Ngoba ukwahlukaniswa kwe-leukemia kanye ne-prognosis stratification kuyinkimbinkimbi, ayikho indlela yokwelapha esayizi eyodwa, futhi kuyadingeka ukuhlanganisa ukuhlukaniswa ngokucophelela kanye ne-prognosis stratification ukwenza amasu okwelashwa. Njengamanje, kunezinhlobo ezilandelayo zezindlela zokwelapha: i-chemotherapy, i-radiotherapy, ukwelashwa okuhlosiwe, i-immunotherapy, i-stem cell transplantation, njll.
Ngokusebenzisa ukwelashwa okuphelele okunengqondo, ukubikezelwa kwe-leukemia kuthuthukiswe kakhulu. Inani elikhulu leziguli liyelapheka noma lizinzile isikhathi eside. Isikhathi se- leukemia “njengesifo esingelapheki” sesidlulile.
Ukwelashwa kwe-AML (okungewona-M3)
Imvamisa kuyadingeka ukwenza kuqala i-chemotherapy eyinhlanganisela, ebizwa nge- "induction chemotherapy", uhlelo olusetshenziswa kakhulu lwe-DA (3 + 7). Ngemuva kokwelashwa kokungeniswa, uma ukuxolelwa kutholakala, ukuqhubeka kwezinqubo zokuqinisa ngamakhemikhali okunamandla noma izinqubo zokufakelwa kwe-stem cell kungaqhutshwa ngokuya ngokuhlelwa kwesigaba sokubikezela. Ngemuva kokwelashwa kokuhlanganiswa, ukwelashwa kokugcinwa ngokuvamile akwenziwa njengamanje, futhi umuthi ungamiswa ukuze ubhekwe futhi ulandelwe njalo.
Ukwelashwa kwe-M3
Ngenxa yempumelelo yokwelapha okuhlosiwe kanye nokwelashwa kwe-apoptosis, i-PML-RARα positive acute promyelocytic leukemia (M3) isibe uhlobo olungcono kakhulu lokubikezela kuyo yonke i-AML. Ucwaningo olwengeziwe luye lwabonisa ukuthi yonke i-trans-retinoic acid ehlanganiswe nokwelashwa kwe-arsenic ingelapha iziguli eziningi ezine-M3. Ukwelashwa kudinga ukwenziwa ngokuqinile ngokwendlela yokwelashwa, futhi ubude bokwelashwa kwesondlo esikhathini esizayo kunqunywa ikakhulukazi yisimo esisele sofuzo lwe-fusion.
KONKE ukwelashwa
I-induction chemotherapy ivame ukwenziwa kuqala, futhi kukhona umehluko ezinhlelweni ezisetshenziswa kakhulu phakathi kwabantu abadala nezingane. Kodwa-ke, eminyakeni yamuva nje, ucwaningo luye lwasikisela ukuthi imiphumela yokusebenzisa imikhuba yezingane ukwelapha iziguli esezikhulile ingahle ibe ngcono kunezindlela zemvelo zabantu abadala. Ngemuva kokuxolelwa, kubalulekile ukugcizelela ekwelapheni ukuqinisa kanye nokunakekela. Iziguli ezisengozini enkulu zinezimo zokwenza ukufakelwa kwe-stem cell. Iziguli ezine-Ph1 chromosome positive zinconyelwa ukwelashwa nge-tyrosine kinase inhibitors.
Ukwelashwa Okungalapheki Kwe-Leukemia
Esigabeni esingapheli, i-tyrosine kinase inhibitors (njenge-imatinib) iyindlela yokwelashwa ekhethwayo. Kunconywa ukubaphatha ngokushesha ngangokunokwenzeka futhi ngamanani anele. Ukuphuza ukusetshenziswa kanye nokusetshenziswa ngendlela engafanele kungaholela kalula ekungazweni nezidakamizwa. Ngakho-ke, uma unquma ukusebenzisa i-imatinib, okokuqala, ungalibali, futhi okwesibili, kufanele ugcizelele ukusetshenziswa kwesikhathi eside (eduze nokuphila), futhi unganciphisi ngokungenangqondo inani noma uyeke ukuyithatha ngesikhathi sokuyithatha, ngaphandle kwalokho. kuzoholela kalula ekungazweni nezidakamizwa. Isigaba esisheshisiwe kanye nesigaba esibucayi ngokuvamile sidinga ukwelashwa okuhlosiwe (i-imatinib yokuthatha noma ukusetshenziswa kwezidakamizwa zesizukulwane sesibili). Uma kungenzeka, ukufakelwa kwe-allogeneic noma ukwelashwa okuhlanganisiwe okufika ngesikhathi kungamukelwa.
Ukwelashwa okungapheli kwe-lymphocyte
Iziguli zangaphambi kwesikhathi ezingenazimpawu ngokuvamile azikudingi ukwelashwa, futhi ekupheleni kwesikhathi, zingakhetha izinhlobonhlobo zezinketho zokwelashwa ngamakhemikhali, njenge-Liu Keran monotherapy, i-fludarabine, i-cyclophosphamide ehlanganiswe ne-merova, kanye nokunye ukwelashwa ngamakhemikhali. I-Bendamustine kanye nama-anti-CD52 monoclonal antibodies nawo ayasebenza. Eminyakeni yamuva nje, kutholakale ukuthi ukwelashwa okuhlosiwe kwe-BCR pathway inhibitors kungase kube nomthelela omkhulu. Iziguli ezinezimo eziphikisayo zingacabangela ukwelashwa kwe-allograft.
Ukwelashwa kwe-central neukemia system
Yize izinhlobo ze-M4 ne-M5 ku-ALL naku-AML zivame ukuhlanganiswa ne-CNSL, amanye ama-leukemias acute nawo angenzeka. Ngoba izidakamizwa ezisetshenziswa kakhulu kunzima ukungena kumgoqo wobuchopho begazi, lezi ziguli imvamisa zidinga ukubhoboza lumbar ukuvimbela nokwelapha i-CNSL. Ezinye iziguli eziphikisayo zingadinga i-radiotherapy yomqondo womgogodla ophelele.
Ngaphandle kweziguli ezimbalwa ezikhethekile ezingazuza ekufakelweni kwe-autologous (isilinganiso sokuphindaphinda kokufakelwa kabusha kwe-autologous siphezulu kakhulu), iningi leziguli ze-leukemia kufanele likhethe ukufakelwa kabusha kwe-xenotransplatform.
Ngokufingqa, ukwelashwa okuvamile komugqa wokuqala we-leukemia akukhona ukufakelwa kabusha. Yize ukufakelwa kabusha kungathola umphumela ongcono wokusinda, izinkinga ezinjengesilinganiso sokuphindaphinda nesifo sokuxhunyelelwa singaphazamisa kakhulu izinga lempilo yeziguli. Ukwelashwa ngemuva kokubuyela emuva kuzoba nzima kakhulu. Ngakho-ke, ukufakelwa kabusha kwesinye isikhathi kuyisinyathelo sokugcina sokukhetha.
