I-lymphoma kaHodgkin

Iyini i-Hodgkin's lymphoma?

I-lymphoma kaHodgkin, ngokuvamile eyaziwa ngokuthi isifo sikaHodgkin, umdlavuza wesimiso somzimba sokuzivikela ezifweni othinta isimiso se-lymphatic. Kungathinta abantu banoma iyiphi iminyaka, nakuba kuvame kakhulu kubantu abaneminyaka engu-20 kuya ku-40 kanye nalabo abaneminyaka engu-55 kuya phezulu.

Amaseli ohlelweni lwe-lymphatic akhula ngendlela engafanele ku-Hodgkin's lymphoma futhi angasabalala ngaphandle kwayo.

One of the two most frequent kinds of lymphatic cancer is Hodgkin’s i-lymphoma. Non-lymphoma, Hodgkin’s on the other hand, is significantly more prevalent.

Intuthuko ekuxilongweni kwe-Hodgkin's lymphoma kanye nokwelashwa kunikeze abantu abanalesi sifo ithuba elingcono lokululama ngokugcwele. Ukubikezelwa kwabantu abane-Hodgkin's lymphoma kuyathuthuka.

I-Lymphomas iwumdlavuza oqala kumangqamuzana amhlophe egazi abizwa ngokuthi ama-lymphocyte. Kunezinhlobo ezimbili eziyinhloko ze-lymphoma:

• IHodgkin lymphoma (HL)
• I-non-Hodgkin lymphoma (NHL)

Ziziphatha, zisakazeke, futhi zisabele ekwelashweni ngendlela ehlukile, ngakho kubalulekile ukuthi wazi ukuthi iyiphi onayo.

Izinhlobo ze-Hodgkin's lymphoma

Izinhlobo ezahlukene ze-Hodgkin lymphoma zingakhula futhi zisakazeke ngendlela ehlukile futhi zingaphathwa ngendlela ehlukile. 

I-Classic Hodgkin lymphoma

I-Classic Hodgkin lymphoma (cHL) ibala izehlakalo ezingaphezu kweziyisi-9 kweziyi-10 ze-Hodgkin lymphoma emazweni athuthukile.

Amaseli omdlavuza ku-cHL abizwa ngokuthi amaReed-Sternberg cells. Lawa maseli ngokuvamile awuhlobo olungavamile lwe-B lymphocyte. Ama-lymph nodes akhulisiwe kubantu abane-cHL ngokuvamile anenani elincane lamaseli e-Reed-Sternberg anamaseli amaningi omzimba avamile azungezile. Lawa amanye amaseli omzimba abangela ukuvuvukala kwama-lymph nodes.

I-HL yakudala inezinhlobo ezi-4 ezingaphansi:

• I-Nodular sclerosis IHodgkin lymphoma or I-NSCHL: Lolu wuhlobo olujwayeleke kakhulu lwesifo iHodgkin emazweni athuthukile. Ibala cishe amacala ayi-7 kwangu-10. Kuvame kakhulu entsheni nakubantu abadala, kodwa kungenzeka kubantu banoma iyiphi iminyaka. Ijwayele ukuqala kuma-lymph nodes entanyeni noma esifubeni.
• I-lymphoma ehlanganisiwe ye-Hodgkin lymphoma or I-MCCHL: Lolu uhlobo lwesibili oluvame kakhulu, olutholakala cishe ezimweni ezi-4 kweziyi-10. Kubonakala kakhulu kubantu abane-HIV. Itholakala nasezinganeni noma kubantu abadala . Ingaqala kunoma iyiphi i-lymph node kodwa ngokuvamile ivela engxenyeni engenhla yomzimba.
• I-Hodgkin lymphoma ecebile ngama-lymphocyte: Lolu hlobo oluncane aluvamile. Ngokuvamile kwenzeka engxenyeni engenhla yomzimba futhi ayivamile ukutholakala kuma-lymph nodes ambalwa.
• I-Hodgkin lymphoma egcwele i-lymphocyte: Lolu uhlobo olungavamile lwesifo se-Hodgkin. Kubonakala ikakhulukazi kubantu abadala kanye nalabo abane-HIV. Inolaka kakhulu kunezinye izinhlobo ze-HL futhi ingase ithuthuke lapho itholwa okokuqala. Kuvame kakhulu kuma-lymph nodes esiswini (esiswini) kanye nase-spleen, isibindi, nomnkantsha wamathambo.

I-Nodular lymphocyte-predominant Hodgkin lymphoma

I-Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) ibalelwa ku-5% amacala. Amaseli omdlavuza ku-NLPHL amaseli amakhulu abizwa ngokuthi ama-popcorn cell (ngoba abukeka njengama-popcorn), ayizinhlobonhlobo zamaseli e-Reed-Sternberg. Ungase futhi uzwe lawa maseli abizwa ngokuthi i-lymphocytic and histiocytic (L&H) cells.

I-NLPHL ivamise ukuqala kuma-lymph nodes entanyeni nangaphansi kwengalo. Ingenzeka kubantu banoma iyiphi iminyaka, futhi ivame kakhulu kwabesilisa kunabesifazane. Lolu hlobo lwe-HL luvame ukukhula kancane futhi luphathwa ngendlela ehlukile kunezinhlobo zakudala. 

Ukuxilongwa kweHodgkin lymphoma

Udokotela wakho uzobuza ngomlando wakho wezokwelapha, kokubili okomuntu siqu nokomndeni. Angase akwenzele ukuhlolwa kanye nezinqubo zokunquma ukuthi unayo yini i-Hodgkin's lymphoma, njenge:

Ukuhlolwa ngokomzimba: Ama-lymph nodes avuvukele, njengalawo asentanyeni, emakhwapheni, nase-groyne, kanye nobende oluvuvukele noma isibindi, ahlolwa udokotela wakho.

Ukuhlolwa kwegazi: Ilebhu ihlola isampula yegazi lakho ukuze ihlole ukuthi ingabe kukhona okukuyo okukhomba ingozi yomdlavuza.

Ukuhlola ukuhlolwa: Izifundo zokucabanga ukucinga izimpawu ze-Hodgkin's lymphoma kwezinye izingxenye zomzimba wakho zinganconywa udokotela wakho. Ama-X-ray, ama-CT scan, kanye ne-positron emission tomography konke ukuhlolwa okungenzeka.

I-lymph node biopsy: Indlela ye-lymph node biopsy yokukhipha i-lymph node ukuze ihlolwe elabhorethri ingase ituswe udokotela wakho. Uma amaseli e-Reed-Sternberg, angamangqamuzana ahlukile, ekhonjwa ngaphakathi kwe-lymph node, uzoxilonga i-Hodgkin's lymphoma yakudala.
Isampula lomnkantsha liyakhishwa ukuze lihlolwe. Inaliti ifakwa ku-hipbone yakho ukuze kukhishwe isampula yomnkantsha ngesikhathi sokuhlolwa komnkantsha kanye nokuhlinzwa kwe-aspiration. Isampula ihlolelwa ukuba khona kwamaseli e-Hodgkin's lymphoma.

Kuye ngesimo sakho, ezinye izivivinyo nokwelashwa kungase kusetshenziswe.

Izigaba ze-Hodgkin's lymphoma

Ngemuva kokuthi udokotela wakho enqume izinga le-Hodgkin's lymphoma yakho, umdlavuza wakho uzonikezwa isigaba. Ukwazi isigaba somdlavuza wakho kusiza udokotela wakho anqume ukubikezela kwakho kanye nezinketho zokwelapha.

Izigaba ze-Hodgkin's lymphoma zihlanganisa:

• Isigaba I. Umdlavuza ukhawulelwe endaweni eyodwa ye-lymph node noma esithweni esisodwa.
• Isigaba II. Kulesi sigaba, umdlavuza usezifundeni ezimbili zama-lymph node noma umdlavuza uhlasele isitho esisodwa kanye nama-lymph nodes aseduze. Kodwa umdlavuza usakhawulelwe engxenyeni yomzimba ngenhla noma ngaphansi kwe-diaphragm.
• Isigaba III. Lapho umdlavuza uthuthela kuma-lymph nodes ngaphezulu nangaphansi kwe-diaphragm, kubhekwa njengesigaba III. Umdlavuza ungase ube engxenyeni eyodwa yezicubu noma isitho eduze kwamaqembu e-lymph node noma kubende.
• Isigaba IV. Lesi yisigaba esithuthuke kakhulu se-Hodgkin's lymphoma. Amangqamuzana omdlavuza asezingxenyeni eziningana zesitho esisodwa noma ngaphezulu kanye nezicubu. Isigaba IV sikaHodgkin's lymphoma asithinti kuphela ama-lymph nodes kodwa nezinye izingxenye zomzimba, njengesibindi, amaphaphu noma amathambo.

Ukwelashwa kwe-Hodgkin's lymphoma

Izindlela zokwelapha ezivame kakhulu ze-HL yi-chemotherapy kanye ne-radiation therapy. Kungase kusetshenziswe eyodwa noma zonke lezi zindlela zokwelapha, kuye ngezimo.

I-Immunotherapy noma i-stem cell transplant ingase isetshenziselwe ukwelapha iziguli ezithile ezihlulekile ukuphendula ekwelashweni kwangaphambili. Ukuhlinzwa akuvamile ukuthi kusetshenziselwe ukwelapha i-HL, ngaphandle kwe-biopsy kanye nesiteji.

Izidakamizwa ze-Chemotherapy ezisetshenziswa eHodgkin lymphoma

I-Chemo ye-Hodgkin lymphoma yakudala (cHL) ihlanganisa izidakamizwa ezimbalwa ngoba imithi ehlukene ibulala amangqamuzana omdlavuza ngezindlela ezahlukene. Izinhlanganisela ezisetshenziselwa ukwelapha i-cHL zivame ukubizwa ngezifinyezo.

I-ABVD irejimeni esetshenziswa kakhulu e-United States:

• I-Adriamycin (doxorubicin)
• I-Bleomycin
• IVinblastine
• I-Dacarbazine (DTIC)

Ezinye izinhlobo ezijwayelekile zihlanganisa:

BEACOPP

• I-Bleomycin
• I-Etoposide (VP-16)
• I-Adriamycin (doxorubicin)
• ICyclophosphamide
• I-Oncovin (vincristine)
• I-Procarbazine
• I-Prednisone

UStanford V

• I-Doxorubicin (Adriamycin)
• I-Mechlorethamine (isinaphi se-nitrogen)
• UVincristine
• IVinblastine
• I-Bleomycin
• I-Etoposide
• I-Prednisone

Omunye umuthi ongathathwa njenge-chemo i-brentuximab vedotin (Adcetris). Lena i-antibody-drug conjugate (ADC), okuyi-monoclonal antibody exhunywe emuthini we-chemo.

Ukwelashwa kwe-radiation ku-Hodgkin lymphoma

Ukwelapha ngemisebe kuvame ukusebenza kahle ekubhubhiseni amaseli e-HL. Ngakolunye uhlangothi, i-Chemotherapy ibonakale iphumelela kakhulu ngokuhamba kwesikhathi. Ngenxa yokuthi kungenzeka kube nemiphumela emibi yesikhathi eside, odokotela namuhla bathambekele ekusebenziseni imisebe emincane nemithamo ephansi yemisebe.

Umshini uletha imisebe egxiliswe kahle yokwelapha i-HL. Imisebe ye-beam yangaphandle igama lalolu hlobo lwemisebe.

Ithimba lemisebe lithatha izilinganiso ezinembile ngaphambi kokuqala ukwelashwa ukuze libale ama-engeli okugxilisa imishayo yemisebe kanye nomthamo odingekayo. Ukulingisa kuwuhlobo lweseshini yokuhlela ngokuvamile ehlanganisa ukuhlola kwesithombe njenge-CT noma izikena ze-PET. Ekwelapheni ngakunye, ukhonkolo, isikhunta somzimba, nezindawo zokumisa ikhanda zingasetshenziswa ukukugcina usesimweni esifanayo. Ezinye izindawo zomzimba wakho zingavikelwa ngokusebenzisa amabhulokhi noma izihlangu. Kungenzeka ukuthi uzocelwa ukuthi ubambe umoya wakho isikhathi esifushane. Umqondo uwukugxilisa imisebe kumdlavuza ukuze kuncishiswe umthelela ezicutshini ezinempilo.

Ukwelashwa ngemisebe kuvame ukwenziwa izinsuku ezinhlanu ngesonto amasonto ambalwa. Inqubo ifana nokuthola i-x-ray, ngaphandle kokuthi imisebe inamandla kakhulu. Ukwelashwa ngakunye kuthatha imizuzu embalwa ubude, kodwa isikhathi sokusetha (sokukwenza wena noma ingane yakho nibe sesikhundleni) sivamise ukuba side. Nakuba ukwelashwa kungenabuhlungu, ezinye izingane ezincane zingase zidinge i-sedation ukuze ziqinisekise ukuthi azinyakazi kuyo yonke inqubo. Izindlela zesimanje zokucabanga zingathola indawo eqondile ye-HL, okuvumela odokotela ukuthi bagxilise imisebe nje ku-lymphoma kuyilapho belondoloza izicubu ezinempilo ezingomakhelwane. Lokhu kungasiza ukugcina imiphumela emibi ibe mincane.

Ukwelashwa kwe-radiation yesayithi okubandakanya

Uma kuziwa ekwelapheni i-HL, odokotela abaningi bakhetha le ndlela entsha ekwelapheni ngemisebe. Imisebe eku-ISRT iqondiswe kuphela kuma-lymph nodes ekuqaleni ayequkethe i-lymphoma, kanye nanoma yiziphi iziza ezizungezile lapho ukonakala kusakazeke khona. Lokhu kunciphisa usayizi wendawo yokwelapha (noma inkambu) futhi kusiza ukugwema ukuchayeka emisebeni yezicubu nezitho ezivamile ezingomakhelwane.

Lokhu akuvamile ukwenziwa namuhla, kodwa imisebe yayivame ukunikezwa ezindaweni ezinkulu ze-lymph node eziqukethe i-lymphoma, kanye nezindawo ezizungezile ze-lymph node ezivamile. Lokhu kwenziwa nje uma kwenzeka i-lymphoma isakazekile, nakuba odokotela bengazange bayibone ngempela kulezi zindawo. Lokhu kubizwa ngokuthi imisebe yasendle enwetshiwe.

• Uma i-lymphoma isemzimbeni ongaphezulu, imisebe yanikezwa insimu yengubo, okwakuhlanganisa izindawo ze-lymph node entanyeni, esifubeni nangaphansi kwezingalo. Kwesinye isikhathi lokhu kwakwelulwa ukuze kufakwe nama-lymph nodes endaweni engaphezulu yesisu (esiswini).
• Inkambu engu-Y ehlanekezelwe Ukwelashwa ngemisebe kwakuhlanganisa ama-lymph nodes angaphezulu kwesisu, ubende, nama-lymph nodes ku-pelvis.
• Lapho imisebe yensimu engu-Y ehlanekezelwe inikezwa kanye nemisebe yensimu ye-mantle, inhlanganisela yabizwa i-irradiation ephelele ye-nodal.

Ngenxa yokuthi cishe zonke iziguli ezine-HL manje sezelashwa nge-chemotherapy, imisebe eyandisiwe yasensimini ayisasetshenziswa.

Ingqikithi yemisebe yomzimba

Abantu abathola ukufakelwa kwe-stem cell bangathola imisebe emzimbeni wonke kanye ne-chemotherapy enedosi ephezulu, ukuzama ukubulala amaseli e-lymphoma emzimbeni wonke.

immunotherapy

I-Immunotherapy ukusetshenziswa kwemithi ukusiza amasosha omzimba womuntu ukuthi abone futhi abhubhise amangqamuzana omdlavuza. I-Immunotherapy ingasetshenziswa ukwelapha abanye abantu abane-Hodgkin lymphoma (HL).

Amasosha omzimba angama-monoclonal
Ama-antibodies angamaprotheni enziwe amasosha akho omzimba ukusiza ukulwa nezifo. Izinguqulo ezenziwe umuntu, ezibizwa ngama-monoclonal antibodies (mAbs), zingaklanywa ukuthi zihlasele into ethile eqondiwe, njengento engaphezulu kwama-lymphocyte (amaseli lapho i-HL iqala khona).

I-Brentuximab vedotin (Adcetris)
Amaseli e-Classic Hodgkin lymphoma (cHL) avamise ukuba ne-CD30 molecule ebusweni bawo. I-Brentuximab vedotin iyi-anti-CD30 antibody exhunywe emuthini we-chemo. I-antibody isebenza njengesignali ye-homing, iletha umuthi we-chemo kumaseli e-lymphoma ane-CD30 kuwo. Umuthi ungena kumaseli uwabulale lapho ezama ukuhlukana abe amaseli amasha.

Lesi sidakamizwa singasetshenziswa:

Njengokwelashwa kokuqala kwesigaba III noma IV cHL (lapho kunikezwa khona kanye ne-chemotherapy)
Kubantu abane-cHL ebuye ngemva kokunye ukwelashwa, okuhlanganisa ngemva kokufakelwa i-stem cell (noma kubantu abangakwazi ukufakelwa omunye umuntu ngesizathu esithile). Inganikezwa yodwa noma kanye ne-chemo.
Ngemva kokufakelwa i-stem cell kubantu abasengozini enkulu yomdlavuza obuyayo ngemva kokwelashwa. Kulesi simo, ngokuvamile inikezwa ngokwayo unyaka.
I-Brentuximab vedotin ifakwe emthanjeni (IV), ngokuvamile njalo emavikini e-3.

Imiphumela emibi evamile ihlanganisa:

Ukulimala kwezinzwa (i-neuropathy)
Ukubalwa kwamaseli egazi aphansi
Ukukhathala
Fever
I-nausea nokuhlanza
Izifo
Uhudo
Akuvamile ukuba kube nemiphumela emibi kakhulu ngesikhathi sokujova i-IV, njengokuphefumula kanzima nomfutho wegazi ophansi

I-Rituximab (Rituxan)
I-Rituximab ingase isetshenziselwe ukwelapha i-nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). Le mAb inamathela entweni ebizwa nge-CD20 kwezinye izinhlobo zamaseli e-lymphoma. Kuvame ukunikezwa kanye ne-chemotherapy kanye/noma ukwelashwa ngemisebe.

I-Rituximab inikezwa njengomuthi we-IV ehhovisi likadokotela noma emtholampilo. Uma isetshenziswa yona ngokwayo, ivamise ukunikezwa kanye ngeviki amaviki angu-4, okungase kuphindwe ezinyangeni ezimbalwa kamuva. Uma inikezwa kanye ne-chemotherapy, ivame ukunikezwa ngosuku lokuqala lomjikelezo we-chemo ngamunye.

Imiphumela emibi evamile ivamise ukuba mnene kodwa ingabandakanya:

Ama-Chills
Fever
I-nausea
Ukuhlambalaza
Ukukhathala
Ukuphathwa yikhanda
Akuvamile ukuba kube nemiphumela emibi kakhulu engenzeka ngesikhathi sokufakwa, njengokuphefumula kanzima kanye nomfutho wegazi ophansi. Uzonikezwa imithi ngaphambi kokwelashwa ngakunye ukusiza ukuthi lokhu kungenzeki. Kodwa noma ngabe lezi zimpawu zenzeka ngesikhathi sokumnika kokuqala, akuvamile ukuthi zenzeke futhi ngemithamo yakamuva.

I-Rituximab kungabangela izifo zangaphambili ze-hepatitis B ukuthi ziphinde zisebenze, ngezinye izikhathi okuholela ezinkingeni ezinzima zesibindi noma ngisho nokufa. Udokotela wakho cishe uzohlola igazi lakho ukuze abone izimpawu ze-hepatitis ngaphambi kokuqala lesi sidakamizwa.

I-Rituximab ingandisa futhi ingozi yakho yokutheleleka izinyanga ezimbalwa ngemva kokumiswa kwesidakamizwa.

Izithiyo zokuvikela izivikeli mzimba
Ingxenye ebalulekile yamasosha omzimba amandla ayo okuzigcina ekuhlaseleni amangqamuzana avamile emzimbeni. Ukwenza lokhu, isebenzisa amaprotheni "okuhlola", asebenza njengokushintshwa kwamangqamuzana omzimba adinga ukuvulwa (noma ukuvala) ukuze kuqale impendulo yokuzivikela komzimba. Ngezinye izikhathi amangqamuzana omdlavuza asebenzisa lezi zindawo zokuhlola ukuze agweme ukuhlaselwa amasosha omzimba.

I-Nivolumab (Opdivo) ne-pembrolizumab (Keytruda) zingama-checkpoint inhibitors angasetshenziswa kubantu abane-Hodgkin lymphoma yakudala abanomdlavuza okhule ngesikhathi sokwelashwa (okuthiwa umdlavuza we-refractory) noma ubuye ngemva kokuzanywa kwezinye izindlela zokwelapha (okuthiwa umdlavuza ophindaphindayo noma ophinde wabuyela emuva).

Le mithi iqondise ku-PD-1, iphrotheni emangqamuzaneni athile amasosha omzimba (abizwa ngokuthi ama-T cell) ngokuvamile esiza ukugcina la mangqamuzana ekuhlaseleni amanye amangqamuzana emzimbeni. Ngokuvimbela i-PD-1, le mithi ikhulisa ukusabela komzimba kumaseli omdlavuza. Lokhu kunganciphisa ezinye izimila noma kubambezele ukukhula kwazo.

Le mithi inikezwa njengokufakwa emthanjeni (IV), ngokuvamile njalo emavikini angu-2, 3, noma angu-6.

Imiphumela emibi engaba khona
Imiphumela emibi yale mithi ingabandakanya:

Ukukhathala
Fever
Isikhukhula
I-nausea
Itching
Ukukhwabanisa isikhumba
Ukulahlekelwa kwesifiso
ubuhlungu Joint
ukuqunjelwa
Uhudo
Okunye, imiphumela emibi kakhulu ivela kancane.

Ukusabela komuthi: Abanye abantu bangase babe nokusabela lapho bethola enye yale mithi. Lokhu kufana nokungezwani komzimba, futhi kungase kuhlanganise imfiva, ukugodola, ukuqubuka kobuso, ukuqubuka, isikhumba esilumayo, ukuzwa isiyezi, ukushaywa umoya, nokuphefumula kanzima. Kubalulekile ukutshela udokotela wakho noma unesi ngokushesha uma unanoma iyiphi yalezi zimpawu ngenkathi uthola eyodwa yale mithi.

Ukusabela kwe-Autoimmune: Le mithi isebenza ngokususa enye yezivikelo zamasosha omzimba. Ngezinye izikhathi isimiso somzimba sokuzivikela ezifweni siqala ukuhlasela ezinye izingxenye zomzimba, okungase kubangele izinkinga ezinkulu noma ezisongela ukuphila emaphashini, emathunjini, esibindini, kwizindlala ezenza amahomoni, izinso, noma kwezinye izitho.

Uma ubona noma yiziphi izinkinga, kufanele utshele ithimba lakho lezempilo ngakho ngokushesha. Uma kwenzeka imiphumela emibi kakhulu, ukwelashwa kungase kudingeke ukuthi kumiswe futhi ungase uthole imithamo ephezulu yama-steroid ukuze ucindezele amasosha akho omzimba.

Ukufakelwa kwe-stem cell ku-Hodgkin lymphoma

Ukufakelwa kwe-stem cell (SCTs) ngezinye izikhathi kusetshenziselwa ukwelapha i-Hodgkin lymphoma okunzima ukuyelapha, njengokugula okungaphenduli ku-chemotherapy (i-chemo) kanye/noma imisebe, noma i-lymphoma ebuya ngemva kokwelashwa.

Imithamo yezidakamizwa ze-Chemotherapy ngokuvamile ilawulwa yimiphumela engemihle ebangelwa yilokhu kwelashwa. Imithamo ephakeme ayinakwenzeka, nakuba ingabulala amangqamuzana omdlavuza amaningi, ngoba ingalimaza umnkantsha, okhiqiza amangqamuzana egazi amasha.

Odokotela bangasebenzisa imithamo ye-chemo esindayo ngemva kokufakelwa kwe-stem cell (ngezinye izikhathi kanye nokwelashwa ngemisebe). Ngenxa yokuthi isiguli sithola ukufakelwa ama-stem cells akha igazi ukuze alungise umnkantsha ngemva komthamo omkhulu we-chemo, lokhu kunjalo.

Ama-stem cells akha igazi angavela egazini noma emnkantsheni futhi asetshenziswe ekufakeni omunye umuntu. Iningi lokufakelwa namuhla lenziwa ngamaseli akhishwe egazini, abizwa ngokuthi yi-peripheral stem cell transplants.