Isifo i-myelo Natural leukemia (CML)

Yini i-myelogenous leukemia engapheli (CML)?

I-Chronic myelogenous leukemia (CML) iwuhlobo olungavamile lomdlavuza womnkantsha othinta izicubu eziyisipontshi ngaphakathi emathanjeni akhiqiza amangqamuzana egazi. Inani lamaseli amhlophe egazi liyakhula ngenxa ye-CML.

Igama elithi "chronic" libhekisela eqinisweni lokuthi i-myelogenous leukemia engapheli iqhubeka kancane kunezinhlobo ezinzima ze-leukemia. Ku-myelogenous leukemia engapheli, igama elithi “myelogenous” (my-uh-LOHJ-uh-nus) libhekisela ohlotsheni lwamaseli aphethwe umdlavuza.

I-Chronic myeloid leukemia kanye ne-chronic granulocytic leukemia ngamanye amagama e-myelogenous leukemia engapheli. Ihlasela kakhulu abantu abadala futhi ayivamisile ukuthi ithinte intsha, kuyilapho ingahlasela noma ubani kunoma iyiphi iminyaka yobudala.

Abantu abane-myelogenous leukemia engapheli manje sebenokubikezelwa okungcono kakhulu ngenxa yentuthuko yokwelashwa. Ngemuva kokuxilongwa, iningi labantu lizongena ekuxolelweni futhi liphile iminyaka eminingi.

Yini i-CML?

I-Chronic myelogenous leukemia (eyaziwa nangokuthi i-CML noma i-chronic granulocytic leukemia) isifo segazi nomnkantsha esikhula kancane esihlasela kakhulu abantu abaneminyaka engamashumi amane noma amahlanu, kanti izingane zihlukile.

1. I-Chronic myelogenous leukemia yisimo lapho umnkantsha ukhiqiza inani elikhulu ngokungavamile lamaseli amhlophe egazi.
2. Amangqamuzana abomvu egazi, amangqamuzana amhlophe egazi, namaplatelet konke kungathinteka yi-leukemia.
3. Ukuncipha kwesisindo kanye nokukhathala kuyizimpawu ezimbili ze-myelogenous leukemia engapheli.
4. Ukuguqulwa kwe-chromosomal ye-Philadelphia (ushintsho) kutholakala kuningi leziguli ze-CML.
5. Ukuxilongwa kwe-myelogenous leukemia engapheli kwenziwa kusetshenziswa ukuhlolwa kwegazi nomnkantsha.
6. I-prognosis (amathuba okululama) kanye nezinketho zokwelashwa kuthonywa izici eziningi.

Izimpawu ze-CML

Izimpawu nezinkomba ze-myelogenous leukemia engapheli azihlali zikhona. Kungenzeka ukuthi izotholwa ngokuhlolwa kwegazi.

Uma kwenzeka, izimpawu ezilandelayo zingase zivele:

1. Ubuhlungu bethambo
2. Kulula ukopha
3. Ngemva kokudla ukudla okuncane, uzizwa wanelisekile.
4. Fever
5. Ukunciphisa umzimba ngaphandle komzamo
6. Ukulahleka kwesifiso.

Izinkinga ze-CML

Uma kukhona okungahambi kahle ezakhini zofuzo zamangqamuzana omnkantsha wakho, i-myelogenous leukemia engapheli iqala. Akukacaci ukuthi yini ebangela le nqubo, kodwa odokotela baye bathola ukuthi iholela kanjani ku-myelogenous leukemia engapheli.

Ichromosome engavamile

Amaseli omuntu anamapheya angu-23 ama-chromosome ngokuzenzakalela. Lawa ma-chromosome ane-DNA, ehlanganisa imiyalelo (izakhi zofuzo) ezilawula amangqamuzana omzimba wakho. Ama-chromosome emangqamuzaneni egazi ashintshana izingxenye ezithile kubantu abane-myelogenous leukemia engapheli. I-chromosome 22 emfushane kakhulu kanye ne-chromosome 9 ende kakhulu kwakheka lapho ingxenye ye-chromosome 9 ishintshanisa izindawo ngesigaba se-chromosome 22.

I-chromosome yase-Philadelphia, eyi-chromosome 22 emfushane, iqanjwe ngegama ledolobha lapho yatholwa khona. U-90% wabantu abane-myelogenous leukemia engapheli banechromosome ye-Philadelphia emangqamuzaneni abo egazi.

Ufuzo olusha ludalwa yi-chromosome yase-Philadelphia. Isakhi sofuzo esisha esibizwa nge-BCR-ABL sakhiwa lapho ufuzo olusuka ku-chromosome 9 luhlangana nofuzo olusuka ku-chromosome 22. Ufuzo lwe-BCR-ABL luhlanganisa imiyalelo etshela ingqamuzana legazi eliphikisayo ukuthi lenze amaprotheni amaningi kakhulu e-tyrosine kinase. I-Tyrosine kinase ikhuthaza umdlavuza ngokuvumela ukukhula okungalawuleki kwegazi elithile amaseli.

Umnkantsha, into eyisiponji ngaphakathi emathanjeni akho, yilapho amangqamuzana akho egazi eqala khona. Umnkantsha wakho udala amaseli angakavuthwa (i-blood stem cells) ngendlela elawulwayo uma usebenza ngokujwayelekile. Lawa mangqamuzana abe esevuthwa futhi abe ngokukhethekile kumangqamuzana egazi abomvu, amhlophe, nama-platelet azungeza wonke umzimba wakho.

Le nqubo iphazamiseka ku-myelogenous leukemia engapheli. Ufuzo lwe-BCR-ABL ludala i-tyrosine kinase evumela amaseli amaningi amhlophe egazi ukuthi athuthuke. I-chromosome yase-Philadelphia ayifani kwabaningi noma kuwo wonke lawa maseli. Amangqamuzana amhlophe egazi avamile ayakhula futhi afe, kuyilapho amangqamuzana amhlophe egazi agulayo awabi. Amangqamuzana amhlophe egazi anesifo aphindaphindeka ngokushesha, akhiphe amangqamuzana egazi anempilo futhi abangele ukulimala komnkantsha.

Ukuxilongwa kwe-CML

Ukuhlolwa namasu alandelayo asetshenziselwa ukuxilonga i-myelogenous leukemia engapheli:

Ukuhlolwa ngokomzimba: Udokotela wakho uzokuhlola futhi athathe izimpawu zakho ezibalulekile, okuhlanganisa ukushaya kwenhliziyo yakho nomfutho wegazi. Uzophinde ahlole ama-lymph nodes, i-spleen, nesisu ukuze abone ukuthi akhulisiwe yini.

Ukuhlolwa kwegazi: Isibalo segazi esiphelele singase sibone ukungahambi kahle kumaseli akho egazi, njengenani eliphezulu ngokungavamile lamaseli amhlophe egazi. Ukuhlolwa kwamakhemikhali egazi okusetshenziselwa ukuhlola ukusebenza kwesitho kungase kwembule okungaqondakali okungasiza udokotela wakho ekwenzeni ukuxilongwa.

Ukuhlolwa komnkantsha: Amasampula omnkantsha aqoqwa ukuze ahlolwe elabhorethri kusetshenziswa i-bone marrow biopsy kanye ne-bone marrow aspiration. Umnkantsha wemvubu yakho uqoqwa kulezi zivivinyo.

Bheka i-chromosome yasePhiladelphia ngalezi zivivinyo. Amasampula egazi noma womnkantsha ahlaziywa ukuze athole ukuba khona kwe-chromosome yase-Philadelphia noma ufuzo lwe-BCR-ABL kusetshenziswa izivivinyo ezikhethekile ezifana nokuhlaziywa kwe-fluorescence in situ hybridization (FISH) kanye nokuhlolwa kwe-polymerase chain reaction (PCR).

Ukwelashwa kwe-CML

• Kunezinhlobo ezahlukene zokwelashwa kweziguli ezine-myelogenous leukemia engapheli.
• Izinhlobo eziyisithupha zokwelashwa okujwayelekile zisetshenzisiwe:
  • Ukwelapha okuhlosiwe
  • Ukwelashwa ngamakhemikhali
  • immunotherapy
  • I-chemotherapy ephezulu ene-stem cell transplant
  • I-Donor lymphocyte infusion (DLI)
  • Ukuhlinzwa
• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Imithi yokwelashwa ehlosiwe

Imithi ehlosiwe iqondise ingxenye ethile yamangqamuzana omdlavuza ewabangela ukuba achume futhi ande ukuze alwe nesifo. Iphrotheni ekhiqizwa isakhi sofuzo se-BCR-ABL, i-tyrosine kinase, iyimpoqo yale mithi ku-myelogenous leukemia engapheli.

Izidakamizwa ezihlosiwe ezivimba isenzo se-tyrosine kinase zifaka:

• I-Imatinib (Gleevec)
• I-Dasatinib (Sprycel)
• I-Nilotinib (Tasigna)
• I-Bosutinib (Bosulif)
• I-Ponatinib (Iclusig)

Kulabo abane-myelogenous leukemia engapheli, imithi eqondiwe iwumugqa wokuqala wokwelapha. Ukuvuvukala noma ukukhukhumala kwesikhumba, isicanucanu, amajaqamba emisipha, ukukhathala, isifo sohudo, nokuqubuka kwesikhumba kuphakathi kwemiphumela engemihle yale mithi ehlosiwe.

Impumelelo yokwelashwa kwemithi ehlosiwe igadwa kusetshenziswa ukuhlolwa kwegazi okuthola ukuba khona kofuzo lwe-BCR-ABL. Odokotela bangase baphenye eminye imithi ehlosiwe, njenge-omacetaxine (Synribo), noma ezinye izindlela zokwelapha uma isifo singaphenduli noma sikhula simelana nokwelashwa okuhlosiwe.

Odokotela kusamele banqume ukuthi kuphephile yini ukuyeka imithi eqondiswe kubantu abane-myelogenous leukemia engapheli. Ngenxa yalokho, ngisho nalapho ukuhlolwa kwegazi kubonisa ukuthi isifo sesiphelile, abantu abaningi bayaqhubeka bethatha imithi ehlosiwe. Ngemva kokulinganisa izinzuzo nezingozi, wena nodokotela wakho ningase ninqume ukuyeka ukwelashwa ngemithi eqondiwe ezimweni ezithile.

Ukufakelwa komnkantsha wethambo

Ukufakelwa komnkantsha, okwaziwa nangokuthi i-stem cell transplant, ukuphela kwendlela yokwelapha i-myelogenous leukemia engapheli unomphela. Kodwa-ke, ngenxa yokuthi ukufakelwa komnkantsha kuyingozi futhi kunamathuba amaningi okuba nemiphumela ephawulekayo, ngokuvamile kugcinelwe labo abangakaphenduli kwezinye izindlela zokwelapha.

Imithamo ephezulu yemithi ye-chemotherapy isetshenziselwa ukubulala amangqamuzana akha igazi emnkantsheni wakho wethambo ngemva kokufakelwa komnkantsha. Ngemva kwalokho, amaseli egazi omnikeli ampontshelwa egazini lakho. Ukuze athathe indawo yamangqamuzana agulayo, amangqamuzana amasha akhiqiza amangqamuzana egazi amasha, anempilo.

Ukwelashwa ngamakhemikhali

I-Chemotherapy imithi yokwelapha i-leukemia ebulala amangqamuzana akhula ngokushesha emzimbeni. Ukwelapha i-myelogenous leukemia eyingozi engapheli, imithi ye-chemotherapy ngezinye izikhathi ihlanganiswa nokwelashwa kwemithi okuhlosiwe. Imithi yokwelapha ngamakhemikhali inemiphumela engemihle ehlukene kuye ngokuthi uthatha yiphi.

Izivivinyo zemitholampilo

Izivivinyo zemitholampilo zibheka izindlela zokwelapha ezisemuva kakhulu zezifo kanye nezindlela ezintsha zokusebenzisa ezindala. Ukubhalisa ocwaningweni lomtholampilo lwe-myelogenous leukemia engapheli kungase kukunikeze ithuba lokuzama ukwelashwa okuphambili, kodwa akuqinisekisi ukwelashwa. Thola ukuthi yiziphi izivivinyo zomtholampilo ezitholakalayo kuwe ngokukhuluma nodokotela wakho. Ningakwazi ukuhlola okuhle nokubi kokuhlolwa komtholampilo ndawonye.