Ubwoko / myeloma / umurwayi / myeloma-kuvura-pdq

Plasma Cell Neoplasms (Harimo na Myeloma Yinshi) Kuvura (®) –Umurwayi

Amakuru Rusange Yerekeye Plasma Cell Neoplasms

INGINGO Z'INGENZI

• Plasma selile neoplasme nindwara umubiri ukora selile nyinshi.

• Plasma selile neoplasme irashobora kuba nziza (ntabwo ari kanseri) cyangwa mbi (kanseri).

• Hariho ubwoko bwinshi bwa plasma selile neoplasms.

• Monoclonal gammopathie ifite akamaro katamenyekanye (MGUS)

• Plasmacytoma

• Myeloma nyinshi

• Myeloma nyinshi hamwe na plasma selile neoplasme irashobora gutera indwara yitwa amyloidose.

• Imyaka irashobora kugira ingaruka kubibazo bya plasma selile neoplasms.

• Ibizamini bisuzuma amaraso, igufwa ryamagufa, ninkari bikoreshwa mugupima myeloma nizindi plasma neoplasme.

• Ibintu bimwe bigira ingaruka kubitekerezo (amahirwe yo gukira) hamwe nuburyo bwo kuvura.

Plasma selile neoplasme nindwara umubiri ukora selile nyinshi.

Plasma selile ikura muri lymphocytes B (selile B), ubwoko bwamaraso yera akorwa mumagufwa. Mubisanzwe, iyo bagiteri cyangwa virusi zinjiye mumubiri, zimwe muri selile B zizahinduka selile plasma. Uturemangingo twa plasma dukora antibodies zo kurwanya bagiteri na virusi, kugirango duhagarike kwandura n'indwara.

Myeloma nyinshi. Uturemangingo twinshi twa myeloma ni selile idasanzwe ya plasma (ubwoko bwamaraso yera) yubaka mumagufwa kandi ikora ibibyimba mumagufwa menshi yumubiri. Uturemangingo dusanzwe twa plasma dukora antibodies zifasha umubiri kurwanya indwara n'indwara. Mugihe umubare wuturemangingo twinshi twa myeloma wiyongera, hakorwa antibodi nyinshi. Ibi birashobora gutuma amaraso yiyongera kandi bigatuma igufwa ryamagufa ridakora selile nziza zamaraso. Ingirabuzimafatizo nyinshi za myeloma nazo zangiza kandi zigabanya amagufwa.

Plasma selile neoplasme ni indwara aho plasma idasanzwe cyangwa selile myeloma ikora ibibyimba mumagufwa cyangwa imyenda yoroshye yumubiri. Uturemangingo twa plasma dukora kandi proteyine ya antibody, yitwa M protein, idakenewe numubiri kandi ntabwo ifasha kurwanya kwandura. Izi poroteyine za antibody zubaka mu magufa kandi zishobora gutuma amaraso yiyongera cyangwa ashobora kwangiza impyiko.

Plasma selile neoplasme irashobora kuba nziza (ntabwo ari kanseri) cyangwa mbi (kanseri).

Monoclonal gammopathie ifite akamaro kataramenyekana (MGUS) ntabwo ari kanseri ariko irashobora guhinduka kanseri. Ubwoko bukurikira bwa plasma selile neoplasme ni kanseri:

• Lymphoplasmacytic lymphoma. (Reba Abakuze Non-Hodgkin Lymphoma Umuti Kubindi bisobanuro.)

• Plasmacytoma.

• Myeloma nyinshi.

Hariho ubwoko bwinshi bwa plasma selile neoplasms.

Plasma selile neoplasms ikubiyemo ibi bikurikira:

Monoclonal gammopathie ifite akamaro katamenyekanye (MGUS)

Muri ubu bwoko bwa plasma selile neoplasm, munsi ya 10% yumusemburo wamagufa ugizwe ningirabuzimafatizo zidasanzwe kandi nta kanseri ihari. Uturemangingo twa plasma idasanzwe dukora proteine ​​M, rimwe na rimwe ikaboneka mugihe gisanzwe cyamaraso cyangwa kwipimisha inkari. Mu barwayi benshi, ingano ya poroteyine M igumaho kandi nta bimenyetso, ibimenyetso, cyangwa ibibazo by'ubuzima.

Mu barwayi bamwe, MGUS irashobora guhinduka indwara ikomeye, nka amyloidose, cyangwa igatera ibibazo impyiko, umutima, cyangwa imitsi. MGUS irashobora kandi guhinduka kanseri, nka myeloma nyinshi, lymphoplasmacytic lymphoma, cyangwa lymphocytike idakira.

Plasmacytoma

Muri ubu bwoko bwa plasma selile neoplasm, selile idasanzwe ya plasma (myeloma selile) iri ahantu hamwe ikora ikibyimba kimwe, cyitwa plasmacytoma. Rimwe na rimwe, plasmacytoma irashobora gukira. Hariho ubwoko bubiri bwa plasmacytoma.

• Muri plasmacytoma yitaruye yamagufa, ikibyimba kimwe cya plasma kiboneka mumagufwa, munsi ya 10% yumusemburo wamagufa ugizwe na selile plasma, kandi ntakindi kimenyetso cya kanseri. Plasmacytoma yamagufwa akenshi iba myeloma myinshi.

• Muri plasmacytoma ikabije, ikibyimba kimwe cya plasma kiboneka mubice byoroshye ariko ntabwo biri mumagufwa cyangwa mumagufwa. Indwara ya plasmacytoma ikabije ikorwa mubice byumuhogo, tonil, na sinan paranasal.

Ibimenyetso nibimenyetso bivana nigihe ikibyimba kiri.

• Mu magufa, plasmacytoma irashobora gutera ububabare cyangwa amagufwa yamenetse.

• Mubice byoroshye, ikibyimba gishobora gukanda ahantu hafi kandi kigatera ububabare cyangwa ibindi bibazo. Kurugero, plasmacytoma mumuhogo irashobora kugora kuyimira.

Myeloma nyinshi

Muri myeloma myinshi, selile idasanzwe ya plasma (selile myeloma) yubaka mumagufwa kandi ikora ibibyimba mumagufwa menshi yumubiri. Ibi bibyimba birashobora gutuma igufwa ryamagufa ridakora selile nziza zamaraso. Mubisanzwe, igufwa ryamagufa rikora ingirabuzimafatizo (selile zidakuze) zihinduka ubwoko butatu bwamaraso akuze:

• Uturemangingo twamaraso dutukura dutwara ogisijeni nibindi bintu mubice byose byumubiri.

• Utugingo ngengabuzima twera turwanya indwara n'indwara.

• Amashanyarazi akora amaraso kugirango afashe kwirinda kuva amaraso.

Mugihe umubare wa selile myeloma wiyongera, hakorwa selile nkeya zitukura, selile yera, na platine. Ingirabuzimafatizo ya myeloma nayo yangiza kandi igabanya amagufwa.

Rimwe na rimwe myeloma myinshi ntabwo itera ibimenyetso cyangwa ibimenyetso. Ibi byitwa gucana myeloma myinshi. Irashobora kuboneka mugihe amaraso cyangwa inkari bikozwe kubindi bihe. Ibimenyetso nibimenyetso bishobora guterwa na myeloma myinshi cyangwa ibindi bihe. Menyesha umuganga wawe niba ufite kimwe muri ibi bikurikira:

• Kubabara amagufwa, cyane cyane inyuma cyangwa imbavu.

• Amagufa avunika byoroshye.

• Umuriro nta mpamvu izwi cyangwa kwandura kenshi.

• Gukomeretsa byoroshye cyangwa kuva amaraso.

• Guhumeka.

• Intege nke zamaboko cyangwa amaguru.

• Kumva unaniwe cyane.

Ikibyimba gishobora kwangiza igufwa kandi kigatera hypercalcemia (calcium nyinshi mumaraso). Ibi birashobora gufata ingingo nyinshi mumubiri, harimo impyiko, imitsi, umutima, imitsi, hamwe nigifu, kandi bigatera ibibazo bikomeye byubuzima.

Hypercalcemia irashobora gutera ibimenyetso nibimenyetso bikurikira:

• Kubura ubushake bwo kurya.

• Isesemi cyangwa kuruka.

• Kumva ufite inyota.

• Inkari kenshi.

• Kuribwa mu nda.

• Kumva unaniwe cyane.

• Intege nke.

• Kuruhuka.

• Urujijo cyangwa ibibazo byo gutekereza.

Myeloma nyinshi hamwe na plasma selile neoplasme irashobora gutera indwara yitwa amyloidose.

Mubihe bidasanzwe, myeloma myinshi irashobora gutera imitsi ya periferique (imitsi itari mubwonko cyangwa uruti rw'umugongo) n'ingingo zikananirwa. Ibi birashobora guterwa nindwara yitwa amyloidose. Intungamubiri za antibodiyite zirubaka kandi zigakomeza hamwe mu mitsi no mu ngingo, nk'impyiko n'umutima. Ibi birashobora gutuma imitsi ningingo bikomera kandi ntibishobora gukora nkuko bikwiye.

Amyloidose irashobora gutera ibimenyetso nibimenyetso bikurikira:

• Kumva unaniwe cyane.

• Ibibara byijimye ku ruhu.

• Ururimi runini.

• Impiswi.

• Kubyimba biterwa n'amazi mu ngingo z'umubiri wawe.

• Kunyeganyega cyangwa kunanirwa mu maguru no mu birenge.

Imyaka irashobora kugira ingaruka kubibazo bya plasma selile neoplasms.

Ikintu cyose cyongera ibyago byo kwandura byitwa impanuka. Kugira ibintu bishobora guteza ibyago ntibisobanura ko uzarwara kanseri; kutagira ibyago bishobora gusobanura ko utazarwara kanseri. Vugana na muganga wawe niba utekereza ko ushobora guhura n'akaga.

Plasma selile neoplasme ikunze kugaragara mubantu bafite imyaka yo hagati cyangwa barengeje imyaka. Kuri myeloma nyinshi na plasmacytoma, izindi mpamvu ziterwa ningaruka zirimo ibi bikurikira:

• Kuba umwirabura.

• Kuba umugabo.

• Kugira amateka yihariye ya MGUS cyangwa plasmacytoma.

• Guhura n'imirasire cyangwa imiti imwe n'imwe.

Ibizamini bisuzuma amaraso, igufwa ryamagufa, ninkari bikoreshwa mugupima myeloma nizindi plasma neoplasme.

Ibizamini hamwe nuburyo bukurikira birashobora gukoreshwa:

• Ikizamini cyumubiri namateka yubuzima: Ikizamini cyumubiri kugirango ugenzure ibimenyetso rusange byubuzima, harimo no gusuzuma ibimenyetso byindwara, nkibibyimba cyangwa ikindi kintu cyose gisa nkidasanzwe. Hazafatwa kandi amateka yubuzima bwumurwayi nindwara zashize hamwe nubuvuzi.

• Amaraso hamwe ninkari immunoglobulin yiga: Uburyo bwo gusuzuma amaraso cyangwa inkari kugirango bapime urugero rwa antibodi zimwe na zimwe (immunoglobuline). Kuri myeloma myinshi, beta-2-microglobuline, M proteine, iminyururu yoroheje yubusa, nizindi poroteyine zakozwe na selile myeloma zirapimwa. Umubare urenze-usanzwe wibintu bishobora kuba ikimenyetso cyindwara.

• Amagufa ya marrow aspiration na biopsy: Gukuraho igufwa ryamagufa, amaraso, nigice gito cyamagufwa winjiza urushinge rudafite epfo na ruguru cyangwa amabere. Inzobere mu by'indwara ireba amagufwa, amaraso, n'amagufwa munsi ya microscope kugirango ishakishe ingirabuzimafatizo zidasanzwe.

Amagufa ya marrow icyifuzo na biopsy. Nyuma yuko agace gato k'uruhu kamaze kunanirwa, urushinge rw'amagufwa rwinjizwa mu igufwa ry'umurwayi. Ingero z'amaraso, amagufwa, n'amagufwa byavanyweho kugirango bisuzumwe kuri microscope.

Ibizamini bikurikira birashobora gukorwa kurugero rwa tissue yakuwe mugihe cyo kwifuza amagufwa na biopsy:

• Isesengura rya Cytogenetike: Ikizamini cya laboratoire aho chromosomes ya selile mucyitegererezo cy'amagufwa ibarwa kandi ikagenzurwa niba hari impinduka, nko kuvunika, kubura, gutondekanya, cyangwa chromosomes ziyongera. Impinduka muri chromosomes zimwe zishobora kuba ikimenyetso cya kanseri. Isesengura rya Cytogenetike rikoreshwa mu gufasha gusuzuma kanseri, gutegura gahunda yo kuvura, cyangwa kumenya uburyo ubuvuzi bukora neza.
• AMAFI (fluorescence in situ hybridisation): Ikizamini cya laboratoire ikoreshwa mu kureba no kubara gen cyangwa chromosomes mu ngirabuzimafatizo no mu ngingo. Ibice bya ADN birimo amarangi ya fluorescent bikozwe muri laboratoire hanyuma bikongerwaho icyitegererezo cy'uturemangingo cyangwa ingirangingo z'umurwayi. Iyo ibyo bice bisize irangi bya ADN bifatanye na gen cyangwa uduce twa chromosomes murugero, biramurika iyo urebye munsi ya microscope ya fluorescent. Ikizamini cy'Amafi gikoreshwa mu gufasha gusuzuma kanseri no gufasha kuvura.
• Flow cytometry: Ikizamini cya laboratoire gipima umubare w'utugingo ngengabuzima, ijanisha ry'utugingo ngengabuzima turi mu cyitegererezo, hamwe n'ibiranga ingirabuzimafatizo, nk'ubunini, imiterere, hamwe n'ibimenyetso by'ibibyimba (cyangwa ibindi) kuri Ubuso. Ingirabuzimafatizo ziva mu cyitegererezo cy'amagufwa y'umurwayi yandujwe irangi rya fluorescent, ashyirwa mu mazi, hanyuma akanyuzamo icyarimwe akoresheje urumuri. Ibisubizo by'ibizamini bishingiye ku kuntu ingirabuzimafatizo zandujwe irangi rya fluorescent zifata urumuri. Iki kizamini gikoreshwa mugufasha gusuzuma no gucunga ubwoko bumwe na bumwe bwa kanseri, nka leukemia na lymphoma.

• Ubushakashatsi bwamagufwa ya skeletale: Mubushakashatsi bwamagufwa ya skeletale, x-imirasire yamagufwa yose mumubiri. X-imirasire ikoreshwa mugushakisha aho igufwa ryangiritse. X-ray ni ubwoko bwingufu zishobora kunyura mumubiri no kuri firime, bigakora ishusho yibice byumubiri.
• Umubare wuzuye wamaraso (CBC) ufite itandukaniro: Uburyo bwo gukuramo urugero rwamaraso no gusuzuma ibi bikurikira:

• Umubare w'uturemangingo tw'amaraso atukura na platine.
• Umubare nubwoko bwingirangingo zamaraso yera.
• Ingano ya hemoglobine (proteyine itwara ogisijeni) mu ngirangingo z'amaraso atukura.
• Igice cyicyitegererezo cyamaraso kigizwe ningirabuzimafatizo zitukura.

• Ubushakashatsi bwa chimie yamaraso: Uburyo bwo gusuzuma urugero rwamaraso kugirango bapime ingano yibintu bimwe na bimwe, nka calcium cyangwa albumine, bisohoka mumaraso ningingo hamwe nuduce twumubiri. Umubare udasanzwe (uri hejuru cyangwa uri munsi yubusanzwe) ibintu bishobora kuba ikimenyetso cyindwara.

• Kwipimisha inkari amasaha 24 : Ikizamini gikusanyirizwamo inkari amasaha 24 kugirango bapime ingano yibintu bimwe. Umubare udasanzwe (uri hejuru cyangwa uri munsi yubusanzwe) ibintu bishobora kuba ikimenyetso cyindwara mumubiri cyangwa tissue ituma. Kurenza urugero rusanzwe rwa poroteyine birashobora kuba ikimenyetso cya myeloma myinshi.

• MRI . Ubu buryo bwitwa kandi magnetic magnetic resonance imaging (NMRI). MRI yumugongo nigitereko irashobora gukoreshwa mugushakisha aho igufwa ryangiritse.

• PET scan (positron emission tomografi scan): Uburyo bwo kubona selile mbi yibibyimba mumubiri. Umubare muto wa glucose ikora radio (isukari) yatewe mumitsi. PET scaneri izenguruka umubiri kandi ikora ishusho yerekana aho glucose ikoreshwa mumubiri. Utugingo ngengabuzima twibibyimba twerekana neza cyane ku ishusho kuko zikora cyane kandi zifata glucose nyinshi kuruta selile zisanzwe.

• CT scan (CAT scan): Uburyo bukora urukurikirane rwamashusho arambuye yibice biri mumubiri, nkumugongo, byafashwe muburyo butandukanye. Amashusho yakozwe na mudasobwa ihujwe na mashini ya x-ray. Irangi rishobora guterwa mumitsi cyangwa kumirwa kugirango bifashe ingingo cyangwa ingirangingo kugaragara neza. Ubu buryo nabwo bwitwa computing tomografiya, tomografiya ya mudasobwa, cyangwa mudasobwa ya axial tomografiya.

• PET-CT scan: Uburyo bukomatanya amashusho kuva positron yoherejwe na tomografiya (PET) scan hamwe na tomografi yabazwe (CT). Gusikana PET na CT bikorwa icyarimwe hamwe nimashini imwe. Gusikana hamwe bitanga amashusho arambuye yibice byimbere mumubiri, nkumugongo, kuruta scan itanga yonyine.

Ibintu bimwe bigira ingaruka kubitekerezo (amahirwe yo gukira) hamwe nuburyo bwo kuvura.

Kumenyekanisha biterwa nibi bikurikira:

• Ubwoko bwa plasma selile neoplasm.

• Intambwe yindwara.

• Niba immunoglobuline runaka (antibody) irahari.

• Niba hari impinduka zimwe na zimwe.

• Niba impyiko yangiritse.

• Niba kanseri yitabira kuvurwa kwambere cyangwa kwisubiramo (iragaruka).

Uburyo bwo kuvura buterwa nibi bikurikira:

• Ubwoko bwa plasma selile neoplasm.

• Imyaka nubuzima rusange bwumurwayi.

• Haba hari ibimenyetso, ibimenyetso, cyangwa ibibazo byubuzima, nko kunanirwa nimpyiko cyangwa kwandura, bifitanye isano nindwara.

• Niba kanseri yitabira kuvurwa kwambere cyangwa kwisubiramo (iragaruka).

Icyiciro cya Plasma Cell Neoplasms

INGINGO Z'INGENZI

• Nta sisitemu isanzwe yo kubika gammopathie ya monoclonal ifite akamaro katamenyekanye (MGUS) na plasmacytoma.

• Nyuma yo gupimwa myeloma nyinshi, hakorwa ibizamini kugirango umenye kanseri iri mu mubiri.

• Icyiciro cya myeloma myinshi ishingiye kurwego rwa beta-2-microglobuline na albumine mumaraso.

• Ibyiciro bikurikira bikoreshwa kuri myeloma myinshi:

• Icyiciro cya I myeloma myinshi

• Icyiciro cya II myeloma myinshi

• Icyiciro cya III myeloma myinshi

• Plasma selile neoplasms ntishobora kwitabira kuvurwa cyangwa irashobora kugaruka nyuma yo kuvurwa.

Nta sisitemu isanzwe yo kubika gammopathie ya monoclonal ifite akamaro katamenyekanye (MGUS) na plasmacytoma.

Nyuma yo gupimwa myeloma nyinshi, hakorwa ibizamini kugirango umenye kanseri iri mu mubiri.

Inzira ikoreshwa mu kumenya ingano ya kanseri mu mubiri yitwa kubika. Ni ngombwa kumenya icyiciro kugirango utegure kuvura.

Ibizamini hamwe nuburyo bukurikira birashobora gukoreshwa kugirango umenye umubare wa kanseri mu mubiri:

• Ubushakashatsi bwamagufwa ya skeletale: Mubushakashatsi bwamagufwa ya skeletale, x-imirasire yamagufwa yose mumubiri. X-imirasire ikoreshwa mugushakisha aho igufwa ryangiritse. X-ray ni ubwoko bwingufu zishobora kunyura mumubiri no kuri firime, bigakora ishusho yibice byumubiri.

• MRI . Ubu buryo bwitwa kandi magnetic magnetic resonance imaging (NMRI).

• Amagufwa ya densitometrie: Uburyo bukoresha ubwoko bwihariye bwa x-ray kugirango bapime ubwinshi bwamagufwa.

Icyiciro cya myeloma myinshi ishingiye kurwego rwa beta-2-microglobuline na albumine mumaraso.

Beta-2-microglobuline na albumine biboneka mumaraso. Beta-2-microglobuline ni poroteyine iboneka mu ngirabuzimafatizo za plasma. Albumin igize igice kinini cyamaraso plasma. Irinda amazi gutembera mu mitsi y'amaraso. Izana kandi intungamubiri mu ngingo, kandi itwara imisemburo, vitamine, ibiyobyabwenge, n'ibindi bintu nka calcium, binyuze mu mubiri. Mu maraso y’abarwayi bafite myeloma myinshi, ingano ya beta-2-microglobuline iriyongera kandi alubumu iragabanuka.

Ibyiciro bikurikira bikoreshwa kuri myeloma myinshi:

Icyiciro cya I myeloma myinshi

Mu cyiciro cya I myeloma nyinshi, urwego rwamaraso niki gikurikira:

• urwego rwa beta-2-microglobuline iri munsi ya 3.5 mg / L; na

• urwego rwa albumin ni 3.5 g / dL cyangwa irenga.

Icyiciro cya II myeloma myinshi

Mu cyiciro cya II myeloma myinshi, urugero rwamaraso ruri hagati yurwego rwa mbere nicyiciro cya III.

Icyiciro cya III myeloma myinshi

Mu cyiciro cya III myeloma myinshi, urugero rwamaraso ya beta-2-microglobuline ni 5.5 mg / L cyangwa irenga kandi umurwayi nawe afite kimwe muri ibi bikurikira:

• urwego rwo hejuru rwa lactate dehydrogenase (LDH); cyangwa

• impinduka zimwe muri chromosomes.

Plasma selile neoplasms ntishobora kwitabira kuvurwa cyangwa irashobora kugaruka nyuma yo kuvurwa.

Plasma selile neoplasms yitwa retractory mugihe umubare wama selile ukomeza kwiyongera nubwo hatanzwe ubuvuzi. Plasma selile neoplasms yitwa gusubiramo iyo bagarutse nyuma yo kuvurwa.

Incamake yo kuvura

INGINGO Z'INGENZI

• Hariho uburyo butandukanye bwo kuvura abarwayi bafite plasma selile neoplasme.

• Ubwoko umunani bwo kuvura bukoreshwa:

• Chimoterapi

• Ubundi buryo bwo kuvura ibiyobyabwenge

• Ubuvuzi bugamije

• Imiti myinshi ya chimiotherapie hamwe no guterwa ingirabuzimafatizo

• Immunotherapy

• Imiti ivura imirasire

• Kubaga

• Gutegereza neza

• Ubwoko bushya bwo kuvura burimo kugeragezwa mubigeragezo byamavuriro.

• Uburyo bushya bwo kuvura

• Umuti wa plasma selile neoplasme urashobora gutera ingaruka mbi.

• Hitaweho ubufasha bugamije kugabanya ibibazo biterwa n'indwara cyangwa kuyivura.

• Abarwayi barashobora kwifuza gutekereza kubijyanye no kwipimisha kwa muganga.

• Abarwayi barashobora kwipimisha kwa muganga mbere, mugihe, cyangwa nyuma yo gutangira kuvura kanseri.

• Ibizamini byo gukurikirana birashobora gukenerwa.

Hariho uburyo butandukanye bwo kuvura abarwayi bafite plasma selile neoplasme.

Ubwoko butandukanye bwo kuvura burahari kubarwayi bafite plasma selile neoplasme. Bumwe mu buryo busanzwe (ubuvuzi bukoreshwa ubu), kandi bumwe burimo kugeragezwa mubigeragezo byamavuriro. Ikigeragezo kivura ni ubushakashatsi bwakozwe bugamije gufasha kunoza imiti igezweho cyangwa kubona amakuru ku buvuzi bushya ku barwayi ba kanseri. Iyo ibizamini byo kwa muganga byerekana ko ubuvuzi bushya buruta ubuvuzi busanzwe, ubuvuzi bushya bushobora kuba ubuvuzi busanzwe. Abarwayi barashobora kwifuza gutekereza kubijyanye no kwipimisha kwa muganga. Ibigeragezo bimwe na bimwe bivura abarwayi batatangiye kwivuza.

Ubwoko umunani bwo kuvura bukoreshwa:

Chimoterapi

Chimoterapi ni umuti wa kanseri ukoresha ibiyobyabwenge kugirango uhagarike imikurire ya kanseri, haba mu kwica selile cyangwa kubabuza gutandukana. Iyo chimiotherapie ifashwe numunwa cyangwa igaterwa mumitsi cyangwa imitsi, imiti yinjira mumaraso kandi irashobora kugera kanseri ya kanseri mumubiri (chimiotherapie sisitemu).

Reba Ibiyobyabwenge Byemewe kuri Myeloma Yinshi nizindi Plasma Cell Neoplasms kubindi bisobanuro.

Ubundi buryo bwo kuvura ibiyobyabwenge

Corticosteroide ni steroid igira ingaruka za antitumor muri myeloma nyinshi.

Ubuvuzi bugamije

Ubuvuzi bugamije ni ubuvuzi bukoresha ibiyobyabwenge cyangwa ibindi bintu kugirango umenye kandi utere kanseri yihariye ya kanseri. Ubuvuzi bugamije bushobora guteza ingaruka mbi ku ngirabuzimafatizo zisanzwe kuruta imiti ya chimiotherapie cyangwa imiti ivura imirasire. Ubwoko butandukanye bwo kuvura bushobora gukoreshwa mu kuvura myeloma nyinshi hamwe nizindi plasma zo mu bwoko bwa plasma. Hariho ubwoko butandukanye bwo kuvura:

• Ubuvuzi bwa Proteasome inhibitor: Ubu buvuzi buhagarika ibikorwa bya proteasomes muri selile kanseri. Proteasome ni poroteyine ikuraho izindi poroteyine zitagikenewe na selile. Iyo poroteyine zidakuwe mu ngirabuzimafatizo, ziriyubaka kandi zishobora gutera kanseri ya kanseri. Bortezomib, carfilzomib, na ixazomib ni intungamubiri za proteasome zikoreshwa mukuvura myeloma nyinshi nizindi plasma ya neoplasme.

• Ubuvuzi bwa antibody ya Monoclonal: Ubu buvuzi bukoresha antibodies zakozwe muri laboratoire, uhereye mubwoko bumwe bwimikorere ya selile. Iyi antibodies irashobora kumenya ibintu biri muri kanseri ya kanseri cyangwa ibintu bisanzwe bishobora gufasha kanseri gukura. Antibodiyite ifata ibintu kandi ikica selile ya kanseri, ikabuza gukura kwayo, cyangwa ikabuza gukwirakwira. Antibodiyite za Monoclonal zitangwa no gushiramo. Bashobora gukoreshwa bonyine cyangwa gutwara ibiyobyabwenge, uburozi, cyangwa ibikoresho bya radio bikoresha kanseri ya kanseri. Daratumumab na elotuzumab ni antibodiyite za monoclonal zikoreshwa mukuvura myeloma nyinshi nizindi plasma neoplasme. Denosumab ni antibody ya monoclonal ikoreshwa mugutinda gutakaza amagufwa no kugabanya ububabare bwamagufwa kubarwayi barwaye myeloma myinshi.

• Ubuvuzi bwa Histone deacetylase (HDAC): Ubu buryo bwo kuvura buhagarika imisemburo ikenewe mu kugabana kandi bishobora guhagarika imikurire ya kanseri. Panobinostat ni inhibitor ya HDAC ikoreshwa mukuvura myeloma nyinshi hamwe nizindi plasma selile neoplasms.

• Ubuvuzi bwa BCL2 inhibitori: Ubu buvuzi buhagarika poroteyine yitwa BCL2. Guhagarika iyi poroteyine birashobora gufasha kwica kanseri kandi bishobora gutuma bumva neza imiti igabanya ubukana. Venetoclax ni inhibitor ya BCL2 irimo kwigwa mukuvura myeloma isubirwamo cyangwa yangiritse.

Reba Ibiyobyabwenge Byemewe kuri Myeloma Yinshi nizindi Plasma Cell Neoplasms kubindi bisobanuro.

Imiti myinshi ya chimiotherapie hamwe no guterwa ingirabuzimafatizo

Umubare munini wa chimiotherapie utangwa kugirango wice selile. Ingirabuzimafatizo nzima, harimo na selile zikora amaraso, nazo zirasenywa no kuvura kanseri. Gutera ingirabuzimafatizo ni uburyo bwo gusimbuza ingirabuzimafatizo. Ingirabuzimafatizo (selile zidakuze) zivanwa mumaraso cyangwa mumagufa yumurwayi (autologique) cyangwa umuterankunga (allogeneic) hanyuma arakonjeshwa akabikwa. Nyuma yuko umurwayi arangije chimiotherapie, selile stem yabitswe irashonga hanyuma igasubizwa umurwayi binyuze muri infusion. Izi ngirabuzimafatizo zongeye gukoreshwa zikura (kandi zigarura) ingirangingo z'amaraso z'umubiri.

Gutera ingirabuzimafatizo. (Intambwe ya 1): Amaraso yakuwe mumitsi mumaboko yumuterankunga. Umurwayi cyangwa undi muntu ashobora kuba umuterankunga. Amaraso atembera mumashini ikuraho ingirabuzimafatizo. Noneho amaraso asubizwa abaterankunga binyuze mumitsi mumaboko yandi. (Intambwe ya 2): Umurwayi yakira chimiotherapie kugirango yice selile zikora amaraso. Umurwayi arashobora guhabwa imiti ivura imirasire (iterekanwa). (Intambwe ya 3): Umurwayi yakira ingirabuzimafatizo binyuze muri catheter yashyizwe mu maraso mu gituza.

Immunotherapy

Immunotherapy nubuvuzi bukoresha sisitemu yumubiri yumurwayi kurwanya kanseri. Ibintu bikozwe numubiri cyangwa bikozwe muri laboratoire bikoreshwa mukuzamura, kuyobora, cyangwa kugarura umubiri kamere irinda kanseri. Ubu bwoko bwo kuvura kanseri nabwo bwitwa biotherapy cyangwa biologique therapy.

• Ubuvuzi bwa Immunomodulator: Thalidomide, lenalidomide, na pomalidomide ni immunomodulator ikoreshwa mu kuvura myeloma nyinshi hamwe nizindi plasma zo mu bwoko bwa plasma.

• Interferon: Ubu buvuzi bugira ingaruka ku kugabana ingirabuzimafatizo za kanseri kandi birashobora kudindiza imikurire.

• CAR T-selile ivura: Ubu buvuzi buhindura selile T yumurwayi (ubwoko bwimikorere yumubiri) kugirango bazibasire proteine ​​zimwe na zimwe hejuru ya selile kanseri. T selile yakuwe kumurwayi kandi reseptor zidasanzwe zongerwa hejuru yazo muri laboratoire. Ingirabuzimafatizo zahinduwe zitwa chimeric antigen reseptor (CAR) T. Ingirabuzimafatizo za CAR T zikurira muri laboratoire ziha umurwayi infusion. Ingirabuzimafatizo za CAR T zigwira mu maraso y’umurwayi kandi zigatera kanseri. CAR T-selile ivura irimo kwigwa mukuvura myeloma nyinshi yagarutse (garuka).

CAR T-selile. Ubwoko bwo kuvura aho selile ya T yumurwayi (ubwoko bwimikorere yumubiri) ihindurwa muri laboratoire kugirango ihuze ingirangingo za kanseri ikabica. Amaraso ava mumitsi mumaboko yumurwayi anyura mumiyoboro yerekeza mumashini ya aperesi (iterekanwa), ikuraho selile yera, harimo na selile T, kandi igasubiza amaraso asigaye kumurwayi. Hanyuma, gene ya reseptor idasanzwe yitwa chimeric antigen reseptor (CAR) yinjizwa muri selile T muri laboratoire. Amamiriyoni ya selile CAR T akura muri laboratoire hanyuma agahabwa umurwayi yatewe. Ingirabuzimafatizo za CAR T zishobora guhuza antigen kuri selile ya kanseri ikabica.

Reba Ibiyobyabwenge Byemewe kuri Myeloma Yinshi nizindi Plasma Cell Neoplasms kubindi bisobanuro.

Imiti ivura imirasire

Imishwarara ivura ni imiti ikoresha kanseri ikoresha ingufu nyinshi za x-imirasire cyangwa ubundi bwoko bwimirasire yica kanseri cyangwa ikabuza gukura. Imiti ivura hanze ikoresha imashini hanze yumubiri kugirango yohereze imirasire yerekeza kumubiri hamwe na kanseri.

Kubaga

Kubaga gukuramo ikibyimba birashobora gukorwa. Muganga amaze gukuraho kanseri zose zishobora kugaragara mugihe cyo kubagwa, abarwayi bamwe bashobora guhabwa imiti ivura imirasire nyuma yo kubagwa kugirango bice selile zose zisigaye. Umuti watanzwe nyuma yo kubagwa, kugirango ugabanye ibyago ko kanseri izagaruka, byitwa kuvura indwara.

Gutegereza neza

Gutegereza witonze ni ugukurikiranira hafi uko umurwayi ameze atabanje kwivuza kugeza ibimenyetso cyangwa ibimenyetso bigaragara cyangwa bihindutse.

Ubwoko bushya bwo kuvura burimo kugeragezwa mubigeragezo byamavuriro.

Iki gice cyincamake gisobanura imiti irimo kwigwa mubigeragezo byamavuriro. Ntishobora kuvuga ubuvuzi bushya burimo kwigwa. Amakuru yerekeye ibizamini byamavuriro araboneka kurubuga rwa NCI.

Uburyo bushya bwo kuvura

Igeragezwa rya Clinical ryiga uburyo butandukanye bwo gukingira indwara, chimiotherapie, kuvura steroid, hamwe nibiyobyabwenge. Uburyo bushya bwo kuvura ukoresheje selinexor nabwo burimo kwigwa.

Umuti wa plasma selile neoplasme urashobora gutera ingaruka mbi.

Kumakuru yingaruka ziterwa no kuvura kanseri, reba urupapuro rwuruhande rwacu.

Hitaweho ubufasha bugamije kugabanya ibibazo biterwa n'indwara cyangwa kuyivura.

Ubu buvuzi bugenzura ibibazo cyangwa ingaruka ziterwa n'indwara cyangwa kuyivura, kandi bikazamura imibereho. Ubuvuzi bufasha butangwa mugukemura ibibazo biterwa na myeloma nyinshi nizindi plasma selile neoplasms.

Ubuvuzi bufasha bushobora kubamo ibi bikurikira:

• Plasmapheresis: Niba amaraso abaye umubyimba wa poroteyine ziyongera kandi bikabangamira gutembera, plasmapheresi ikorwa kugirango ikureho plasma na proteyine ziyongera mu maraso. Muri ubu buryo, amaraso akurwa kumurwayi hanyuma akoherezwa hakoreshejwe imashini itandukanya plasma (igice cyamazi cyamaraso) na selile yamaraso. Plasma yumurwayi irimo antibodi zidakenewe kandi ntisubizwa umurwayi. Uturemangingo dusanzwe twamaraso dusubizwa mumaraso hamwe na plasma yatanzwe cyangwa gusimbuza plasma. Plasmapheresis ntabwo ibuza antibodi nshya gukora.

• Imiti myinshi ya chimiotherapie hamwe no guterwa ingirangingo fatizo: Niba amyloidose ibaye, ubuvuzi bushobora kuba bukubiyemo imiti myinshi ya chimiotherapie ikurikirwa no guterwa ingirabuzimafatizo ukoresheje ingirabuzimafatizo z'umurwayi.

• Immunotherapy: Immunotherapy hamwe na thalidomide, lenalidomide, cyangwa pomalidomide ihabwa kuvura amyloidose.

• Ubuvuzi bugamije: Ubuvuzi bugamije hamwe na proteasome inhibitor butangwa kugirango hagabanuke urugero immunoglobuline M iri mumaraso no kuvura amyloidose. Ubuvuzi bugamije hamwe na antibody ya monoclonal itangwa kugirango igabanuka ryamagufwa kandi igabanye ububabare bwamagufwa.

• Ubuvuzi bwimirasire: Ubuvuzi bwimirasire butangwa kumagufa yomugongo.

• Chimiotherapie: Chimiotherapie itangwa kugirango igabanye ububabare bwumugongo buterwa na osteoporose cyangwa kuvunika kwumugongo.

• Ubuvuzi bwa Bisphosphonate: Ubuvuzi bwa Bisphosphonate butangwa kugirango ugabanye amagufwa gahoro kandi bigabanye ububabare bwamagufwa. Reba incamake ya ikurikira kubindi bisobanuro kuri bisphosifone nibibazo bijyanye nikoreshwa ryabyo:

• Ububabare bwa Kanseri

• Ingorane zo mu kanwa za Chimiotherapie n'umutwe / Imirasire y'ijosi

Abarwayi barashobora kwifuza gutekereza kubijyanye no kwipimisha kwa muganga.

Ku barwayi bamwe, kwitabira ikizamini cyamavuriro birashobora kuba uburyo bwiza bwo kuvura. Ibigeragezo bivura biri mubikorwa byubushakashatsi bwa kanseri. Igeragezwa rya Clinical rikorwa kugirango hamenyekane niba imiti mishya ya kanseri itekanye kandi ifite akamaro cyangwa nziza kuruta ubuvuzi busanzwe.

Benshi mubuvuzi busanzwe bwa kanseri bushingiye kubigeragezo byambere byubuvuzi. Abarwayi bitabiriye kwipimisha barashobora kuvurwa bisanzwe cyangwa kuba mubambere bahawe imiti mishya.

Abarwayi bitabira ibizamini byo kwa muganga nabo bafasha kunoza uburyo kanseri izavurwa mugihe kizaza. Nubwo ibigeragezo bivura bitaganisha ku buvuzi bushya, akenshi basubiza ibibazo byingenzi kandi bigafasha gutera imbere ubushakashatsi.

Abarwayi barashobora kwipimisha kwa muganga mbere, mugihe, cyangwa nyuma yo gutangira kuvura kanseri.

Igeragezwa rimwe na rimwe ririmo abarwayi bataravurwa. Ibindi bigeragezo bipima abarwayi bafite kanseri itameze neza. Hariho kandi ibizamini byo kwa muganga bipima uburyo bushya bwo guhagarika kanseri kongera kugaruka (kugaruka) cyangwa kugabanya ingaruka zo kuvura kanseri.

Igeragezwa rya Clinical ririmo kubera mu bice byinshi by'igihugu. Amakuru yerekeye ibizamini byamavuriro ashyigikiwe na NCI urashobora kubisanga kurubuga rwa NCI. Ibizamini bya Clinical bishyigikiwe nandi mashyirahamwe murashobora kubisanga kurubuga rwa ClinicalTrials.gov.

Ibizamini byo gukurikirana birashobora gukenerwa.

Bimwe mubizamini byakozwe mugupima kanseri cyangwa kumenya icyiciro cya kanseri birashobora gusubirwamo. Ibizamini bimwe bizasubirwamo kugirango harebwe uburyo ubuvuzi bukora neza. Ibyemezo bijyanye no gukomeza, guhindura, cyangwa guhagarika ubuvuzi birashobora gushingira kubisubizo byibi bizamini.

Bimwe mubizamini bizakomeza gukorwa buri gihe nyuma yubuvuzi burangiye. Ibisubizo by'ibi bizamini birashobora kwerekana niba ubuzima bwawe bwarahindutse cyangwa niba kanseri yarongeye (garuka). Ibi bizamini rimwe na rimwe byitwa gukurikirana-ibizamini cyangwa kugenzura.

Umuti wa Monoclonal Gammopathie yingirakamaro itamenyekanye

Kumakuru yerekeye imiti yavuzwe hepfo, reba igice cyo kuvura.

Kuvura gammopathie ya monoclonal ifite akamaro katamenyekanye (MGUS) mubisanzwe itegereje. Kwipimisha buri gihe kugirango harebwe urugero rwa poroteyine M mu maraso no kwisuzumisha ku mubiri kugira ngo hamenyekane ibimenyetso cyangwa ibimenyetso bya kanseri bizakorwa.

Koresha ubushakashatsi bwamavuriro kugirango ushakishe NCI ifashwa na kanseri ivura abarwayi. Urashobora gushakisha ibigeragezo ukurikije ubwoko bwa kanseri, imyaka yumurwayi, n’aho ibizamini bikorerwa. Amakuru rusange yerekeye ibizamini byamavuriro nayo arahari.

Kuvura Plasmacytoma Yigunze

Kumakuru yerekeye imiti yavuzwe hepfo, reba igice cyo kuvura.

Kuvura plasmacytoma yonyine yamagufwa mubisanzwe ni imiti ivura amagufwa.

Koresha ubushakashatsi bwamavuriro kugirango ushakishe NCI ifashwa na kanseri ivura abarwayi. Urashobora gushakisha ibigeragezo ukurikije ubwoko bwa kanseri, imyaka yumurwayi, n’aho ibizamini bikorerwa. Amakuru rusange yerekeye ibizamini byamavuriro nayo arahari.

Kuvura Plasmacytoma idasanzwe

Kumakuru yerekeye imiti yavuzwe hepfo, reba igice cyo kuvura.

Kuvura plasmacytoma idasanzwe irashobora kubamo ibi bikurikira:

• Imishwarara ivura ikibyimba hamwe na lymph node hafi.

• Kubaga, mubisanzwe bikurikirwa no kuvura imirasire.

• Gutegereza witonze nyuma yubuvuzi bwambere, hakurikiraho kuvura imirasire, kubaga, cyangwa chimiotherapie niba ikibyimba gikuze cyangwa gitera ibimenyetso cyangwa ibimenyetso.

Koresha ubushakashatsi bwamavuriro kugirango ushakishe NCI ifashwa na kanseri ivura abarwayi. Urashobora gushakisha ibigeragezo ukurikije ubwoko bwa kanseri, imyaka yumurwayi, n’aho ibizamini bikorerwa. Amakuru rusange yerekeye ibizamini byamavuriro nayo arahari.

Umuti wa Myeloma myinshi

Kumakuru yerekeye imiti yavuzwe hepfo, reba igice cyo kuvura.

Abarwayi badafite ibimenyetso cyangwa ibimenyetso ntibashobora gukenera kuvurwa. Aba barwayi barashobora gutegereza neza kugeza ibimenyetso cyangwa ibimenyetso bigaragara.

Iyo ibimenyetso cyangwa ibimenyetso bigaragara, hari ibyiciro bibiri kubarwayi bakira:

• Abarwayi bato, babishoboye bemerewe guterwa ingirangingo.

• Abarwayi bakuze, badakwiriye batemerewe guterwa ingirangingo.

Abarwayi barengeje imyaka 65 mubisanzwe bafatwa nkabato kandi bakwiriye. Abarwayi barengeje imyaka 75 ntibemerewe guterwa ingirangingo. Ku barwayi bari hagati yimyaka 65 na 75, imyitozo igenwa nubuzima bwabo muri rusange nibindi bintu.

Ubuvuzi bwa myeloma nyinshi bukorwa mubice:

• Ubuvuzi bwa Induction: Iki nicyiciro cya mbere cyo kuvura. Intego yacyo ni ukugabanya umubare windwara, kandi irashobora gushiramo kimwe cyangwa byinshi muribi bikurikira:

• Ku barwayi bato, babishoboye (bemerewe guhindurwa):

• Chimoterapi.

• Ubuvuzi bugamije hamwe na proteasome inhibitor (bortezomib).

• Immunotherapy (lenalidomide).

• Ubuvuzi bwa Corticosteroid.

• Ku barwayi bakuze, badakwiriye (ntibemerewe guhindurwa):

• Chimoterapi.

• Ubuvuzi bugamije hamwe na proteasome inhibitor (bortezomib cyangwa carfilzomib) cyangwa antibody ya monoclonal (daratumumab).

• Immunotherapy (lenalidomide).

• Ubuvuzi bwa Corticosteroid.

• Guhuriza hamwe imiti ya chimiotherapie: Iki nicyiciro cya kabiri cyo kuvura. Umuti mugice cyo guhuriza hamwe nukwica selile zose zisigaye. Imiti myinshi ya chimiotherapie ikurikirwa na:

• insimburangingo imwe ya autologique stem selile, aho hakoreshwa ingirabuzimafatizo yumurwayi kuva mumaraso cyangwa mumagufa; cyangwa

• insimburangingo ebyiri zo mu bwoko bwa autologique zikurikirwa na autologique cyangwa allogeneic stem selile selile, aho umurwayi yakira ingirabuzimafatizo ziva mumaraso cyangwa igufwa ryumuterankunga; cyangwa

• imwe ya allogeneic stem selile transplant.

• Ubuvuzi bwo gufata neza: Nyuma yubuvuzi bwambere, ubuvuzi bwo kubungabunga akenshi butangwa kugirango bufashe gukomeza indwara mugihe kirekire. Ubwoko butandukanye bwo kuvura burimo kwigwa kugirango ukoreshwe, harimo ibi bikurikira:

• Chimoterapi.

• Immunotherapy (interferon cyangwa lenalidomide).

• Ubuvuzi bwa Corticosteroid.

• Ubuvuzi bugamije hamwe na proteasome inhibitor (bortezomib cyangwa ixazomib).

Koresha ubushakashatsi bwamavuriro kugirango ushakishe NCI ifashwa na kanseri ivura abarwayi. Urashobora gushakisha ibigeragezo ukurikije ubwoko bwa kanseri, imyaka yumurwayi, n’aho ibizamini bikorerwa. Amakuru rusange yerekeye ibizamini byamavuriro nayo arahari.

Umuti wo Gusubiramo cyangwa Kwisubiramo Byinshi Myeloma

Kumakuru yerekeye imiti yavuzwe hepfo, reba igice cyo kuvura.

Umuti wa myeloma wongeye gusubiramo cyangwa wangiritse ushobora kuba urimo ibi bikurikira:

• Gutegereza neza abarwayi bafite uburwayi buhamye.

• Ubuvuzi butandukanye nubuvuzi bumaze gutangwa, kubarwayi bafite ikibyimba cyakomeje kwiyongera mugihe cyo kuvura. (Reba uburyo bwinshi bwo kuvura Myeloma.)

• Imiti imwe yakoreshejwe mbere yisubiramo irashobora gukoreshwa mugihe gusubiramo bibaye nyuma yumwaka umwe cyangwa myinshi nyuma yubuvuzi bwambere. (Reba uburyo bwinshi bwo kuvura Myeloma.)

Ibiyobyabwenge byakoreshejwe bishobora kubamo ibi bikurikira:

• Ubuvuzi bugamije hamwe na antibodiyite za monoclonal (daratumumab cyangwa elotuzumab).

• Ubuvuzi bugamije hamwe na proteasome inhibitor (bortezomib, carfilzomib, cyangwa ixazomib).

• Immunotherapy (pomalidomide, lenalidomide, cyangwa thalidomide).

• Chimoterapi.

• Histone deacetylase inhibitor ivura hamwe na panobinostat.

• Ubuvuzi bwa Corticosteroid.

• Ikigeragezo cyamavuriro ya CAR T-selile.

• Igeragezwa rya clinique yubuvuzi bugamije hamwe na molekile ntoya (selinexor) hamwe nubuvuzi bwa corticosteroid.

• Igeragezwa rya clinique yubuvuzi bugamije hamwe na BCL2 inhibitor (venetoclax).

Koresha ubushakashatsi bwamavuriro kugirango ushakishe NCI ifashwa na kanseri ivura abarwayi. Urashobora gushakisha ibigeragezo ukurikije ubwoko bwa kanseri, imyaka yumurwayi, n’aho ibizamini bikorerwa. Amakuru rusange yerekeye ibizamini byamavuriro nayo arahari.

Kugira ngo Wige byinshi kuri Plasma Cell Neoplasms

Kubindi bisobanuro byaturutse mu kigo cyigihugu cya kanseri kubyerekeye myeloma nyinshi nizindi plasma plasma neoplasms, reba ibi bikurikira:

• Multi Myeloma / Izindi Plasma Cell Neoplasms Urupapuro rwurugo

• Ibiyobyabwenge Byemewe kuri Myeloma myinshi nizindi Plasma Cell Neoplasms

• Intego zo kuvura Kanseri

• Gutera Amaraso Yimitsi Yimitsi

• Immunotherapy yo kuvura Kanseri

Kumakuru rusange ya kanseri nibindi bikoresho biva mu kigo cyigihugu cya kanseri, reba ibi bikurikira:

• Ibyerekeye Kanseri

• Gutegura

• Chimiotherapie nawe: Inkunga kubantu barwaye Kanseri

• Ubuvuzi bwimirasire nawe: Inkunga kubantu barwaye Kanseri

• Guhangana na Kanseri

• Ibibazo byo Kubaza Muganga wawe kuri Kanseri

• Abacitse ku icumu n'abarezi

Gutondekanya itariki Gutondekanya amanota

Emera igitekerezo auto-refresher

Ongeraho igitekerezo cyawe

urukundo.co yakira ibitekerezo byose . Niba udashaka kumenyekana, iyandikishe cyangwa winjire . Nubuntu.