Review na Tsarin Cell Transplantation ga Myelofibrosis na Farko
Zaɓin samun magani mafi kyau ga myelofibrosis na farko zai iya zama ƙalubale. Sau da yawa babu wani zabi mai kyau. Akwai jiyya da yawa don myelofibrosis na farko, amma kawai sabbin kwayoyin sifofin hematopoietic (wanda aka kiransa a matsayin kututtukan karfin jini) shine curative.
Me Ya Sa Ba Kowane Ɗaya Ya Sami Dashi?
Kyakkyawar magani yana da ban mamaki, saboda haka zaka iya mamaki dalilin da yasa kowa da kowa na farko da aka fi sani da myelofibrosis ba zai karbi dashi ba.
Hakanan game da ma'auni na hadarin da kuma amfani.
Yin jiyya a cikin myelofibrosis na farko ana fitar da shi ta hanyar hadarin da ya danganci alamu da alamun da ke fuskantar. Idan ba ku da alamun bayyanar cututtuka ko kuna da alamun cututtuka tare da cutar mai ƙananan haɗari, rayuwa mai mahimmanci bayan ganewar asali shine shekaru 15.4. A wannan yanayin, matsalolin rikitarwa (ƙwayar cuta ko cuta mai kama da rashin lafiya da kuma mutuwa) da ke hade da dashi ya fi ƙarfin magani. Nazarin ya nuna cewa rayuwar shekaru biyar a cikin mutanen da ke da ƙananan haɗari ko tsaka-tsaki-1-hadarin cututtuka sun kasance ƙananan idan sun yi nasara da tsire-tsire mai satar kwayoyin hematopoietic. Duk da haka, a cikin tsaka-tsaka-2 da kuma mummunar haɗarin cutar, tsawon shekaru biyar aka inganta a cikin mutanen da suka karbi dashi idan aka kwatanta da wadanda basu yi hakan ba.
Idan kana da myelofibrosis mai tsaka-tsaka-tsaka-tsaka-2 ko haɗari mai zurfi, ƙwayar sakon kwayoyin hematopoietic (HSCT) shine maganin da aka fi so. Domin tsofaffi yana kara yawan haɗarin rikice-rikice masu rikitarwa (yawanci sakandare zuwa satar da cuta tare da cuta ), HSCT ya tanadar tarihi ga mutanen da ke da myelofibrosis na farko a cikin shekaru 60.
Tun da shekarun shekaru masu yawa na myelofibrosis a ganewar asali su ne 67, wannan mahimmanci yana ƙayyade adadin mutanen da ke da myelofibrosis na farko waɗanda zasu kasance masu takara don wannan farfadowa. Bugu da ƙari, mai ba da gudummawa don HSCT yana da matsala. Yarinyar (mahaifi da uba a matsayin mai karɓa) yana da ɗaya a cikin hutu huɗu na kasancewa wasa, ƙara ƙayyade adadin mutanen da zasu iya shawo kan wannan farfadowa.
Bayanin ƙaddamarwa na Post-Transplant
A halin yanzu, kashi 40 zuwa 60 cikin mutanen da ke da myelofibrosis na farko waɗanda suke shan dashi suna rayuwa tsawon akalla uku zuwa hudu. Akwai wasu shaidun da za su nuna cewa yin jigilar cututtuka (cire cirewa) kafin haɓakawa yana haɗuwa da ingantaccen rayuwar rayuwa musamman a cikin maza, amma dalilin dashi ba a fahimta ba. Bugu da ƙari, mutanen da suka bunkasa myelofibrosis bayan nauyin polycythemia ko mahimmancin thrombocythemia sun kasance suna da wata rayuwa mafi rayuwa bayan da aka dasa su fiye da mutane da filayen myelofibrosis.
Wanene ba ya cancanci?
Wasu mutanen da ke fama da mummunan haɗari ba su da 'yan takarar HSCT. Wannan shi ne ainihin ƙaddara ta hanyar yiwuwar rayuwa bayan HSCT.
Abubuwa kamar ƙwararruɗa masu yawa (fiye da takwas inci a karkashin haƙar riba) da kuma fiye da 20 karfin jini kafin a sashi (musamman idan kana da duka biyu) an hade da rage tsawon shekaru biyar bayan an dasa su.
Mene ne idan ba a cancanci ba?
Don haka menene aka bada shawara idan kana da myelofibrosis na babban haɗari amma ba ka cancanci HSCT ko ba ka da mai ba da taimako? Idan kana da alamun bayyanar cututtuka irin su ciwo mai raɗaɗi na ƙwaƙwalwa, gajiya, ciwo mai zafi, suturar rana, da dai sauransu, ruxolitinib zai zama wata hanya mai kyau.
An nuna Ruxolitinib don rage yawan bayyanar cututtuka, rage girman ƙwayar ƙanƙara, da kuma inganta anemia a cikin mutanen da ke da myelofibrosis na farko. Wani madadin HSCT zai iya zama shiga cikin gwaji. Wannan zai ba ku damar yin amfani da magunguna da ake nazarin su a matsayin magungunan myelofibosis na farko.
Ba abu mai sauƙin koyo cewa ba cancanci samun magani ba, amma ka tuna don gano dukkanin zaɓinka.
Future na Transplants a matsayin magani
Tare da ingantawa a cikin jiyya game da dasawa, kamar tsarin da ake amfani dashi don karɓar rawanin kasusuwan kafin dasawa da kuma magunguna da ake amfani da su don hana gwaninta da cuta mai kulawa, ana aiwatar da karin sifofi a cikin mutane fiye da shekaru 60 tare da masu bada taimako (dangi ba daidai daidai ko dace da masu ba da taimako ba tare da dangantaka ba).
Wasu cibiyoyin zasu sassauta mutane tare da myelofibrosis har zuwa shekara 75.
Da fatan, tare da cigaban ci gaba, HSCT zai samuwa ga mutane da yawa tare da myelofibrosis. Saboda myelofibrosis na farko shine yanayin da yake da wuya, zai ɗauki shekaru kafin mu fahimci muhimmancin masu ba da taimako ga HSCT saboda wannan cuta.
Sources:
Ballen K. Ta yaya za a gudanar da tambayar dashi a cikin myelofibrosis. Ciwon Kankara ta Blood. 2012; 2: e59.
Tefferi A. Gudanarwa na myelofibrosis na farko. A: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Samun shiga ranar 29 ga Yuni, 2016.)