Nekuti iroukemia kupatsanura uye kufungidzira stratification kwakaomarara, hapana imwe-saizi-inokodzera-yese nzira yekurapa, uye zvinodikanwa kuti ubatanidze kungwarira kupatsanura uye kufungidzira stratification kugadzira zvirongwa zvekurapa. Parizvino, kune kunyanya anotevera marudzi ekurapa nzira: chemotherapy, radiotherapy, yakanangwa kurapa, immunotherapy, stem cell transplantation, nezvimwe.
Kubudikidza nekurapa kwakaringana, kufungidzira kweleukemia kwakagadziriswa zvakanyanya. Huwandu hwakakura hwevarwere hunogona kurapwa kana hwakareba-hwakagadzikana. Nguva yeleukemia se "chirwere chisingarapike" yadarika.
AML kurapwa (isiri-M3)
Zvinowanzo fanirwa kutanga waita musanganiswa chemotherapy, inonzi "induction chemotherapy", inowanzo shandiswa DA (3 + 7) scheme. Mushure mekunyorwa kwekurapa, kana kuregererwa kukakwanisika, kumwe kusimbisa kwakanyanya chemotherapy kana stem cell yekuisa nzira inogona kuenderera zvinoenderana nechiratidzo chekuzivisa kurongedzwa. Mushure mekusimbisa kurapwa, kurapwa kwekuchengetedza hakuwanzo kuitwa parizvino, uye mushonga unogona kumiswa kuti uongororwe uye kugara uchiteverwa.
M3 kurapwa
Nekuda kwekubudirira kwekurapa kwakanangwa uye induced apoptosis therapy, PML-RARα positive acute promyelocytic leukemia (M3) yave yakanakisa prognostic mhando muAML yese. Zvimwe uye zvimwe zvidzidzo zvakaratidza kuti yese-trans retinoic acid inosanganiswa ne arsenic kurapwa inogona kurapa vazhinji varwere vane M3. Iyo yekurapa inoda kuitiswa zvakanyatsoenderana nemaitiro ekurapa, uye kureba kwekuchengetedza kurapwa mune yakazotevera nguva inonyanya kugadziriswa nemamiriro akasara eiyo fusion gene.
Kurapa KWESE
Induction chemotherapy inowanzoitwa kutanga, uye kune misiyano muzvirongwa zvinowanzo shandiswa pakati pevakuru nevana. Nekudaro, mumakore achangopfuura, ongororo dzakaratidza kuti mhedzisiro yekushandisa marimimi evana kurapa vakuru varwere inogona kunge iri nani pane echinyakare maitiro evakuru. Mushure mekuregererwa, zvinodikanwa kuomerera pakubatanidzwa uye kurapwa kwekuchengetedza. Vakuru-vane njodzi varwere vane mamiriro ekuita stem maseru kuisirwa. Varwere vane Ph1 chromosome yakanaka inokurudzirwa kurapwa ne tyrosine kinase inhibitors.
Chisingaperi Myelogenous Leukemia Kurapa
Muchikamu chisingaperi, tyrosine kinase inhibitors (yakadai se imatinib) ndiyo inoshandiswa kurapwa. Inokurudzirwa kuvarapa nekukurumidza uye muhuwandu hwakakwana. Kunonoka kushandiswa uye kushandiswa zvisina kufanira kunogona kutungamirira nyore kune kurwisa zvinodhaka. Nokudaro, kana ukasarudza kushandisa imatinib, kutanga kwezvose, usanonoka, uye chechipiri, unofanira kuomerera pakushandiswa kwenguva refu (pedyo nehupenyu), uye usaderedza zvishoma kana kurega kuitora panguva yekuitora, kana zvisina kudaro. zvichava nyore kutungamirira kukudzivisa zvinodhaka. Chikamu chekukurumidza uye chikamu chakaoma chinowanzoda kurapa kwakanangwa (imatinib uptake kana kushandiswa kwechipiri-chizvarwa zvinodhaka). Kana zvichibvira, allogeneic transplantation kana panguva yakakodzera musanganiswa therapy inogona kugamuchirwa.
Chisingaperi lymphocyte kurapa
Varwere vekutanga asymptomatic kazhinji havadi kurapwa, uye munguva yekupedzisira, vanogona kusarudza akasiyana siyana echemotherapy sarudzo, senge Liu Keran monotherapy, fludarabine, cyclophosphamide yakasanganiswa nemerova, uye imwe chemotherapy. Bendamustine uye anti-CD52 monoclonal antibodies anoshandawo. Mumakore achangopfuura, zvakaonekwa kuti kurapa kwakanangwa kweBCR pathway inhibitors kunogona kuita zvakakosha. Varwere vane refractory mamiriro vanogona kufunga nezveallograft therapy.
Kurapa kwepakati tsinga system leukemia
Kunyangwe mhando dzeM4 uye M5 muZVESE uye AML zvinowanzo kuve zvinosanganiswa neCNSL, mamwe maacukemia akanyanya anogona zvakare kuitika. Nekuti zvinowanzo shandiswa zvinodhaka zvakaoma kupinda mukati meropa-huropi chipingamupinyi, varwere ava vanowanzoda lumbar puncture kudzivirira nekubata CNSL. Vamwe varatidziri varwere vangangoda yakazara-huropi musana tambo radiotherapy.
Kunze kweavo vashoma varwere vanogona kuwana rubatsiro kubva kune autologous kuisirwa (iyo autologous transplantation yekudzokororazve mwero wakanyanya kwazvo), ruzhinji rwevarwere veleukemia vanofanirwa kusarudza xenotransplantation yekuisa.
Muchidimbu, iyo yekutanga-mutsara wekutanga kurapwa kweleukemia haisi kuisirwa. Kunyangwe kuiswa kuchikwanisa kuwana zvirinani kurarama, matambudziko akadai sekudzokororazve mwero uye kubatanidza-kurwisa-kuitisa chirwere chinogona kukanganisa zvakanyanya hupenyu hwevarwere. Kurapa mushure mekutangazve kuchave kwakaoma. Naizvozvo, kuisazve inhanho yekupedzisira yesarudzo.
