Ikozvino uye Kubudirira Kurapa kweCLL

Zvemukati

• Mhedziso
• Kurapa kune yakaderera-njodzi CLL
• Mishonga yekurapa yepakati- kana yakanyanya njodzi CLL
• Chemotherapy uye immunotherapy
• Targeted Therapies
• Kuisirwa ropa
• Radiation
• Dutu sero uye mapfupa emongo
• Kubudirira kurapwa
• Kusanganiswa kwezvinodhaka
• MOTO T-cell kurapa
• Mimwe mishonga iri kuongororwa
• Kutora

Mhedziso

Chisingaperi lymphocytic leukemia (CLL) kenza inononoka kukura yechirwere chemuviri. Nekuti iri kunonoka-kukura, vanhu vazhinji vane CLL havadi kutanga kurapwa kwemakore mazhinji mushure mekuonekwa kwavo.

Kana kenza ikangotanga kukura, pane nzira zhinji dzekurapa dziripo dzinogona kubatsira vanhu kuwana kuregererwa. Izvi zvinoreva kuti vanhu vanogona kusangana nenguva dzakareba kana pasina chiratidzo chekenza mumuviri wavo.

Iyo chaiyo yekurapa sarudzo yaunogamuchira zvinoenderana nezvinhu zvakasiyana. Izvi zvinosanganisira kuti CLL yako iratidzike kana kuti kwete, danho reiyo CLL zvichibva pamhedzisiro yekuongororwa kweropa uye kuongorora kwepanyama, uye zera rako uye hutano hwakazara.

Kunyangwe pasina mushonga weCLL parizvino, budiriro mumunda dzave pedyo.

Kurapa kune yakaderera-njodzi CLL

Vanachiremba vanowanzo tarisa CLL vachishandisa system inonzi iyo Rai system. Yakadzika-njodzi CLL inotsanangura vanhu vanowira mu "nhanho 0" pasi peiyo Rai system.

Muchikamu che0, iyo lymph node, spleen, uye chiropa hazvina kuwedzerwa. Red red sero uye maplatelet kuverenga ari padyo neyakajairwa.

Kana iwe uine njodzi yakadzika CLL, chiremba wako (kazhinji hematologist kana oncologist) angangokuraira iwe kuti "mirira utarise" kune zviratidzo. Maitiro aya anonzi zvakare anoshanda ekuongorora.

Mumwe munhu ane njodzi yakaderera CLL anogona kusada kuenderera mberi kwekurapwa kwemakore mazhinji. Vamwe vanhu havazomboda kurapwa. Iwe unenge uchiri kuda kuona chiremba kuti ugare uchiongororwa uye kuongororwa kwebhu.

Mishonga yekurapa yepakati- kana yakanyanya njodzi CLL

Pakati-panjodzi CLL inotsanangura vanhu vane nhanho 1 kusvika padanho 2 CLL, zvinoenderana neRai system. Vanhu vane nhanho 1 kana 2 CLL vakawedzera lymph node uye vanogona kunge vakawedzera spleen nechiropa, asi padyo neyakajairika tsvuku sero reropa uye platelet kuverenga.

Yakanyanya-njodzi CLL inotsanangura varwere vane danho rechitatu kana danho rechina gomarara. Izvi zvinoreva kuti iwe unogona kunge uine yakawedzera spleen, chiropa, kana lymph node. Low red red cell cell kuverenga zvakajairika. Muchikamu chepamusoro-soro, platelet kuverenga ichave akaderera zvakare.

Kana iwe uine CLL yepakati- kana yakanyanya njodzi, chiremba wako angangokurudzira kuti utange kurapwa ipapo ipapo.

Chemotherapy uye immunotherapy

Munguva yakapfuura, kurapwa kwakajairwa kweCLL kwaisanganisira musanganiswa wemakemikari uye maununotherapy, akadai se:

• fludarabine uye cyclophosphamide (FC)
• FC pamwe ne antibody immunotherapy inozivikanwa se rituximab (Rituxan) kune vanhu vadiki pane makumi matanhatu nemashanu
• bendamustine (Treanda) pamwe rituximab yevanhu vakura kupfuura makumi matanhatu nemashanu
• chemotherapy pamwe chete nemamwe ma immunotherapies, senge alemtuzumab (Campath), obinutuzumab (Gazyva), uye ofatumumab (Arzerra). Idzi sarudzo dzinogona kushandiswa kana denderedzwa rekutanga rekurapa risingashande.

Targeted Therapies

Kwemakore mashoma apfuura, kunzwisiswa kuri nani kweiyo biology yeCLL kwakatungamira kune akati wandei ekurapa kwakanangwa. Iyi mishonga inonzi yakanangwa marapirwo nekuti anoendeswa kune chaiwo mapuroteni anobatsira CLL maseru kukura.

Mienzaniso yemishonga yakanangwa yeCLL inosanganisira:

• ibrutinib (Imbruvica): inokanganisa iyo enzyme inozivikanwa seBruton's tyrosine kinase, kana BTK, yakakosha pakurarama kweCLL cell.
• venetoclax (Venclexta): inotarisira iyo BCL2 protein, puroteni inoonekwa muCLL
• idelalisib (Zydelig): inodzivirira kinase protein inozivikanwa sePI3K uye inoshandiswa kudzokazve CLL
• duvelisib (Copiktra): zvakare inonanga PI3K, asi inowanzo shandiswa chete mushure mekunge kumwe kurapwa kurapa
• acalabrutinib (Calquence): imwe BTK inhibitor inogamuchirwa mukupera kwa2019 kweCLL
• venetoclax (Venclexta) pamwe chete neobinutuzumab (Gazyva)

Kuisirwa ropa

Ungangoda kugashira intravenous (IV) kuwedzerwa ropa kuti uwedzere masero eropa.

Radiation

Radiation Therapy inoshandisa yakakwira-simba maarticles kana mafungu ekubatsira kuuraya cancer maseru uye kudzikisira marwadzo akawedzera lymph node. Radiation Therapy haiwanzoshandiswa mune CLL kurapwa.

Dutu sero uye mapfupa emongo

Chiremba wako anogona kukurudzira stem cell kuisirwa kana kenza yako ikasapindura kune mamwe marapirwo. Iyo stem cell yekuisa inokutendera iwe kuti ugamuchire yakakwira doses ye chemotherapy kuuraya mamwe cancer maseru.

Doses yepamusoro ye chemotherapy inogona kukonzera kukuvara kumongo wako wepfupa. Kuti utsive maseru aya, uchafanirwa kugashira mamwe masero emaseru kana mwongo wemabhonzo kubva kune mupi ane hutano.

Kubudirira kurapwa

Huwandu hukuru hwenzira dziri pasi pekuferefetwa kurapa vanhu vane CLL. Zvimwe zvakave zvichangobvumidzwa neFood and Drug Administration (FDA).

Kusanganiswa kwezvinodhaka

Muna Chivabvu 2019, iyo FDA yakabvumidza venetoclax (Venclexta) pamwe ne obinutuzumab (Gazyva) kurapa vanhu vaimbove vasina kurapwa CLL seye chemotherapy-yemahara sarudzo.

Muna Nyamavhuvhu 2019, vaongorori vakaburitsa mhedzisiro kubva kuChikamu III chekiriniki kutongwa kuchiratidza kuti mubatanidzwa we rituximab uye ibrutinib (Imbruvica) inochengetedza vanhu vasina hosha kwenguva yakareba kupfuura mwero wazvino wekurapa.

Izvi zvinosanganisa zvinoita kuti zvive nyore kuti vanhu vagone kuita vasina chemotherapy zvachose mune ramangwana. Asiri-chemotherapy ekurapa marimimeni akakosha kune avo vasingakwanise kutsungirira zvine hukasha chemotherapy-zvine chekuita nemhedzisiro.

MOTO T-cell kurapa

Imwe yedzinonyanya kuvimbisa ramangwana nzira dzekurapa kweCLL ndeye CAR T-cell kurapwa. CAR T, inomirira chimeric antigen receptor T-cell therapy, inoshandisa immune system yemunhu maseru kurwisa gomarara.

Maitiro acho anosanganisira kutora uye kushandura maseru emunhu kuti azive zvirinani uye aparadze maseru ekenza. Maseru anozodzorerwa mumuviri kuti iwande uye kurwisa kenza.

MOTO T-masero ekurapa ari kuvimbisa, asi iwo anotakura njodzi. Imwe njodzi ndeye mamiriro anonzi cytokine release syndrome. Iyi ndiyo mhinduro yekuzvimba inokonzerwa neyakaiswa CAR T-maseru. Vamwe vanhu vanogona kusangana kwakasimba uko kunogona kutungamira kurufu kana kukasakurumidza kurapwa.

Mimwe mishonga iri kuongororwa

Mimwe mimwe mishonga yakanangwa iri kuongororwa mukiriniki miedzo yeCLL inosanganisira:

• Zanubrutinib (BGB-3111)
• entospletinib (GS-9973)
• tirabrutinib (ONO-4059 kana GS-4059)
• umbralisib (TGR-1202)
• cirmtuzumab (UC-961)
• ublituximab (TG-1101)
• pembrolizumab (Keytruda)
• nivolumab (Opdivo)

Kana kamwe kiriniki miedzo yapera, mimwe yemishonga iyi inogona kubvumidzwa yekurapa CLL. Taura nachiremba wako nezve kujoina kiriniki kuyedzwa, kunyanya kana izvozvi marapirwo ekurapa asiri kukushandira.

Kliniki miedzo inoongorora kushanda kwemishonga mitsva pamwe nemusanganiswa wemishonga yakatobvumidzwa. Iyi mishonga mitsva inogona kushanda zvirinani kwauri kupfuura iyo iripo parizvino. Ikozvino pane mazana emakiriniki ekuedzwa anoenderera kweCLL.

Kutora

Vanhu vazhinji vanoonekwa kuti vane CLL havazomboda kutanga kurapwa ipapo ipapo. Kana chirwere ichi chikatanga kufambira mberi, une nzira zhinji dzekurapa dziripo Kune zvakare hwakawanda hwakasiyana hwemakiriniki ekuyedza kusarudza kubva kune ayo ari kutsvaga marapirwo matsva uye musanganiswa marapirwo.