Myelodysplastic ciwo, ko MDS, ya haɗa da nau'in cuta daban-daban da ke shafar ƙwayar mai. Sakamakon yaro ya sa sabon jini jini, sel fata da platelets don yin katsewa, saboda haka mummunan aikin hauka zai iya haifar da anemia, ƙididdigar ƙananan ƙwayoyin cuta, da sauran matsalolin.
Babban mahimmanci tare da MDS sune) waɗannan ƙananan ƙidaya da dukan matsalolin da suka shafi; da kuma b) yiwuwar MDS ta ci gaba da ciwon ciwon daji - muraye sankarar myeloid m , ko AML.
Dabbobin MDS daban-daban suna bi da su sosai. Ba duk magungunan MDS ba ne mai dacewa ga kowane mai haƙuri tare da MDS. Zaɓuɓɓuka na MDS sun hada da kulawa da goyan baya, farfadowa mai tsanani, tsauraran ƙararrawa, da / ko gwaji na asibiti.
Ra'ayin Nazarin
Lokacin da kake tattaunawa da shirin likita na MDS da likitanku, abubuwan da ake kira masu haƙuri suna iya zama mahimmanci. Misalan abubuwan da suka shafi haƙuri sun haɗa da wadannan:
- Yadda kuka kasance tare da ayyukan yau da kullum kafin nazarin MDS
- Wasu yanayin kiwon lafiya da kuke da shi
- Yawan ku
- Kudin kudi na daban-daban jiyya
- Wanne kasada na magani da kake yarda
Halaye na nau'i nau'i na MDS mahimmanci ne. Misalan ƙayyadaddun halaye da bincike sun haɗa da wadannan:
- Alamar da kuma sakamakon gwajin kwayoyin jikin ku, wanda zai taimaka wajen gano ƙayyadaddun da kuke samuwa, yana yiwuwa MDS zai cigaba da cutar sankarar bargo , da kuma abin da za'a iya tsammanin sakamakon wasu cututtuka.
- Yadda MDS naka ke tasiri akan yawan kwayoyin lafiya a cikin jininku
- Yaya mummunan cututtukanka ya kasance dangane da yawan tsaran "blast" a jikinka
Manufofinku don abin da kuke so ku fita daga magungunan ma yana cikin cikin shirin. Misalan daban-daban dabarun maganin sun haɗa da wadannan:
- Kawai don jin dadi
- Yi iyakancewa da buƙatar ku da yawa daga jini
- Inganta anemia , neutropenia , da thrombocytopenia
- Samu gafara
- Cure MDS naka
Watch kuma Ku jira
Ga marasa lafiya wadanda ke da MDS mai ƙananan ƙaddara kamar yadda Ƙungiyar Kulawa ta Ƙasashen Duniya, ko IPSS, ta ƙaddara, da kuma ƙaddamar da ƙimar jini (CBC) , wani lokacin mahimmancin maganin kulawa ne da kulawa, kamar yadda ake bukata.
A wannan yanayin, za a buƙaci a kula da ku don canje-canje a gadonku wanda zai iya nuna ci gaba da cutar. CBC na yau da kullum, kazalika da yunkurin ɓaɓɓuka mai yaduwar nama da kuma biopsy , zai iya zama ɓangare na saka idanu.
Taimakon tallafi
Taimakon tallafi yana nufin hanyoyin kwantar da hankulan da ake amfani dashi don kulawa da sarrafa MDS; wadannan jiyya na iya inganta lafiyar mutum, amma sun dakatar da haɗari da kwayoyin halittar MDS.
Harkokin jini
Idan jinin ku ya fara fada kuma kun fuskanci bayyanar cututtuka, zaku iya amfana daga sassauran jini ko jini. Ƙaƙarin shawarar samun fassarar zai dogara ne akan wasu hanyoyin kiwon lafiya da kuke da kuma yadda kuka ji.
Iron Overload da Chelation Far
Idan ka fara buƙatar ƙwayar jini sau ɗaya a kowane wata, ƙila ka kasance cikin haɗari don tasowa yanayin da ake kira baƙin ƙarfe.
Matakan ƙarfe na baƙin ƙarfe a cikin jini na jini zai iya haifar da karuwa a cikin shaguna a cikin jikin ku. Irin wannan matakan ƙarfe zai iya lalata kwayoyin ku.
Doctors na iya magance magungunan ƙarfe daga magunguna masu amfani da magungunan da ake kira iron chelators, wanda ya hada da maganin maganin, ko kashi, ko wani jiko da ake kira infraxamine mesylate (Desferal). Gudanar da jagorancin Ƙungiyar Ciwon Kankara ta Kasa ta Kasa, ko NCCN, ta ba da shawarar da likita zai iya yi don yanke shawara idan kana buƙatar gyaran maganin baƙin ƙarfe.
Dalili na Karuwar Wasu mutane da MDS anemia zasu iya amfana daga samun karuwar maganin magungunan da ake kira 'erythropoietin' stimulation agents ko proteins (ESAs).
Misalai na ESA sun hada da epoetin alfa (Eprex, Procrit or Epogen) ko tsawon aikin darbepoetin alfa (Aranesp). Wadannan magunguna an ba su a matsayin allura a cikin abin da ke ciki (magungunan subcutaneous). Duk da yake waɗannan kwayoyi ba su da amfani ga dukkan marasa lafiya MDS, zasu iya taimakawa wajen hana yaduwar jini a wasu.
Kwararka na iya bayar da shi don farawa a cikin wani abu mai mahimmanci , irin su G-CSF (Neupogen), ko GM-CSF (leukine) , idan yawan ƙwayar jinin ku ya zama ƙasa saboda sakamakon MDS. Ayyukan dindindin-dindindin suna taimakawa wajen ƙarfafa jikinka don samar da karin rashin lafiya suna fada da jini mai tsabta wanda ake kira neutrophils. Idan matakan neutrophil suna da ƙasa, kun kasance mafi girma da hadarin ƙaddamar da kamuwa da cuta mai hatsari. Kula da duk wani alamun kamuwa da cuta ko zazzabi, kuma ga likitaccen likita a cikin gaggawa idan ka damu.
Low-Intensity Far
Tsarancin ƙananan ƙananan yana nufin yin amfani da ƙananan ƙwayar cutar kumburi ko jamiái da aka sani da mahimmancin amsawar halitta. Wadannan jiyya sunfi dacewa da su a cikin saitunan, amma wasu daga cikinsu na iya buƙatar kulawa da goyan baya ko kuma wasu lokuta daga asibiti, don yin la'akari da kamuwa da cutar.
Epigenetic Far
Ƙungiyar magungunan da ake kira hypomethylating ko demethylating agents su ne makamai mafi girma a cikin yaki da MDS.
Azacitidine (Vidaza) ya yarda da FDA don amfani a duk fannonin Faransanci-Amurka-Birtaniya (FAB) da dukkan nau'ikan MDSS. Ana ba da wannan magani ne a matsayin injection subcutaneous na kwana bakwai a jere, kowane kwana 28 don akalla 4-6 hawan. Sakamakon binciken azacitidine sun nuna kashi 60 cikin 100 na amsawa, tare da kimanin kashi 23 cikin dari na samun gafara ko cikakkiyar sukar cutar. Azacitidine sau da yawa yakan haifar da wani digo na farko a cikin ƙididdigar jini wanda ba zai sake dawowa ba sai bayan na farko ko biyu hawan.
Wani nau'i na wakili na hypomethylating wanda aka yi amfani dashi don MDS shine decitabine (Dacogen). Sakamakon kama da azacitidine, an yarda da FDA ga kowane MDS. An yi amfani da tsarin tsarin kulawa tare da cututtuka masu ƙananan ƙarfi, saboda haka an dauke shi azaman ƙananan farfadowa. Za a iya ba da yanke shawara a cikin intravenously ko subcutaneously. Ɗaya daga cikin binciken da aka ba da ladabi a cikin kwanaki biyar ya nuna kusan kashi 40 cikin dari. Ana gudanar da bincike a madadin tsarin tsarin dosing.
Immunosuppressive Far da kuma Biologic Response Masu gyara
A MDS, an kashe kwayoyin jinin jini, da jini mai launin jini da kuma platelets da suka mutu kafin su isa girma don a sake su daga kasusuwa a cikin jini. A wasu lokuta, lymphocytes (nau'in jini na jini) suna da alhakin wannan. Ga marasa lafiya, yana iya zama tasiri don amfani da farfadowa da ke tasiri ga tsarin rigakafi.
Ƙungiyar cututtukan kwayoyin halitta, masu ƙananan ƙarfin hali (maganganu masu mahimmanci na halitta) sun hada da anti-thymocyte globulin (ATG), cyclosporine, thalidomide, lenalidomide, furotin necrosis factor furotin protein, da analogues na bitamin D. Dukkan wadannan sun nuna akalla wasu a farkon gwajin, amma mutane da yawa suna bukatar karin gwaje-gwajen gwaji don fahimtar tasiri a cikin nau'ikan MDS.
Mutanen da ke da irin wannan MDS da aka kira ciwon 5q-ciwon, wanda akwai cututtukan kwayoyin cuta a cikin chromosome 5, na iya samun amsa ga miyagun ƙwayoyi da ake kira lenalidomide (Revlimid). Yawancin lokaci, ana amfani da lanalidomide a marasa lafiya tare da matsanancin matsanancin rashin lafiya na IPSS MDS wadanda suke da alaka da jinin jini. A cikin nazarin lenalidomide, mutane da yawa marasa lafiya sun rage bukatun transfusion - kimanin kashi 70 cikin dari, a gaskiya - amma ci gaba da samun ƙananan platelet da neutrophil ƙidaya. Amfanin amfani da MDS mafi girma, ko subtypes fiye da 5q-ciwo tare da lenalidomide har yanzu suna binciken.
Babban Harkokin Intensity
Chemotherapy
Wasu marasa lafiya da suka fi girma MDS, ko kuma FAB iri-iri RAEB da RAEB-T, za a iya bi da su tare da ƙwayar cutar kima. Wannan chemotherapy, irin wannan da ake amfani dashi wajen kula da cutar cutar sankarar mielogenous (AML), yana nufin halakar da yawancin kwayoyin mahaukaci a cikin kasusuwan da ke jagorantar MDS.
Duk da yake maganin ƙwayar cuta zai iya zama da amfani a wasu likitocin MDS, yana da muhimmanci a yi la'akari da cewa marasa lafiya marasa lafiya da wasu yanayin kiwon lafiya sun fuskanci ƙari. Abubuwan da za su iya amfani da ita dole ne su fi ƙarfin hadarin.
Bincike yana gudana don kwatanta sakamakon sakamakon cutar kyamara a kan wadanda ke da azacitidine ko decitabine.
Sanya Cell Transplant
Marasa lafiya tare da babban halayen IPSS MDS zai iya samun nasarar maganin cutar su tare da maganin allogeneic na sashi . Abin takaici, yanayin haɗari na wannan hanya yana ƙin amfani da ita. A gaskiya, allogeneic stem cell transplant zai iya samun magani na mutuwa mutuwar kudi har zuwa 30%. Saboda haka, wannan farfadowa ana amfani da ita ne kawai a cikin marasa lafiya marasa lafiya da suke lafiya.
Nazarin na yau da kullum suna nazarin muhimmancin wadanda ba su da myeloablative da ake kira "mini" transplants a cikin marasa lafiya marasa lafiya tare da MDS. Duk da yake waɗannan nau'in tsire-tsire sun yi la'akari da su kamar yadda ba su da tasiri fiye da yadda aka tsara dashi, yawan abin da ake ragewa a cikin su zai iya zama wani zaɓi ga marasa lafiya waɗanda ba za su cancanci ba.
Takaitaccen:
Saboda daban-daban na MDS da iri daban-daban masu haƙuri, babu magani daya-size-all-treatment. Saboda haka yana da mahimmanci ga marasa lafiya na MDS don tattauna duk zaɓuɓɓuka tare da ƙungiyar kiwon lafiya, kuma su sami farfadowa wanda zai samar musu da mafi kyawun amfani tare da ƙananan yawan guba.
Gwaje-gwajen gwaje-gwaje tare da sababbin hanyoyin kwantar da hankali don MDS sunyi aiki, don haka dakatar da sauraro. Alal misali, an bincika Ruxolitinib (Jakafi) don maganin marasa lafiya da rashin lafiya mai tsaka-tsaka-1 ko MDS.
Sources:
Greenberg PL, Attar E, Bennett JM, et al. Hanyoyin Myelodysplastic: Ka'idojin Nazarin Harkokin Kasuwanci a Oncology. JNCCN. 2013; 11 (7): 838-874.
Kantarjian H, O'Brien S, Giles F, et al. Decitabine low-dose jadawalin (100 MG / m2 / Course) a cikin myelodysplastic ciwo (MDS). Daidaita 3 jerin jimla daban daban. Jinin jini. 2005; 106 m. Asbtract 2522.
Malcovati L, Hellström-Lindberg E, Bowen D, et al. Sanin asali da jiyya na ƙwayoyin cuta na myelodysplastic na farko a cikin manya: shawarwari daga Ciwon cutar sankarar na Turai. Jinin jini . 2013; 122 (17): 2943-2964.
Nimer, S. "Myelodysplastic Syndromes" Blood May 2008. 111: 4841- 4851.
Scott, B., Deeg, J. "Myelodysplastic Syndromes" Binciken Nazarin Zaman Lafiya na shekara 2010. 61: 345-358.