-kawai bad, ƙwayoyin waje (misali, kwayoyin cutar da kwayar cutar).
Abin baƙin ciki shine, kwayoyin ciwon daji suna yaudarar cewa suna yinwa da bayyana magungunan kansu, kuma wannan shine dalilin da ya sa jikinka ba ya kaiwa mummunan ciwo, kamar yadda zakuyi tunanin zai.
Masana kimiyya, duk da haka, sunyi yaki ta hanyar samar da hanyoyin kwantar da hankula wanda ke toshe wadannan wuraren bincike akan kwayoyin cutar kanjamau a cikin fata cewa yanzu tsarin jiki na jiki zai gane ciwon daji kamar kasashen waje, ya fara farmaki, ya kuma share shi.
Abubuwan da ke cikin masu sarrafawa
Tabbas, matsalolin zasu iya tashi idan tsarin mutum ya ci gaba da rikita rikicewa kuma zai fara kai hari ga al'ada, kwayoyin lafiya banda ganyayyun kwayoyin cutar ciwon daji.
A wasu kalmomi, mummunan kumburi, lalata kwayoyin halitta, da cututtuka na autoimmune zai iya faruwa tare da yin amfani da wadannan maƙaryata masu bincike.
A gaskiya ma, bincike ya nuna cewa wadannan cututtuka, wadanda ake kira abubuwa masu banbanci, suna faruwa har zuwa kashi 85 cikin dari na mutane bayan magani tare da mai hanawa ipilimumab. Suna faruwa a cikin kashi 70 cikin dari na mutane bayan jiyya tare da maɓuɓɓuka masu shafewa na nivolumab ko pembrolizumab.
A gefe guda, ipilimumab ya hana kariya ta CTLA-4 (magungunan T-lymphocyte na cytotoxic 4) kuma an yi amfani dasu don magance melanoma .
Nivolumab da kuma pembrolizumab manufa PD-1 (sun shirya mai karɓar mai mutuwa-1) kuma an yi amfani dasu don magance cututtuka irin su melanoma, ciwon daji na ƙwayar halittar jini, ciwon ƙwayar cutar kututtukan kwayoyin cutar, da lymphoma na Hodgkin.
Komawa ga abubuwa masu guba, duk da haka, tsarin da aka saba amfani dasu shine wadanda suke hana su "kuskure" a cikin jikin su ne fata, ciwon gastrointestinal, hanta, da kuma endocrin tsarin.
Skin Wadannan abubuwa
Matsarar fata shine mafi yawan abin da ke faruwa a cikin kwayar cutar wanda ya danganta da ɗaukar magunguna, kuma su ma sukan fara faruwa a farkon magani.
Misalai na matsalolin fata sun hada da rash, itching, alopecia (gashi gashi), da kuma vitiligo .
Matsaloli na bakin ciki kamar busassun baki da kuma maganin mucositis (yayin da ulcers ke cikin baki) na iya faruwa.
Jiyya na rash yawanci entails ta amfani da topical corticosteroid cream. Ko da yake idan raguwa yana da tsanani, an yi amfani da corticosteroid na al'ada a wasu lokuta. Samun maganin antihistamine na maganganu kamar Benadryl (diphenhydramine) zai iya taimakawa wajen yin amfani da shi.
Ba shakka, idan damuwa yana da tsanani, ma'anar cewa yana rufe fiye da kashi 30 cikin jiki, mai yiwuwa mutum zai buƙatar ciwon sukarin da aka ba ta cikin kwayar cutar (a cikin intravenously) sannan kuma wani ɓangaren magungunan kwayoyi.
Yana da mahimmanci a lura da cewa raunuka masu tsanani kamar Stevens-Johnson ciwo ba su da wata sanarwa a cikin mutanen da ke daukar maƙallacin bincike.
Wannan shine dalilin da ya sa ku ko likitan likitanku na likita za ku kula da ku a hankali yayin da kuke shan rigakafi da sauri kuma ku ga likitan binciken idan likitanku ya damu (kamar idan yake farawa) ko kuma idan ba ku da sauƙi tare da matakan sauki kamar corticosteroid cream.
Gastrointestinal Tract Abubuwa
Diarrhea da colitis, wanda ke haifar da ciwo na ciki da kuma wani lokacin jini a cikin kwakwalwa, sune matsaloli biyu na hanji wanda zai iya faruwa saboda sakamakon ɗaukar maɓallin binciken. Idan waɗannan cututtuka sun auku, suna nuna sama kusan makonni shida ko daga baya bayan fara immunotherapy.
Wannan ya ce, wadannan cututtuka masu kamala sun zama mafi mahimmanci a cikin waɗanda ke karɓar CTLA-4 mai hana kwayoyin cuta (alal misali, ipilimumab don ci gaba da melanoma), idan aka kwatanta da wadanda suke karɓar PD-1 (alal misali, nivolumab don ƙananan cell cell ne kwayar cutar kanjamau).
Jiyya na m da farkon zawo ya hada da yawan abinci mai amfani da ruwa, da cin abinci mai maganin maganin rage cin abinci , da kuma yiwuwar magani mai maganin maganin cutar kamar Imodium (loperamide). Amma idan ciwo zai ci gaba fiye da kwana biyu ko uku, duk da waɗannan magunguna masu sauki, ko kuma idan zazzaɓi ya fi tsanani (hudu ko fiye da motsi na zuciya a kowace rana), za a yi nazari sosai don sake gwada zafin jiki-kamar idan kamuwa da cuta shine mai laifi, ba magani ba.
Idan an kawar da kamuwa da cuta, kuma ana ganin dalilin ya zama magunguna, ana buƙatar corticosteroids kuma a wasu lokuta ma magunguna masu magungunan da za su shafe tsarin na rigakafi kamar Remicade (infliximab).
Ɗaya daga cikin manyan barazanar rayuwa, ko da yake ba a sani ba, rikitarwa na colitis da likitoci ke kallo don ƙaddarar hanzari (inda rami ya ƙunshi bango na hanji daga mummunan ƙumburi).
Hanyoyin Hanyoyi
Masu maganin bincike zasu iya haifar da hawan haɗari a cikin hanta enzymes, wanda halayyar hanta ƙonewa. Wadannan darajar suna ganin kimanin watanni biyu zuwa uku bayan fara farfadowa.
Yawancin lokaci, likita zai saka idanu akan gwajin jinin hanta , musamman ma kafin kowane jigilar immunotherapy, kuma idan an ƙara hawan enzymes, za a yi aiki don sanin ko ma'anar ta danganci immunotherapy ko wani abu (alal misali, wani magani ko kamuwa da cutar bidiyo).
Kamar sauran cututtukan da ba su da alaka da cutar, idan an ƙaddara dalilin da za'a danganta shi da immunotherapy, za'a tsara wa corticosteroids. Idan hanta mai haɗari yana da tsanani, magani tare da immunotherapy na iya buƙatar tsayawa gaba daya.
Endocrine System Wadannan abubuwa
Abubuwa masu rikitarwa marasa lalacewa zasu iya faruwa a cikin tsarin endocrine na jiki, wanda ya hada da glandon gwaninta, glanden giro, da glandon adrenal. A matsakaici, bayyanar cututtuka sun bayyana a kusa da makonni tara bayan farawa magani kuma zasu iya hada da:
- Wulo
- Rashin rauni
- Jiɗa
- Rikici
- Ciwon kai
- Rashin ci
- Matsaran hangen nesa
- Fever
Ɗaya daga cikin mafi yawan cutocrine sakamako masu tasiri shi ne hypothyroidism , wanda shine lokacin da mutum ya taso wani underactive thyroid.
An yi rahoton glandon thyroid wanda ake kira hyperthyroidism. Dukkanin ka'idodin zasu iya sarrafawa ta hanyar likitancin jini kuma an gano su ta hanyar gwajin jini, mafi yawanci gwajin jini na hormone (TSH). Hypothyroidism na bukatar magani tare da hormone thyroid, wanda ake kira Synthroid (levothyroxine).
Bugu da ƙari, hypothyroidism, wani matsala na karshen endocrin wanda zai iya samuwa sakamakon sakamakon binciken da ke hana immunotherapy shi ne hypophysitis, wanda shine ƙonewa na glandon gurasar-wanda aka kira shi gland shine saboda ya sake haifar da adadin hormones a jiki.
Hypophysitis na iya haifar da gajiya da ciwon kai da kuma gwajin jini yana nuna matakan hormone marasa ƙarfi. Zane-zane na hoto na iya nuna kumburi na glandan gizon. Idan an gano dasu ba da daɗewa ba, ƙwayoyin corticosteroids mai girma zasu iya kwantar da hankulan ƙananan ƙananan don hana ƙwayar magunguna na maye gurbin hormone.
Idan gindarin ya kamu da shi, mutum zai iya ci gaba da karfin jini, rashin jin dadi, da kuma matsaloli na electrolyte irin su matakan potassium mai girma da kuma matakan sodium low a jini. Wannan gaggawa ne na gaggawa kuma yana buƙatar mutum ya yi asibiti da karɓar corticosteroids.
A ƙarshe, irin sautin farko da na ciwon ciwon sukari yana da alaka da ɗaukar wani mai hana PD-1. Wannan shine dalilin da yasa likitoci zasu duba glucose (sukari a cikin jini) lokacin farawa.
Saukar Ƙari
Wani immunotherapy zai iya jawo kumburi a cikin huhu, kuma wannan ana kiransa pneumonitis, ko da yake yana da wuya, idan aka kwatanta da abin da aka ambata a sama. Wannan mummunan sakamako shine musamman damuwa ga mutanen dake fama da ciwon ciwon huhu na ciwon huhu da ke fama da rigakafi, kamar yadda kwayar cutar ta riga ta ɓace daga ciwon daji. Zai iya haifar da bayyanar cututtuka kamar tari ko matsalolin numfashi.
Duk da yake yawanci mummunar tasiri, pneumonitis na iya zama barazanar rai. Idan ana tsammanin, likitan ka zai fitar da wasu ƙananan ciwon huhu kamar ƙwayar cuta (wanda ake kira ciwon huhu) ko cigaba da ciwon ciwon daji. Wani likita zai umurci CT scan na kirji don taimakawa wajen ganewar asali.
Jiyya yakan haɗa da dakatar da immunotherapy don wani lokacin da aka tsara lokacin da mutum ke kula da ƙwayoyin su. Corticosteroids ana sau da yawa aka ba, kuma a cikin lokuta mai tsanani, wani immunosuppressant kamar Remicade (infliximab) na iya buƙatar idan mutum bai sami mafi alhẽri tare da steroids.
A ƙarshe, wasu cututtuka masu lalacewa da suka shafi rashin lafiyar jiki sun ruwaito kamar nasu ko matsalolin ido. A cikin wannan misali, likitanku zai mayar da ku ga likita, likitan ne ko likitan magungunan likitoci , don samin asali da mahimmanci.
Kalma Daga
Idan kai ko ƙaunatacciyar suna ɗaukar magunguna, yana da kyau a san abin da ke tattare da ita, saboda suna da mahimmanci daga waɗanda ke haɗe da chemotherapies na al'ada.
A wasu kalmomi, alamun da alamun da ke tattare da waɗannan cututtuka suna da mahimmanci ga likitoci na likitanci. Duk da haka, kada ku ji tsoron su. Maimakon haka, zama ilimi da kan faɗakarwa, kamar yadda mutane da yawa zasu warware idan an gane su da sauri.
> Sources:
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> Linardou H, Gogas H. Gudanar da ciwon rigakafin rigakafi ga marasa lafiya da melanoma. Ann Transl Med . 2016 Jul; 4 (14): 272.
> Michot JM et al. Abubuwa masu ban sha'awa da suka shafi bala'in da suka shafi rikice-rikice na matsala: cikakken nazari. Eur J Cancer . 2016 Feb; 54: 139-48.
> Mista M, Wolchok J. Abubuwanda ke hade da mai sarrafawa immunotherapy. A: UpToDate, Atkins MB (Ed), UpToDate, Waltham, MA.
> Villadolid J, A. Amin. Rashin hankalin masu zanga-zangar a cikin aikin likita: sabuntawa game da gudanarwa na abubuwa masu cutar. Tsarin Cutar Canji na Transl . 2015 Oktoba; 4 (5): 560-75.