Jiran, Chemotherapy, Monoclonal Antibodies, ko Stem Cell Transplants na CLL
Mene ne mafi kyawun magani don cutar cutar sankarar lymphocytic na kullum (CLL)?
Review of Kwanan nan Lymphocytic cutar sankarar bargo (CLL)
Idan kun saba da bayyanar cututtuka da kuma abubuwan haɗari ga CLL , kuma sunyi ta hanyar ganewar asali da kuma yin watsi da CLL kuna yiwuwa su shirya mataki na gaba. Hakika, kun ji yalwa game da magunguna daban-daban don ciwon daji.
Abin baƙin ciki, a wannan lokacin babu wata farfadowa da aka dauka a matsayin magani don cutar cutar sankarar lymphocytic na kullum (CLL). Amma ko da ba tare da magani ba, wasu mutane na iya rayuwa har shekaru da shekarun da suka kamu da cutar. A halin yanzu, ana kula da magani don samar da marasa lafiya daga alamun su, tare da fatan tabbatar da kyakkyawar rayuwa da kuma tsagaitawa mai tsawo.
Watch kuma Ku jira
Marasa lafiyar marasa lafiya da ke fama da kwayar cutar CLL, irin su bugu na dare, furuci, asarar hasara, anemia (ƙananan jinin jini,) thrombocytopenia (ƙananan platelet ƙidayar) ko cututtuka masu yawa bazai iya amfana daga magani ba. Far a wannan mataki a cikin cutar ba zai tsawanta rayuwarka ba, kuma ba zai rage jinkirin ciwon cutar sankarar bargo ba. Sabili da haka, ana amfani da tsarin "agogon tsaro" da yawa. A cikin yanayin tsaro da jirage, likitan jini ko likitan ilimin likitancinku zai bi ku kuma zai bukaci aikin jinin ku kuma gwada lafiyan ku ta kowane likitan kowane watanni shida zuwa 12.
A tsakanin ziyara, zaku bukaci kula da alamun cewa ciwon ku na iya cigaba. Kuna iya lura:
- Kusawa a cikin ƙananan lymph naka
- Raunin rashin tausayi ko zafi
- Alamomin anemia kamar kamuwa da fata da jin dadi sosai
- Kwayoyin cuta ko kuma kamuwa da cuta wanda kawai ba zai tafi ba
- Matsalar ƙuƙwalwa ko sauƙaƙewa
Mutane da yawa marasa lafiya zasu iya kasancewa a agogon ido kuma suna jira tsawon shekaru kafin a nemi magani ga CLL . Zai iya zama da wuya a fahimci cewa kana da ciwon daji, sa'an nan kuma "jira shi ya kara muni" kafin ka bi da shi. Kuna iya jin kamar kuna so ku yaki wannan cutar sankarar bargo da kuma samun shi tare da!
Duk da yake yana da wuya a yi haƙuri, yana da matukar muhimmanci ka fahimci cewa kallon da jira shi ne daidaitattun lokacin da CLL ba ya nuna alamar bayyanar. Bincike zuwa wannan batu bai nuna wani amfani ga farawa farawa ba.
Chemotherapy
Shekaru da dama, maganin kumburi tare da kuturu (chlorambucil) shine tsarin kulawa da CLL da zarar ciwon daji ya fara ci gaba. Duk da yake mafi yawan marasa lafiya sunyi kyau a kan wannan farfadowa, bai samar da cikakken bayani ba (CR) sau da yawa. Wadannan kwanaki, ana amfani da chlorambucil ne kawai a cikin marasa lafiya wadanda ke da wasu matsalolin kiwon lafiyar da suke hana su samun karuwa, sunadarai masu guba.
Kwanan nan kwanan nan, an gano Fodara (fludarabine) chemotherapy yana da mahimmanci wajen magance marasa lafiya da kuma sake komawa CLL. Ya inganta CR da ci gaba na cigaba (PFS) idan aka kwatanta da chlorambucil, amma har yanzu bai nuna wani amfani a rayuwa gaba (OS) ba lokacin da aka yi amfani da ita.
Wani magungunan miyagun ƙwayoyi daga iyali guda ɗaya, Nipent (pentostatin,) an yi amfani da su a matsayin ɓangare na tsarin CLL.
Ainihin ingantacciyar aikin CLL ya faru yayin da Cytoxan (cyclophosphamide) aka hade tare da haɗin fludarabine. Amfani da wannan tsarin ("FC" ko "Flu / Cy"), an karɓa mahimmancin magani kamar yadda CR, PFS, da OS suka nuna. Duk da yake hada wadannan kwayoyi guda biyu yana haifar da karuwa a cikin guba, ba zai haifar da mummunan cututtuka mai tsanani ba.
Monoclonal Antibodies
An cigaba da inganta cigaba a cikin tsarin CLL ta hanyar kariyar magunguna guda daya.
Magunguna na monoclonal sune kwayoyin rigakafi da suka kai hari kan ciwon daji. Kodayake kayi amfani da tsarin da ke gane sunadarai masu hasara a kan kwayar cutar ko kwayar cuta, wadannan kwayoyi "sun gane" alamu masu mahimmanci a kan ciwon daji. Bugu da ƙari na Rituxan antibody monoclonal (rituximab) zuwa tsari ("FCR" yarjejeniya) ya bawa mutane tare da CLL ajin amsawa na 90% da 96% da CR na 50% zuwa 70%.
Wani mawaki na daya, Garba (alemtuzumab) An yarda da Cibiyar Abinci da Harkokin Kiyaye na Amurka (FDA) don amfani a wajen kula da CLL. An yi niyya ne ga maɓallin antigen "cell" fiye da rituximab, kuma za a iya amfani da kanta ko a hade tare da chemotherapy.
Sanya Cell Transplant
Yayin da sauran cututtuka na jini, an gudanar da bincike mai yawa don kwatanta sakamakon lafiyar marasa lafiya da suka karbi chemotherapy, a kan suturar kwayar jini . Tun da shekarun shekaru saba'in da ake ciki na marasa lafiya CLL sun kasance a tsakanin shekarun 65 zuwa 70, yawanci tsofaffi don a yi la'akari da dan takara, wadanda ba a yi nazari akan wannan yawan ba.
Bayan sun faɗi haka, kashi 40 cikin 100 na marasa lafiya CLL suna da shekaru 60 da 12% a ƙarƙashin shekarun 50. Tsarin siginar cell zai iya ba da dama don maganin marasa lafiya CLL marasa lafiya.
Allogeneic ƙaddara kwayar halitta (dashi ta amfani da kwayoyin da ke bayarwa) yana amfani da ƙananan allurai na chemotherapy don bi da cutar sankarar bargo da kuma ba da gudummawar kwayoyin jini don sake sake tsarin tsarin rigakafin marasa lafiya. Abinda ke amfani da shi a cikin kwayar halitta mai amfani da kwayoyin halitta shine cewa yayin da zai iya zama mai guba, zai iya haifar da sakamako na "gwanin-versus-leukemia". Wato, samfurori da aka ba da kwayar halitta sun gane da kwayoyin cutar sankarar bargo kamar mahaukaci da kuma kai musu farmaki.
Kodayake wadannan fasahohin suna cigaba da karuwa sosai, har yanzu akwai wasu matsaloli masu yawa a cikin 15 zuwa 25% na marasa lafiya, wanda aka dasa shi da cutar da ke dauke da cutar wanda wanda ke bayarwa ya gane cewa kwayoyin halitta marasa lafiya sun kasance kasashen waje kuma sun kaddamar da farmaki.
Saboda cututtukan cututtuka na allogeneic na kwayar halitta, ba a nuna su don inganta sakamakon marasa lafiya ba.
A halin yanzu, bincike don tantance muhimmancin aikin wanda ba shi da mahimmanci , ko kuma "mini" canje-canje a cikin CLL yana ƙarƙashin. Magungunan da ba a cikin myeloablative sun dogara da illa ga cututtukan kwayoyin cuta da kuma ƙwayar cutar "sankarar-a-leukemia" sakamakon maganin ciwon daji. Irin wannan farfadowa na iya samar da wani zaɓi na zafin jiki don mutanen da suka fi girma waɗanda ba za su iya jure wa daidaitattun allogeneic ba.
Tsarin mai amfani na autologous wanda aka yi amfani da shi a cikin tsarin kula da CLL sun nuna sakamakon rashin talauci da kuma mummunar cutar sake dawowa da cutar, wani lokaci har ma bayan shekaru bayan dashi. Duk da yake yana iya rage yawan guba, ragowar autologous ba shi da tasiri a zalunta CLL fiye da maganin myeloablative . A sakamakon haka, ba a yi amfani dashi na autologous ba don yawan marasa lafiya CLL.
Radiation Far
A cikin marasa lafiya tare da CLL, yin amfani da maganin radiation yana iyakance ne don samar da taimako na alama. Ana iya amfani dashi don biyan wuraren yankakken lymph wanda ke haifar da rashin jin daɗi ko tsoma baki tare da motsi ko aiki na gabobin da ke kusa.
Splenectomy
Ga marasa lafiya da ke fuskantar kararrawa da yawa saboda sakamakon ƙwayoyin CLL, splenectomy , ko kuma cirewa na yarinya, na iya taimakawa wajen taimakawa wajen inganta yawan jini da kuma taimakawa wasu rashin jin daɗi. Kamar yadda ake amfani da maganin radiation, ana amfani da splenectomy don taimakawa wajen sarrafa bayyanar cututtukan cututtuka kuma baya bada magani ga cutar sankarar bargo.
Girma shi Up
A wannan lokacin, yayin da magani na CLL zai iya samar da marasa lafiya da alamar cutar da cutar ta cutar sankarar bargo, ba zai iya samar da magani ba, kuma irin wannan cututtukan ya bambanta tsakanin mutane daban-daban. Duk da haka, fahimtarmu game da irin wannan cutar sankarar bargo yana ci gaba. Yin amfani, alal misali, na sassan cell transplants ga mutanen da ke CLL sun inganta sosai a lokacin tsakanin shekara ta 2006 zuwa 2016. Nazarin bincike zai ci gaba da cigaba da yiwuwar samar da hanyoyin magance cutar da tsawon lokaci ko maganin CLL.
Sources
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