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Unyango lwe-Non-Hodgkin Lymphoma Treatment (®) -Ingxelo yePatient

Ulwazi ngokubanzi malunga ne-Hodgkin Lymphoma yobuntwana

IINGONGOMA EZIPHAMBILI

• Ubuntwana obungeyi-Hodgkin lymphoma sisifo apho iiseli ezinobungozi (zomhlaza) zenza inkqubo ye-lymph.

• Ezona ntlobo ziphambili ze-lymphoma ziHodgkin lymphoma kunye ne-non-Hodgkin lymphoma.

• Zintathu iintlobo eziphambili zobuntwana ezingezizo iHodgkin lymphoma.

• Ukuqola kwe-B-cell non-Hodgkin lymphoma

• I-lymphoblastic lymphoma

• I-Anaplastic cell cell enkulu

• Ezinye iintlobo ze-non-Hodgkin lymphoma zinqabile ebantwaneni.

• Unyango lwangaphambili lomhlaza kunye nokuba namandla omzimba atyhafileyo kuchaphazela umngcipheko wokuba ne-non-Hodgkin lymphoma yobuntwana.

• Iimpawu zobuntwana ezingezo-Hodgkin lymphoma zibandakanya iingxaki zokuphefumla kunye nokudumba kwe-lymph node.

• Uvavanyo oluvavanya umzimba kunye nenkqubo ye-lymph lusetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa isifo sobuntwana esingeyoHodgkin lymphoma.

• I-biopsy yenziwa ukufumanisa isifo sobuntwana esingeyoHodgkin lymphoma.

• Izinto ezithile zichaphazela ukuxela kwangaphambili (ithuba lokufumana kwakhona) kunye nokhetho lonyango.

Ubuntwana obungeyi-Hodgkin lymphoma sisifo apho iiseli ezinobungozi (zomhlaza) zenza inkqubo ye-lymph.

Ubuntwana obungeyi-Hodgkin lymphoma luhlobo lomhlaza olwenzeka kwinkqubo ye-lymph, eyinxalenye yenkqubo yomzimba yokuzikhusela. Inceda ukukhusela umzimba kusulelo nakwizifo.

Inkqubo ye-lymph yenziwe ngezi zinto zilandelayo:

• Lymph: Umbala, ulwelo olunamanzi oluhamba ngemithambo ye-lymph kwaye luphethe ii-lymphocyte ze-T kunye ne-B. IiLymphocyte ziluhlobo lweeseli ezimhlophe zegazi.

• Imikhumbi ye-Lymph: Uthungelwano lweetyhubhu ezibhityileyo eziqokelela i-lymph kwiindawo ezahlukeneyo zomzimba kwaye ziyibuyisele kwigazi.

• Iimpawu zeLymph: ezincinci, ezimilise ubhontshisi ezicoca ulusu kwaye zigcine iiseli ezimhlophe zegazi ezinceda ukulwa usulelo kunye nezifo. Iimpawu ze-lymph zifunyenwe kunye nenethiwekhi yemithambo ye-lymph kuwo wonke umzimba. Amaqela e-lymph node afunyanwa entanyeni, ngaphantsi kwekhwapha, kwi-mediastinum, kwisisu, kwi-pelvis, nakwi-groin.

• I-Spleen: Ilungu elenza ii-lymphocyte, ligcina iiseli ezibomvu zegazi kunye nee-lymphocyte, zihluza igazi, zitshabalalise iiseli zegazi ezindala. I-spleen ikwicala lasekhohlo lesisu kufutshane nesisu.

• I-Thymus: Ilungu apho ii-lymphocyte ze-T zikhula kwaye zanda. I-thymus isesifubeni emva kwethambo lesifuba.

• Iitoni: Amabini amancinci amancinci e-lymph emva komqala. Kukho itoni enye kwicala ngalinye lomqala.

• Umongo wethambo: Isithambo esithambileyo, esinesiponji embindini wamathambo athile, anjengethambo lesinqe kunye nethambo lesifuba. Iiseli ezimhlophe zegazi, iiseli ezibomvu zegazi, kunye neeplatelets zenziwe kumongo wethambo.

I-Anatomy yenkqubo ye-lymph, ebonisa iinqanawa ze-lymph kunye nezitho ze-lymph ezibandakanya i-lymph nodes, i-tonsils, i-thymus, i-spleen kunye nomongo wethambo. I-Lymph (i-fluid ecacileyo) kunye nee-lymphocyte zihamba kwiinqanawa ze-lymph nakwii-lymph nodes apho i-lymphocytes zitshabalalisa izinto ezinobungozi. I-lymph ingena egazini ngomthambo omkhulu kufutshane nentliziyo.

I-non-Hodgkin lymphoma ingaqala kwii-lymphocyte ze-B, ii-lymphocyte ze-T, okanye iiseli zokubulala zendalo. I-lymphocyte inokufumaneka egazini kwaye iqokelele kwii-lymph node, spleen, kunye ne-thymus.

Izicubu ze-lymph ziyafumaneka nakwezinye iindawo zomzimba ezinje ngesisu, idlala lengqula, ingqondo kunye nolusu.

I-non-Hodgkin lymphoma inokwenzeka kubantu abadala nakubantwana. Unyango lwabantwana lwahlukile kunonyango lwabantu abadala. Jonga ezi zishwankathelo zilandelayo ze- ngolwazi malunga nonyango lwe-non-Hodgkin lymphoma kubantu abadala:

• I-Lymphoma yabantu abadala engekho kwiHodgkin

• Unyango lwe-CNS lweLymphoma

• Unyango lweMycosis Fungoides (kubandakanya i-Sezary Syndrome)

Ezona ntlobo ziphambili ze-lymphoma ziHodgkin lymphoma kunye ne-non-Hodgkin lymphoma.

IiLymphomas zahlulwe zaziindidi ezimbini ngokubanzi: iHodgkin lymphoma kunye ne-non-Hodgkin lymphoma. Esi sishwankathelo simalunga nonyango lobuntwana olungenayo iHodgkin lymphoma. Jonga isishwankathelo se- soNyango lweHodgkin Lymphoma yonyango ngolwazi malunga nobuntwana beHodgkin lymphoma.

Zintathu iintlobo eziphambili zobuntwana ezingezizo iHodgkin lymphoma.

Uhlobo lwe-lymphoma lunqunywe yindlela iiseli ezibukeka ngayo phantsi kwe-microscope. Ezi ntlobo zintathu ziphambili zobuntwana ezingezo-Hodgkin lymphoma zezi:

Ukuqola kwe-B-cell non-Hodgkin lymphoma

Ukukhula kwe-B-cell non-Hodgkin lymphomas kubandakanya:

• IBurkitt kunye neBurkitt-efana ne-lymphoma / leukemia: IBurkitt lymphoma kunye neBurkitt leukemia ziindlela ezahlukeneyo zesifo esinye. I-Burkitt lymphoma / leukemia sisifo esinobundlongondlongo (esikhula ngokukhawuleza) kwii-lymphocyte ze-B ezixhaphakileyo ebantwaneni nakubantu abadala abancinci. Ingenzeka esiswini, iringi kaWaldeyer, amasende, ithambo, umongo wethambo, ulusu, okanye inkqubo ye-nervous system (CNS). I-leukemia yeBurkitt ingaqala kwii-lymph node njengeBurkitt lymphoma kwaye isasazeke egazini kunye nomongo wethambo, okanye ingaqala egazini nasemnkantsheni wethambo ngaphandle kokwenza ii-lymph node kuqala.

Zombini iBurkitt leukemia kunye neBurkitt lymphoma zinxulunyaniswe nosulelo kwi-Epstein-Barr virus (EBV), nangona usulelo lwe-EBV lusenokwenzeka kwizigulana eziseAfrika kunaseMelika. IBurkitt kunye neBurkitt-efana ne-lymphoma / leukemia ifunyaniswa xa isampulu yethishu ihlolwe kwaye utshintsho oluthile kuhlobo lwe-MYC lufunyenwe.

• Ukusasaza i-B-cell lymphoma enkulu: Ukusasaza i-B-cell lymphoma enkulu lolona hlobo luqhelekileyo lwe-non-Hodgkin lymphoma. Luhlobo lwe-B-cell non-Hodgkin lymphoma ekhula ngokukhawuleza kwii-lymph node. I-spleen, isibindi, umongo wethambo, okanye ezinye izitho zihlala zichaphazeleka. Ukusasaza i-B-cell lymphoma enkulu kwenzeka rhoqo kulutsha kunakubantwana.

• I-B-cell lymphoma yokuqala : Uhlobo lwe-lymphoma olukhula kwiiseli ze-B kwi-mediastinum (indawo engasemva kwesifuba sesifuba). Ingasasazeka kwizitho ezikufuphi kubandakanya imiphunga kunye nengxowa ejikeleze intliziyo. Ingasasazeka kwii-lymph node kunye nezitho ezikude kubandakanya nezintso. Kubantwana nakwishumi elivisayo, i-B-cell lymphoma ephambili ye-mediastinal yenzeka rhoqo kulutsha oludala.

I-lymphoblastic lymphoma

I-lymphoblastic lymphoma luhlobo lwe-lymphoma echaphazela ikakhulu i-T-cell lymphocyte. Ihlala ifom kwi-mediastinum (indawo engasemva kwethambo lesifuba). Oku kubangela ingxaki yokuphefumla, ukuvutha, ingxaki yokuginya, okanye ukudumba kwentloko nentamo. Isenokusasazeka kwii-lymph node, ithambo, umongo wethambo, ulusu, i-CNS, izitho zesisu kunye nezinye iindawo. I-lymphoblastic lymphoma ifana ne-lymphoblastic leukemia (YONKE).

I-Anaplastic cell cell enkulu

I-Anaplastic cell cell lymphoma luhlobo lwe-lymphoma echaphazela ikakhulu i-T-cell lymphocyte. Ihlala yenzeka kwii-lymph node, ulusu, okanye ithambo, kwaye ngamanye amaxesha ifom yamathumbu, isisu, umphunga, izicwili ezigubungela imiphunga kunye nesihlunu. Izigulana ezine-aplastic cell cell enkulu ene-receptor, ebizwa ngokuba yi-CD30, kumphezulu weeseli zazo. Kubantwana abaninzi, i-anaplastic cell cell lymphoma iphawulwa ngotshintsho kwi-ALK gene eyenza iprotein ebizwa ngokuba yi-anaplastic lymphoma kinase. Ugqirha wezifo ujonga olu tshintsho lweseli kunye nofuzo ukunceda ukufumanisa isifo se-lymphoma enkulu.

Ezinye iintlobo ze-non-Hodgkin lymphoma zinqabile ebantwaneni.

Ezinye iintlobo zobuntwana ezingezo-Hodgkin lymphoma aziqhelekanga. Oku kubandakanya:

• Uhlobo lwabantwana lwe-follicular lymphoma: Kubantwana, i-follicular lymphoma yenzeka ikakhulu emadodeni. Kungenzeka ukuba ifumaneke kwindawo enye kwaye ingasasazeki kwezinye iindawo emzimbeni. Ihlala ibumba kwiitoni kunye nakwii-lymph node entanyeni, kodwa inokubakho nakumatyhalarha, kwizintso, kumathambo esiswini, nakwincindi yamathe.

• I-Marginal zone lymphoma: I- Marginal zone lymphoma luhlobo lwe-lymphoma ekhula kwaye isasazeke kancinci kwaye ihlala ifumaneka kwinqanaba lokuqala. Inokufumaneka kwii-lymph node okanye kwiindawo ezingaphandle kwe-lymph nodes. Indawo yangaphantsi ye-lymphoma efumaneka ngaphandle kwe-lymph node ebantwaneni ibizwa ngokuba zii-lymphoid tissue (MALT) lymphoma. I-MALT inokunxulunyaniswa nosulelo lwe-Helicobacter pylori yendlela yesisu kunye nosulelo lweChlamydophila psittaci lwenwebu yokudibana ehambisa iliso.

• Inkqubo yokuqala ye-nervous system (CNS) i-lymphoma: I- CNS ye-primary lymphoma inqabile kakhulu kubantwana.

• I-Peripheral T-cell lymphoma: I-Peripheral T-cell lymphoma yinto enobundlobongela (ekhula ngokukhawuleza) engekho i-Hodgkin lymphoma eqala kwii-lymphocyte ezivuthiweyo. Ii-lymphocyte ze-T zikhula kwi-thymus gland kwaye ziye kwezinye iindawo zenkqubo ye-lymph, ezinje ngee-lymph node, umongo wethambo kunye nodakada.

• I-T-cell lymphoma enqamlezileyo : I- T-cell lymphoma eqingqiweyo iqala kulusu kwaye inokubangela ukuba ulusu lutshise okanye lwenze ithumba. Inqabile kakhulu ebantwaneni, kodwa ixhaphake kakhulu kulutsha nakubantu abadala abancinci. Kukho iintlobo ezahlukeneyo ze-T-cell lymphoma ezinqamlezileyo, ezinje nge-lymphoma enkulu, i-panniculitis-efana ne-T-cell lymphoma, i-gamma-delta T-cell lymphoma, kunye ne-mycosis fungoides. I-Mycosis fungoides ayifane yenzeke ebantwaneni nakwishumi elivisayo.

Unyango lwangaphambili lomhlaza kunye nokuba namandla omzimba atyhafileyo kuchaphazela umngcipheko wokuba ne-non-Hodgkin lymphoma yobuntwana.

Nantoni na eyandisa umngcipheko wokufumana isifo ibizwa ngokuba yingozi. Ukuba nomngcipheko akuthethi ukuba uza kuba nomhlaza; ukungabinamngcipheko oko akuthethi ukuba awuzukufumana umhlaza. Thetha nogqirha wakho ukuba ucinga ukuba umntwana wakho usengozini.

Imingcipheko enokubakho yobuntwana engeyiyo iHodgkin lymphoma ibandakanya oku kulandelayo:

• Unyango lwangaphambili lomhlaza.

• Ukosulelwa yintsholongwane kaEpstein-Barr okanye intsholongwane kaGawulayo.

• Ukuba namajoni omzimba abuthathaka emva kokufakelwa okanye kumayeza anikwe emva kokufakelwa.

• Ukuba nezifo ezithile ezizuzwe njengelifa (ezinje nge-DNA yokulungisa ii-syndromes ezibandakanya i-ataxia-telangiectasia, i-Nijmegen breakage syndrome, kunye nokusilela kokulungiswa komgaqo-siseko).

Ukuba isifo se-lymphoma okanye se-lymphoproliferative sinxulunyaniswa nenkqubo yamajoni omzimba ebuthathaka kwizifo ezithile ezizuzwe njengelifa, usulelo lwe-HIV, ukufakelwa okanye amayeza anikwe emva kokufakelwa, imeko leyo ibizwa ngokuba sisifo se-lymphoproliferative esinxulunyaniswa nokungasebenzi komzimba. Iindidi ezahlukeneyo zesifo se-lymphoproliferative ezinxulunyaniswa nokungasebenzi komzimba zibandakanya:

• Isifo seLymphoproliferative esidibene ne-primary immunodeficiency.

• Inxulumene ne-HIV engeyiyo iHodgkin lymphoma.

• Emva kwesifo se-lymphoproliferative isifo.

Iimpawu zobuntwana ezingezo-Hodgkin lymphoma zibandakanya iingxaki zokuphefumla kunye nokudumba kwe-lymph node.

Ezi kunye neminye imiqondiso inokubangelwa kukungabikho kweHodgkin lymphoma yobuntwana okanye ngezinye iimeko. Jonga kugqirha ukuba umntwana wakho unazo ezi zinto zilandelayo:

• Ingxaki yokuphefumla.

• Ukukhawuleza.

• Ukukhohlela.

• Izandi zokuphefumla eziphezulu.

• Ukudumba kwentloko, intamo, umzimba ongaphezulu, okanye iingalo.

• Ingxaki yokuginya.

• Ukudumba okungenasiphelo kwee-lymph node entanyeni, phantsi kwekhwapha, esiswini, okanye emhlubulweni.

• Isigaqa esingenabuhlungu okanye ukudumba kumasende.

• Umkhuhlane ngaphandle kwesizathu esaziwayo.

• Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.

• Ukubila ebusuku.

Uvavanyo oluvavanya umzimba kunye nenkqubo ye-lymph lusetyenziselwa ukufumanisa (ukufumana) kunye nokufumanisa isifo sobuntwana esingeyoHodgkin lymphoma.

Ezi mvavanyo zilandelayo kunye neenkqubo zinokusetyenziswa:

• Uvavanyo lomzimba kunye nembali: Uvavanyo lomzimba ukukhangela iimpawu zempilo ngokubanzi, kubandakanya nokujonga iimpawu zesifo, ezinje ngamaqhuma okanye nayiphi na into ebonakala ingaqhelekanga. Imbali yemikhwa yempilo yesigulana kunye nezifo zangaphambili kunye nonyango ziya kuthathwa.

• Izifundo ze-chemistry yegazi: Inkqubo apho kuvavanywa khona isampulu yegazi ukulinganisa izixa zezinto ezithile ezikhutshelwe egazini ngamalungu kunye nezicubu emzimbeni, kubandakanya i-electrolyte, i-lactate dehydrogenase (LDH), i-uric acid, igazi urea nitrogen (BUN) , i-creatinine, kunye nexabiso lokusebenza kwesibindi. Inani elingaqhelekanga (eliphezulu okanye elisezantsi kunesiqhelo) lwento elinokuba ngumqondiso wesifo.

• Uvavanyo lomsebenzi wesibindi: Inkqubo apho kuvavanywa isampulu yegazi ukulinganisa izixa zezinto ezithile ezikhutshelwe egazini sisibindi. Ixabiso elingaphezulu kwesiqhelo kwento inokuba luphawu lomhlaza.

• Ukuskena i-CT (ukuskena i-CAT): Inkqubo eyenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi emzimbeni, ezithathwe kwii-engile ezahlukeneyo. Imifanekiso yenziwe yikhompyuter edityaniswe kumatshini we-x-ray. Idayi inokufakwa ngaphakathi emthanjeni okanye iginywe ukunceda amalungu okanye izicwili zibonise ngokucacileyo. Le nkqubo ikwabizwa ngokuba yi-computed tomography, ikhompyuter ye-tomography, okanye ikhompyuter ye-axial tomography.

Ikhompyuter ye-tomography (CT) yesisu. Umntwana ulele phezu kwetafile etyibilika ngesikena se-CT, esithatha imifanekiso ye-x-ray engaphakathi esiswini.

• Ukuskena i-PET (positron emission tomography scan) Inkqubo yokufumana iiseli zethumba ezinobungozi emzimbeni. Inani elincinci leswekile ene-radioactive (iswekile) itofelwe emthanjeni. Iskena se-PET sijikeleza ujikeleze umzimba kwaye senze umfanekiso wendawo esetyenziswa kuyo iswekile emzimbeni. Iiseli zethumba ezinobungozi zibonakala ziqaqambile emfanekisweni kuba ziyasebenza kwaye zithatha iswekile eninzi kuneseli eziqhelekileyo. Ngamanye amaxesha i-PET scan kunye ne-CT scan zenziwa ngaxeshanye. Ukuba kukho nawuphi na umhlaza, oku kwandisa amathuba okuba kufumaneke.

Ukuskena i-Positron emission tomography (PET). Umntwana ulele phezu kwetafile etyibilika kwisikena sePET. Ukuphumla kwentloko kunye nomtya omhlophe kunceda umntwana ukuba alale. Inani elincinci leswekile ene-radioactive (iswekile) itofwe emthanjeni womntwana, kwaye iskena senza umfanekiso apho iswekile isetyenziswa khona emzimbeni. Iiseli zomhlaza zibonakala ziqaqambile emfanekisweni kuba zithatha iswekile eninzi kuneseli eziqhelekileyo.

• I-MRI (imaging resonance imaging): Inkqubo esebenzisa umazibuthe, amaza erediyo kunye nekhompyuter ukwenza uthotho lwemifanekiso eneenkcukacha zeendawo ezingaphakathi komzimba. Le nkqubo ikwabizwa ngokuba yimifanekiso yenyukliya yokujonga umfanekiso (i-NMRI).

Imagnetic resonance imaging (MRI) yesisu. Umntwana ulele phezu kwetafile etyibilika kwisikena se-MRI, esithatha imifanekiso engaphakathi komzimba. Iphedi esiswini somntwana inceda ukwenza imifanekiso icace gca.

• Ukugqobhoza iLumbar: Inkqubo esetyenziselwa ukuqokelela i-cerebrospinal fluid (CSF) ukusuka kumqolo womqolo. Oku kwenziwa ngokubeka inaliti phakathi kwamathambo amabini emqolo kunye nakwi-CSF ejikeleze intambo yomqolo kunye nokususa isampulu yolwelo. Isampulu ye-CSF ihlolwe phantsi kwemicroscope ngeempawu zokuba umhlaza usasazekile waya kwingqondo nakumqolo. Le nkqubo ikwabizwa ngokuba yi-LP okanye impompo yomqolo.

Ukugqobhoza iLumbar. Isigulana silele endaweni egobileyo phezu kwetafile. Emva kokuba indawo encinci kumqolo ongezantsi ifakwe inaliti, inaliti yomgogodla (inaliti ende, ebhityileyo) ifakwe kwinxalenye esezantsi yomqolo womqolo ukususa ulwelo lwe-cerebrospinal fluid (CSF, eboniswe ngombala oluhlaza okwesibhakabhaka). Ulwelo lunokuthunyelwa kwilabhoratri kuvavanyo.

• I-x-ray yesifuba: IX-reyi yamalungu namathambo ngaphakathi kwesifuba. IX-reyi luhlobo lwe-beam yamandla enokuhamba emzimbeni nakwifilimu, yenza umfanekiso weendawo ezingaphakathi komzimba.

• Uvavanyo lwe-Ultrasound: Inkqubo apho amaza esandi aphembelela amandla aphezulu (i-ultrasound) akhutshelwa ngaphandle kwizicubu zangaphakathi okanye kwizitho zokwenza i-echoes. Iingqungquthela zenza umfanekiso wezicubu zomzimba ezibizwa ngokuba yi-sonogram. Umfanekiso unokuprintwa ukuze ujongwe kamva.

I-ultrasound yesisu. I-ultrasound transducer edityaniswe kwikhompyuter icinezelwe kulusu lwesisu. I-transducer igxotha amaza esandi kumalungu angaphakathi nakwizicubu ukwenza ii-echoes ezenza i-sonogram (umfanekiso wekhompyuter).

I-biopsy yenziwa ukufumanisa isifo sobuntwana esingeyoHodgkin lymphoma.

Iiseli kunye nezicubu ziyasuswa ngexesha le-biopsy ukuze zibonwe phantsi kwemicroscope ngugqirha wezilwanyana ukujonga imiqondiso yomhlaza. Ngenxa yokuba unyango luxhomekeke kuhlobo lwe-non-Hodgkin lymphoma, iisampulu ze-biopsy kufuneka zihlolwe ngugqirha wezifo onamava ekufumaniseni ubuntwana obungenayo iHodgkin lymphoma.

Enye yezi ndlela zilandelayo zinokwenziwa:

• I-biopsy ekhethekileyo: Ukususwa kwe-lymph node yonke okanye i-lump of tissue.

• Incisional biopsy: Ukususwa kwenxalenye yesigaqa, i-lymph node, okanye isampulu yethishu

• I-biopsy engundoqo: Ukususwa kwethishu okanye inxenye ye-lymph node usebenzisa inaliti ebanzi.

• Fine-inaliti aspiration (FNA) biopsy: Ukususwa kwethishu okanye inxenye ye-lymph node usebenzisa inaliti encinci.

Inkqubo esetyenzisiweyo ukususa isampulu yethishu ixhomekeke ekubeni likhona phi ithumba emzimbeni:

• Umnqweno wethambo kunye ne-biopsy: Ukususwa komongo wethambo kunye neqhekeza elincinci lokufaka inaliti engenamathambo kwi-hipbone okanye kwi-breastbone.

Umnqweno wethambo lomnqweno kunye ne-biopsy. Emva kokuba indawo encinci yolusu iphonyiwe, inaliti yomongo wethambo ifakwa kwithambo lesinqe somntwana. Iisampulu zegazi, ithambo, kunye nomongo wethambo ziyasuswa ukuze zihlolwe phantsi kwemicroscope.

• Mediastinoscopy: Inkqubo yotyando yokujonga amalungu, izicwili kunye ne-lymph node phakathi kwemiphunga yeendawo ezingaqhelekanga. Ukuqhekeka (ukusika) kwenziwa ngaphezulu kwesifuba kunye ne-mediastinoscope ifakwe esifubeni. I-mediastinoscope sisixhobo esibhityileyo, esifana netyhubhu esinokukhanya kunye nelensi yokujonga. Ikwanaso nesixhobo sokususa iisampulu zethishu okanye i-lymph node, ezijongwa phantsi kwemicroscope kwimpawu zomhlaza.

• I-antiastinotomy yangaphakathi: Inkqubo yotyando yokujonga amalungu kunye nezicubu phakathi kwemiphunga naphakathi kwethambo lesifuba nentliziyo kwimimandla engaqhelekanga. Ukuqhawulwa (ukusikwa) kwenziwa ecaleni kwethambo lesifuba kwaye kufakwa i-mediastinoscope esifubeni. I-mediastinoscope sisixhobo esibhityileyo, esifana netyhubhu esinokukhanya kunye nelensi yokujonga. Ikwanaso nesixhobo sokususa iisampulu zethishu okanye i-lymph node, ezijongwa phantsi kwemicroscope kwimpawu zomhlaza. Oku kukwabizwa ngokuba yinkqubo yeClainlain.

• I-Thoracentesis: Ukususwa kolwelo kwisithuba esiphakathi kwempahla yesifuba kunye nemiphunga, kusetyenziswa inaliti. Ugqirha wezifo ujonga ulwelo phantsi kwemicroscope ukukhangela iiseli zomhlaza.

Ukuba umhlaza ufumanekile, kungenziwa ezi mvavanyo zilandelayo ukufundisisa iiseli zomhlaza:

• I-Immunohistochemistry: Uvavanyo lwaselebhu olusebenzisa ii-antibodies ukukhangela ii-antigen ezithile (iimpawu) kwisampulu yesicwili somguli. Amachiza omzimba ahlala enxulunyaniswa ne-enzyme okanye idayi ye-fluorescent. Emva kokuba ii-antibodies zibophelela kwi-antigen ethile kwisampulu yethishu, i-enzyme okanye idayi iyasebenza, kwaye i-antigen iya kuthi emva koko ibonwe phantsi kwemicroscope. Olu hlobo lovavanyo lusetyenziselwa ukufumanisa isifo somhlaza kunye nokunceda uxelele olunye uhlobo lomhlaza kolunye uhlobo lomhlaza.

• Ukuhamba kwe-cytometry: Uvavanyo lwelebhu olulinganisa inani leeseli kwisampulu, ipesenti yeeseli eziphilayo kwisampulu, kunye neempawu ezithile zeeseli, ezinje ngobungakanani, imilo, kunye nobukho beempawu zethumba (okanye ezinye) umphezulu weseli. Iiseli ezivela kwisampulu yegazi lesigulana, umongo wethambo, okanye ezinye izicwili zinamabala edayi ye-fluorescent, ibekwe kulwelo, emva koko idlulise nganye nganye kwitampu yokukhanya. Iziphumo zovavanyo zisekwe kwindlela iiseli ezazinebala ledayi ye-fluorescent zisabela njani kwimbonakalo yokukhanya. Olu vavanyo lusetyenziselwa ukunceda ekuchongeni nasekulawuleni iintlobo ezithile zomhlaza, ezinje ngeleukemia kunye ne-lymphoma.

• Uhlalutyo lweCytogenetic: Uvavanyo lwaselebhu apho ii-chromosomes zeeseli kwisampulu yegazi okanye umongo wethambo zibalwa kwaye zijongwa kulo naluphi na utshintsho, njengokwaphuka, ukulahleka, ukulungiswa ngokutsha, okanye ii-chromosomes ezongezelelweyo. Utshintsho kwii-chromosomes ezithile kunokuba luphawu lomhlaza. Uhlalutyo lweCytogenetic lusetyenziselwa ukunceda ekuchongeni umhlaza, ukucwangcisa unyango, okanye ukufumanisa ukuba lusebenza njani unyango.

• I-FISH (i-fluorescence in situ hybridization): Uvavanyo lwaselebhu olusetyenziselwa ukujonga nokubala ii-genes okanye ii-chromosomes kwiiseli nakwizicubu. Amacandelo e-DNA aqukethe idayi ye-fluorescent yenziwa elebhu kwaye yongezwa kwisampulu yeeseli zomguli okanye izicwili. Xa ezi ziqwenga zeDNA zidayiweyo zinamathela kwimfuza ethile okanye kwiindawo zechromosomes kwisampulu, ziyakhanya xa zijongwa phantsi kwemicroscope ebengezelayo. Uvavanyo lwe-FISH lusetyenziselwa ukunceda ekuchongeni umhlaza kunye nokunceda ekucwangciseni unyango.

• Immunophenotyping: Uvavanyo lwaselabhoratri olusebenzisa izilwa-buhlungu ukufumanisa iiseli zomhlaza ngokusekwe kwiindidi zeantigens okanye iimpawu zokumakisha phezu kweeseli. Olu vavanyo lusetyenziselwa ukunceda ukufumanisa iintlobo ezithile ze-lymphoma.

• Izinto ezithile zichaphazela ukuxela kwangaphambili (ithuba lokufumana kwakhona) kunye nokhetho lonyango.

Ukuxela kwangaphambili (ithuba lokuchacha) kunye nokhetho kunyango luxhomekeke:

• Uhlobo lwe-lymphoma.

• Uphi na apho likhona ithumba emzimbeni xa kufunyaniswa ithumba.

• Inqanaba lomhlaza.

• Nokuba kukho utshintsho oluthile kwii-chromosomes.

• Uhlobo lonyango lokuqala.

• Nokuba i-lymphoma iphendule kunyango lokuqala.

• Iminyaka yesigulana kunye nempilo ngokubanzi.

Amanqanaba obuNtwana boHodgkin Lymphoma

IINGONGOMA EZIPHAMBILI

• Emva kobuntwana i-non-Hodgkin lymphoma ifunyenwe, kuvavanywa ukwenziwa ukufumanisa ukuba iiseli zomhlaza zisasazekile ngaphakathi kwinkqubo ye-lymph okanye kwamanye amalungu omzimba.

• Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

• Amanqanaba alandelayo asetyenziselwa ukungabikho kweHodgkin lymphoma yobuntwana:

• Inqanaba I

• Inqanaba II

• Inqanaba III

• Inqanaba IV

Emva kobuntwana i-non-Hodgkin lymphoma ifunyenwe, kuvavanywa ukwenziwa ukufumanisa ukuba iiseli zomhlaza zisasazekile ngaphakathi kwinkqubo ye-lymph okanye kwamanye amalungu omzimba.

Inkqubo esetyenziselwa ukufumanisa ukuba umhlaza usasazekile ngaphakathi kwenkqubo ye-lymph okanye kwamanye amalungu omzimba kuthiwa yi-staging. Iziphumo zovavanyo kunye neenkqubo ezisetyenziselwa ukuxilonga i-non-Hodgkin lymphoma inokusetyenziselwa ukubeka esiteji. Jonga icandelo loLwazi ngokubanzi malunga nenkcazo yezi mvavanyo kunye neenkqubo. Ulwazi oluqokelelwe kwinkqubo yokubeka inqanaba lesifo. Kubalulekile ukwazi inqanaba ukuze ucwangcise unyango.

Le nkqubo ilandelayo inokusetyenziselwa ukumisela inqanaba:

• Ukuskena amathambo: Inkqubo yokujonga ukuba ngaba kukho iiseli ezahlula ngokukhawuleza, ezinje ngeeseli zomhlaza, emathanjeni. Inani elincinci kakhulu lezinto ezisasazeka ngemitha lifakwa emthanjeni kwaye lihamba ngokuhamba kwegazi. Izinto ezinemitha eqhumayo ziqokelela emathanjeni anomhlaza kwaye zifunyenwe siskena.

Zintathu iindlela umhlaza onwenwa ngayo emzimbeni.

Umhlaza unokusasazeka ngezicubu, inkqubo ye-lymph, kunye negazi:

• Izicubu. Umhlaza usasazeka ukusuka apho waqala ngokukhula waya kwiindawo ezikufuphi.

• Inkqubo yeLymph. Umhlaza usasazeka ukusuka apho waqala ngokungena kwinkqubo ye-lymph. Umhlaza uhamba ngemithambo ye-lymph ukuya kwamanye amalungu omzimba.

• Igazi. Umhlaza usasazeka ukusuka apho waqala ngokungena egazini. Umhlaza uhamba ngemithambo yegazi uye kwamanye amalungu omzimba.

Amanqanaba alandelayo asetyenziselwa ukungabikho kweHodgkin lymphoma yobuntwana:

Inqanaba I

Inqanaba I lobuntwana elingesilo iHodgkin lymphoma. I-Cancer ifunyanwa kwiqela elinye le-lymph nodes okanye enye indawo ngaphandle kwe-lymph nodes, kodwa akukho mhlaza ufunyanwa kwisisu okanye kwi-mediastinum (indawo phakathi kwemiphunga).

Kwinqanaba lobuntwana elingelilo iHodgkin lymphoma, umhlaza ufumaneka:

• kwelinye iqela nkovu iindawo; okanye

• kwindawo enye engaphandle kwe-lymph nodes.

Akukho mhlaza ufunyanwa esiswini okanye kwi-mediastinum (indawo phakathi kwemiphunga).

Inqanaba II

Isigaba II sobuntwana esingenguHodgkin lymphoma. Umhlaza ufumaneka kwindawo enye ngaphandle kwe-lymph node nakwi-lymph node ezikufutshane (a); okanye kwiindawo ezimbini nangaphezulu ngentla (b) okanye ngaphantsi (c) uvalo; okanye umhlaza uqalwe esiswini, kwisihlomelo, okanye emathunjini (d) kwaye ungasuswa ngotyando.

Kwinqanaba II lobuntwana obungenguHodgkin lymphoma, umhlaza ufumaneka:

• kwindawo enye ngaphandle kwe-lymph node nakwi-lymph node ezikufutshane; okanye

• kwiindawo ezimbini okanye nangaphezulu ngaphezulu okanye ngaphantsi kovalo, kwaye inokuba isasazeke kwii-lymph node ezikufuphi; okanye

• ukuba iqalile esiswini okanye emathunjini kwaye ingasuswa ngokupheleleyo ngoqhaqho. Umhlaza unokusasazeka kwiindawo ezithile ezikufuphi.

Inqanaba III

Isigaba III sobuntwana esingenguHodgkin lymphoma. Umhlaza ufumaneka kwindawo enye ubuncinci ngaphezulu nangaphantsi kwesithambisi (a); okanye umhlaza uqale esifubeni (b); okanye umhlaza uqale esiswini kwaye usasazeka kwisisu (c); okanye kwindawo ejikeleze umqolo (awuboniswanga).

Kwinqanaba lesithathu lobuntwana elingelilo iHodgkin lymphoma, umhlaza ufumaneka:

• kwindawo enye ubuncinci ngaphezulu kovalo kwaye kwindawo enye ubuncinci ngaphantsi kovalo; okanye

• ukuba uqale esifubeni; okanye

• ukuba iqalile kwisisu kwaye isasazeka kwisisu; okanye

• kwindawo ejikeleze umqolo.

Inqanaba IV

Isigaba IV sobuntwana esingenguHodgkin lymphoma. Umhlaza ufumaneka kumongo wethambo, kwingqondo, okanye kwi-fluid ye-cerebrospinal fluid (CSF). Umhlaza unokufumaneka nakwezinye iindawo zomzimba.

Kwinqanaba le-IV lobuntwana elingelilo iHodgkin lymphoma, umhlaza ufumaneka kumongo wethambo, kwingqondo, okanye kwi-fluid yecerebrospinal. Umhlaza unokufumaneka nakwezinye iindawo zomzimba.

Ukuphinda-phinda ukungabikho kweHodgkin Lymphoma

Ukuphindaphindeka kobuntwana obungeyiyo iHodgkin lymphoma ngumhlaza ophindaphindiweyo (ubuyile) emva kokuba unyangiwe. Ubuntwana obungeyi-Hodgkin lymphoma bunokubuya kwinkqubo ye-lymph okanye kwezinye iindawo zomzimba.

Unyango ngoKhetho lonyango

IINGONGOMA EZIPHAMBILI

• Kukho iintlobo ezahlukeneyo zonyango lwabantwana abane-non-Hodgkin lymphoma.

• Abantwana abane-non-Hodgkin lymphoma kufuneka unyango lwabo lucwangciswe liqela loogqirha abaziingcali kunyango lomhlaza wabantwana.

• Unyango lwe-non-Hodgkin lymphoma yobuntwana inokubangela iziphumo ebezingalindelekanga.

• Iindidi ezintandathu zonyango zisetyenziswa:

• Unyango ngamayeza

• Unyango ngemitha

• I-dose ephezulu ye-chemotherapy kunye nokufakelwa kweseli

• Unyango ekujoliswe kulo

• Olunye unyango lweziyobisi

• Unyango ngemifanekiso

• Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

• Unyango lwe-Immunotherapy

• Izigulana zinokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi.

• Izigulana zinokungena kuvavanyo lweklinikhi ngaphambi, ngexesha, okanye emva kokuqala unyango lomhlaza.

• Iimvavanyo zokulandelela zisenokufuneka.

Kukho iintlobo ezahlukeneyo zonyango lwabantwana abane-non-Hodgkin lymphoma.

Iindidi ezahlukeneyo zonyango ziyafumaneka kubantwana abane-non-Hodgkin lymphoma. Olunye unyango lusemgangathweni (unyango olusetyenziswayo ngoku), kwaye olunye luvavanywa kuvavanyo lweklinikhi. Uvavanyo lweklinikhi yonyango luphononongo olwenzelwe ukunceda ukuphucula unyango lwangoku okanye ukufumana ulwazi kunyango olutsha kwizigulana ezinomhlaza. Xa uvavanyo lwezonyango lubonisa ukuba unyango olutsha lungcono kunonyango oluqhelekileyo, unyango olutsha kunokuba lunyango olusemgangathweni.

Ukuthatha inxaxheba kuvavanyo lweklinikhi kufuneka kuthathelwe ingqalelo kubo bonke abantwana abane-non-Hodgkin lymphoma. Olunye uvavanyo lwezonyango luvuleleke kuphela kwizigulana ezingaluqalanga unyango.

Abantwana abane-non-Hodgkin lymphoma kufuneka unyango lwabo lucwangciswe liqela loogqirha abaziingcali kunyango lomhlaza wabantwana.

Unyango luya kujongwa yi-oncologist yabantwana, ugqirha ogxile ekunyangeni abantwana abanomhlaza. I-oncologist yabantwana isebenza nabanye ababoneleli ngezempilo abaziingcali ekunyangeni abantwana nge-non-Hodgkin lymphoma kwaye abagxile kwiindawo ezithile zamayeza. Oku kunokubandakanya ezi ngcali zilandelayo:

• Ugqirha wabantwana.

• Imitha ye-oncologist.

• I-hematologist yezilwanyana.

• Ugqirha wabantwana.

• Ingcali yomongikazi wabantwana.

• Ingcali yokuvuselela.

• Ingcali yeengqondo.

• Unontlalontle.

Unyango lwe-non-Hodgkin lymphoma yobuntwana inokubangela iziphumo ebezingalindelekanga.

ngolwazi malunga neziphumo ebezingalindelekanga eziqala ngexesha lonyango lomhlaza, jonga iphepha lethu leZiphumo ebezingalindelekanga.

Iziphumo ebezingalindelekanga ezivela kunyango lomhlaza eziqala emva konyango kwaye ziqhubeke iinyanga okanye iminyaka zibizwa ngokuba ziziphumo ezifike kade. Iziphumo zokunyanga komhlaza zingabandakanya oku kulandelayo:

• Iingxaki zomzimba.

• Utshintsho kwiimvakalelo, iimvakalelo, ukucinga, ukufunda, okanye inkumbulo.

• Umhlaza wesibini (iintlobo ezintsha zomhlaza).

Ezinye iziphumo ezinokufika emva kwexesha zinokunyangwa okanye zilawulwe. Kubalulekile ukuba uthethe noogqirha bomntwana wakho malunga nefuthe unyango lomhlaza olunokuba nalo emntwaneni wakho. (Jonga isishwankathelo se- malunga neZiphumo eziMva zaNyango zoMhlaza woMntwana ngolwazi oluthe kratya.)

Iindidi ezintandathu zonyango zisetyenziswa:

Unyango ngamayeza

I-Chemotherapy yonyango lomhlaza olusebenzisa iziyobisi ukunqanda ukukhula kweeseli zomhlaza, nokuba zibulale iiseli okanye uziyekise ekwahlukaneni. Xa i-chemotherapy ithathwa ngomlomo okanye ifakwe kwi-vein okanye kwimisipha, amachiza angena kwigazi kwaye anokufikelela kwiiseli zomhlaza kuwo wonke umzimba (systemic chemotherapy). Xa i-chemotherapy ibekwe ngqo kwi-cerebrospinal fluid (intrathecal chemotherapy), ilungu, okanye indawo yomzimba efana nesisu, amachiza ikakhulu achaphazela iiseli zomhlaza kwezo ndawo. Ukudibanisa i-chemotherapy yonyango kusetyenziswa amachiza amabini okanye nangaphezulu.

Indlela i-chemotherapy enikezelwa ngayo ixhomekeke kuhlobo kunye nenqanaba lomhlaza ophathwayo.

I-Intrathecal chemotherapy inokusetyenziselwa ukunyanga i-lymphoma yobuntwana engeyiyo iHodgkin ethe yasasazeka, okanye isasazeka kwingqondo. Xa isetyenziselwa ukunciphisa amathuba omhlaza aya kusasazeka kwingqondo, ibizwa ngokuba yi-CNS prophylaxis. I-intrathecal chemotherapy inikwa ukongeza kwi-chemotherapy ngomlomo okanye ngemithambo. Amanqanaba aphezulu e-chemotherapy anokusetyenziswa njenge-CNS prophylaxis.

Unyango lwe-chemotherapy. Amachiza e-anticancer afakwe kwisithuba se-intrathecal, esi sithuba esigcina i-cerebrospinal fluid (CSF, eboniswe ngombala oluhlaza okwesibhakabhaka). Zimbini iindlela zokwenza oku. Enye indlela, eboniswe kwinxalenye ephezulu yomzobo, kukujova amachiza kwindawo yokugcina izilwanyana i-Ommaya (isikhongozeli esimile okomgangatho obekwe phantsi kwentloko entloko ngexesha lotyando; ibamba amachiza njengoko ehamba ngombhobho omncinci esiya kwingqondo ). Enye indlela, eboniswe kwinxalenye esezantsi yomzobo, kukujova amachiza ngqo kwi-CSF kwinxalenye esezantsi yomqolo womqolo, emva kokuba indawo encinci kumqolo ongezantsi ifakwe amanxeba.

Jonga iziyobisi ezivunyiweyo ze-non-Hodgkin Lymphoma ngolwazi oluthe kratya.

Unyango ngemitha

Unyango ngemitha lunyango olusebenzisa amandla aphezulu e-x-reyi okanye ezinye iintlobo zemitha yokubulala iiseli zomhlaza okanye ukuzigcina zikhula. Zimbini iintlobo zonyango lwe-radiation:

• Unyango lwangaphandle lwemitha lusebenzisa umatshini ngaphandle komzimba ukuthumela imitha kumhlaza.

• Unyango lwangaphakathi lwemitha lusebenzisa into enemitha ye-radio etywinwe kwiinaliti, iimbewu, iingcingo, okanye iicatheters ezibekwe ngqo okanye kufutshane nomhlaza.

Indlela unyango lwe-radiation olunikezelwa ngayo ixhomekeke kuhlobo lwe-non-Hodgkin lymphoma ephathwayo. Unyango lwangaphandle lwemitha lungasetyenziselwa ukunyanga i-lymphoma yobuntwana engeyiyo iHodgkin esasazekileyo, okanye enokuthi isasaze, kwingqondo nakwimithambo yomqolo. Unyango lwangaphakathi lwemitha alusetyenziswanga ukunyanga i-non-Hodgkin lymphoma.

I-dose ephezulu ye-chemotherapy kunye nokufakelwa kweseli

Amanqanaba aphezulu e-chemotherapy anikezelwa ukubulala iiseli zomhlaza. Iiseli ezisempilweni, kubandakanya iiseli ezenza igazi, nazo ziyatshatyalaliswa lunyango lomhlaza. Ukufakelwa kweseli kwistem kunyango endaweni yeeseli ezenza igazi. Iiseli zeziqu (iiseli zegazi ezingafakwanga) ziyasuswa egazini okanye kumongo wethambo wesigulana okanye somnikeli kwaye zibandisiwe kwaye zigcinwe. Emva kokuba isiguli sigqibe i-chemotherapy, iiseli ezigciniweyo ezigciniweyo ziyanyibilika kwaye zibuyiselwe kwisigulana ngokufakwa. Ezi seli ze-stem ziphinde zafakwa zikhula ziye (kwaye zibuyisele) iiseli zegazi lomzimba.

Jonga iziyobisi ezivunyiweyo ze-non-Hodgkin Lymphoma ngolwazi oluthe kratya.

Ukufakelwa kweseli. (Inyathelo 1): Igazi lithathwa emthanjeni engalweni yomnikeli. Isigulana okanye omnye umntu angangumnikeli. Igazi lihamba ngomatshini osusa iiseli zeziqu. Emva koko igazi libuyiselwa kulowo unikeleyo ngomthambo okwenye ingalo. (Inyathelo 2): Isigulana sifumana ichemotherapy yokubulala iiseli ezenza igazi. Isigulana sinokufumana unyango ngemitha (engaboniswanga). (Inyathelo 3): Isigulana sifumana iiseli zeziqu ngokusebenzisa ipayinti ebekwe kwisitya segazi esifubeni.

Unyango ekujoliswe kulo

Unyango ekujoliswe kulo luhlobo lonyango olusebenzisa iziyobisi okanye ezinye izinto ukuchonga nokuhlasela iiseli ezithile zomhlaza ngaphandle kokonakalisa iiseli eziqhelekileyo. Ama-antibodies e-Monoclonal, i-tyrosine kinase inhibitors, kunye ne-immunotoxins zintathu iintlobo zonyango olujolisiweyo olusetyenziswayo okanye olufundwayo kunyango lwe-non-Hodgkin lymphoma yobuntwana.

Unyango lwe-monoclonal antibody yonyango lomhlaza olusebenzisa ii-antibodies ezenziwe elebhu ezivela kuhlobo olunye lweeseli zomzimba. Ezi antibodies zinokuchonga izinto ezikumhlaza iiseli okanye izinto eziqhelekileyo ezinokunceda iiseli zomhlaza zikhule. Amachiza omzimba ancamathele kwizinto kwaye abulale iiseli zomhlaza, athintele ukukhula kwazo, okanye azigcine zisasazeka. Iintsholongwane zeMonoclonal zinikezelwa ngokufakwa. Zingasetyenziselwa zodwa okanye ukuphatha iziyobisi, ityhefu, okanye izinto ezinemitha yeathom ngqo kwiiseli zomhlaza.

• I-Rituximab isetyenziselwa ukunyanga iintlobo ezininzi zobuntwana ezingezizo iHodgkin lymphoma.

• I-Pembrolizumab isetyenziselwa ukunyanga i-B-cell lymphoma ephambili engaphendulanga kunyango okanye iphinde yabuya (ibuya) emva konyango ngolunye unyango. Unyango lwe-pembrolizumab luye lwafundwa ikakhulu kubantu abadala.

• I-Brentuximab vedotin yi-monoclonal antibody edityaniswe nesiyobisi se-anticancer esisetyenziselwa ukunyanga i-anaplastic cell cell lymphoma.

I-bispecific monoclonal antibody yenziwe ngamalungu amabini ahlukeneyo omzimba abopha kwizinto ezimbini ezahlukeneyo kwaye abulale iiseli zomhlaza. Unyango lwe-Bispecific monoclonal antibody isetyenziswa kunyango lweBurkitt kunye neBurkitt-efana ne-lymphoma / leukemia kunye nokusasazeka kwe-B-cell lymphoma enkulu.

I-Tyrosine kinase inhibitors (i-TKIs) yebhloko ethintela ukuba amathumba kufuneka akhule. Ezinye ii-TKI zikwagcina amathumba ekukhuleni ngokuthintela ukukhula kwemithambo yegazi emitsha kumathumba. Ezinye iintlobo ze-kinase inhibitors, ezinje nge-crizotinib, zifundelwa ubuntwana obungeyi-Hodgkin lymphoma.

Ii-Immunotoxins zinokubopha iiseli zomhlaza kwaye zibabulale. I-Denileukin diftitox yi-immunotoxin esetyenziselwa ukunyanga i-T-cell lymphoma.

Unyango ekujolise kulo luyafundelwa kunyango lwe-non-Hodgkin lymphoma ebuyileyo (ebuyayo).

Jonga iziyobisi ezivunyiweyo ze-non-Hodgkin Lymphoma ngolwazi oluthe kratya.

Olunye unyango lweziyobisi

I-Retinoids iziyobisi ezinxulumene nevithamini A. Unyango lwe-Retinoid kunye ne-bexarotene isetyenziselwa ukunyanga iintlobo ezininzi ze-T-cell lymphoma.

IiSteroids zihormone ezenziwe ngokwendalo emzimbeni. Kananjalo zinokwenziwa elebhu kwaye zisetyenziswe njengeziyobisi. Unyango lwe-Steroid lusetyenziselwa ukunyanga i-T-cell lymphoma.

Unyango ngemifanekiso

I-Phototherapy yonyango lomhlaza olusebenzisa ichiza kunye nohlobo oluthile lokukhanya kwelaser ukubulala iiseli zomhlaza. Iyeza elingasebenziyo lide libonakaliswe kukukhanya lifakwe emthanjeni. Iyeza liqokelela ngakumbi kwiiseli zomhlaza kuneeseli eziqhelekileyo. Umhlaza wolusu kulusu, ukukhanya kwe-laser kukhanyisiwe kulusu kwaye ichiza liyasebenza kwaye libulala iiseli zomhlaza. I-Phototherapy isetyenziselwa unyango lwe-T-cell lymphoma.

Iindidi ezintsha zonyango ziyavavanywa kuvavanyo lweklinikhi.

Eli candelo lesishwankathelo lichaza unyango olufundwayo kuvavanyo lweklinikhi. Isenokungakhankanyi lonke unyango olutsha olufundwayo. Ulwazi malunga novavanyo lweklinikhi luyafumaneka kwiwebhusayithi yeNCI.

Unyango lwe-Immunotherapy

I-Immunotherapy lunyango olusebenzisa amajoni omzimba omzimba ukulwa nomhlaza. Izinto ezenziwe ngumzimba okanye ezenziwe elebhu zisetyenziselwa ukonyusa, ukuqondisa, okanye ukubuyisela ukhuseleko lwendalo lomzimba kumhlaza. Olu hlobo lonyango lomhlaza lukwabizwa ngokuba yi-biotherapy okanye unyango lwe-biologic.

I-Epstein-Barr virus (EBV) -i-cytotoxic T-lymphocyte luhlobo lweeseli zomzimba ezinokubulala iiseli ezithile, kubandakanya iiseli zangaphandle, iiseli zomhlaza, kunye neeseli ezosulelwe yi-EBV. IiCytotoxic T-lymphocyte zingohlulwa kwezinye iiseli zegazi, zikhule elebhu, emva koko zinikwe isigulana ukubulala iiseli zomhlaza. I-EBV-ekhethekileyo i-cytotoxic T-lymphocyte ifundwa ukunyanga isifo se-lymphoproliferative yasemva kokufakelwa.

Izigulana zinokufuna ukucinga ngokuthatha inxaxheba kuvavanyo lweklinikhi.

Kwezinye izigulana, ukuthatha inxaxheba kuvavanyo lweklinikhi kunokuba lolona khetho lonyango lufanelekileyo. Uvavanyo lwezonyango luyinxalenye yenkqubo yophando ngomhlaza. Uvavanyo lwezonyango luyenziwa ukufumanisa ukuba unyango lomhlaza olutsha lukhuselekile kwaye luyasebenza okanye lungcono kunonyango oluqhelekileyo.

Uninzi lonyango oluqhelekileyo lwanamhlanje lomhlaza lusekwe kuvavanyo lweklinikhi lwangaphambili. Izigulana ezithatha inxaxheba kuvavanyo lweklinikhi zingafumana unyango olusemgangathweni okanye zibe phakathi kwabokuqala ukufumana unyango olutsha.

Izigulana ezithatha inxaxheba kuvavanyo lweklinikhi zikwanceda ukuphucula indlela umhlaza oza kunyangwa ngayo kwixa elizayo. Nokuba uvavanyo lwezonyango alukhokeleli kunyango olusebenzayo, bahlala bephendula imibuzo ebalulekileyo kwaye bancedisa ukuqhubela phambili uphando.

Izigulana zinokungena kuvavanyo lweklinikhi ngaphambi, ngexesha, okanye emva kokuqala unyango lomhlaza.

Olunye uvavanyo lwezonyango lubandakanya kuphela izigulana ezingekafumani unyango. Olunye uvavanyo lokuvavanywa kunyango kwizigulana ezinomhlaza ongakhange ubengcono. Kukwakho nezilingo zeklinikhi ezivavanya iindlela ezintsha zokumisa umhlaza ekubuyeleni (ekubuyeni) okanye ukunciphisa iziphumo ebezingalindelekanga zonyango lomhlaza.

Uvavanyo lwezonyango lwenzeka kwiindawo ezininzi zelizwe. Ulwazi malunga novavanyo lweklinikhi oluxhaswe yi-NCI lunokufumaneka kwiphepha lewebhu le-NCI. Uvavanyo lwezonyango oluxhaswa yiminye imibutho lunokufumaneka kwiwebhusayithi yeClinicalTrials.gov.

Iimvavanyo zokulandelela zisenokufuneka.

Ezinye zeemvavanyo ezenziweyo ukufumanisa umhlaza okanye ukufumanisa inqanaba lomhlaza zinokuphindwa. Olunye uvavanyo luya kuphindwa ukuze kubonwe ukuba lusebenza njani unyango. Izigqibo malunga nokuqhubeka, ukutshintsha, okanye ukuyeka unyango zinokusekwa kwiziphumo zolu vavanyo.

Ezinye zeemvavanyo ziya kuqhubeka ukwenziwa amaxesha ngamaxesha emva kokuba unyango luphelile. Iziphumo zolu vavanyo zingabonisa ukuba imeko yomntwana wakho itshintshile okanye ukuba umhlaza ubuye wabuya (buyela). Olu vavanyo ngamanye amaxesha lubizwa ngokuba luvavanyo olulandelayo okanye ukuhlolwa.

Ukhetho kunyango lwe-Non-Hodgkin Lymphoma

Kweli Candelo

• IBurkitt kunye neBurkitt-efana ne-lymphoma / leukemia

• Ukhetho kunyango lwe-Burkitt kunye ne-Burkitt-like lymphoma / leukemia

• Izinketho zonyango lweBurkitt ephindaphindiweyo kunye neBurkitt-like lymphoma / leukemia

• Ukusasaza i-B-cell lymphoma enkulu

• Unyango olunokukhethwa kusandul 'ukufumanisa ukuba lusasazeka kwi-B-cell lymphoma enkulu

• Unyango olukhethiweyo kunyango oluphindaphindiweyo lokusasaza i-B-cell lymphoma enkulu

• Isiseko se-Mediastinal B-cell Lymphoma

• Ukhetho kunyango lwe-B-cell lymphoma esandula ukufunyanwa

• Unyango olunokukhethwa kunyango lwe-B-cell lymphoma

• I-lymphoblastic yeLymphoma

• Ukhetho kunyango lwe-lymphoblastic lymphoma

• Ukhetho kunyango lwe-lymphoblastic lymphoma

• I-Anaplastic enkulu yeLymphoma yeseli

• Ukhetho kunyango lwe-lymphoma enkulu yesifo esandula ukufunyanwa

• Unyango olunokukhethwa kunyango oluphindaphindayo lwe-cell enkulu ye-lymphoma

• Isifo seLymphoproliferative esinxulunyaniswa nokungasebenzi kakuhle kwaBantwana

• Unyango ukhetho lwesifo se-lymphoproliferative esinxulunyaniswa nokungasebenzi kakuhle komzimba

• Izinketho zonyango lwe-non-Hodgkin lymphoma ehambelana ne-DNA yokulungisa i-syndromes yesiphene

• Izinketho zonyango kwi-HIV engeyiyo iHodgkin lymphoma

• Unyango ukhetho lwasemva kwesifo se-lymphoproliferative isifo

• RHL yeNHL eyenzeka kuBantwana

• Unyango olunokukhethwa kunyango lwe-follicular lymphoma

• Izinketho zonyango kummandla we-lymphoma

• Ukhetho kunyango lwe-CNS lymphoma

• Unyango ukhetho lweparipheral T-cell lymphoma

• Izinketho zonyango lwe-T-cell lymphoma

Ngolwazi malunga nonyango oludweliswe ngezantsi, jonga kwiCandelo loKhetho ngokujonga uKhetho.

IBurkitt kunye neBurkitt-efana ne-lymphoma / leukemia

Ukhetho kunyango lwe-Burkitt kunye ne-Burkitt-like lymphoma / leukemia

Ukhetho kunyango lwe-Burkitt kunye neBurkitt-efana ne-lymphoma / leukemia inokubandakanya:

• Utyando lokususa ithumba kangangoko kunokwenzeka, kulandele ukudityaniswa kwemichiza.

• Ukudibanisa i-chemotherapy kunye okanye ngaphandle kwonyango ekujoliswe kulo (rituximab).

Izinketho zonyango lweBurkitt ephindaphindiweyo kunye neBurkitt-like lymphoma / leukemia

Izinketho zonyango lweBurkitt ephindaphindiweyo kunye neBurkitt-njenge-non-Hodgkin lymphoma / leukemia inokubandakanya:

• Ukudibanisa i-chemotherapy kunye okanye ngaphandle kwonyango ekujoliswe kulo (rituximab).

• Unyango oluphezulu lwe-chemotherapy kunye nokufakelwa kweseli ye-stem kunye neeseli zesigulana okanye iiseli zomnikeli.

• Unyango ekujoliswe kulo nge-bispecific antibody.

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

Ukusasaza i-B-cell lymphoma enkulu

Unyango olunokukhethwa kusandul 'ukufumanisa ukuba lusasazeka kwi-B-cell lymphoma enkulu

Ukhetho kunyango lwe-B-cell lymphoma enkulu inokubandakanya:

• Utyando lokususa ithumba kangangoko kunokwenzeka, kulandele ukudityaniswa kwemichiza.

• Ukudibanisa i-chemotherapy kunye okanye ngaphandle kwonyango ekujoliswe kulo (rituximab).

Unyango olukhethiweyo kunyango oluphindaphindiweyo lokusasaza i-B-cell lymphoma enkulu

Ukhetho kunyango lokusasazeka okuphindaphindiweyo kwe-B-cell lymphoma inokubandakanya:

• Ukudibanisa i-chemotherapy kunye okanye ngaphandle kwonyango ekujoliswe kulo (rituximab).

• Unyango oluphezulu lwe-chemotherapy kunye nokufakelwa kweseli ye-stem kunye neeseli zesigulana okanye iiseli zomnikeli.

• Unyango ekujoliswe kulo nge-bispecific antibody.

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

Isiseko se-Mediastinal B-cell Lymphoma

Ukhetho kunyango lwe-B-cell lymphoma esandula ukufunyanwa

Ukhetho kunyango lwe-B-cell lymphoma esandula kufunyaniswa esisiseko inokubandakanya:

• Ukudibanisa i-chemotherapy kunye nonyango ekujoliswe kulo (rituximab).

Unyango olunokukhethwa kunyango lwe-B-cell lymphoma

Ukhetho kunyango lwe-B-cell lymphoma yangaphambi kwexesha eliphakathi inokubandakanya:

• Unyango ekujoliswe kulo (pembrolizumab).

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

I-lymphoblastic yeLymphoma

Ukhetho kunyango lwe-lymphoblastic lymphoma

I-lymphoblastic lymphoma inokuthi ihlelwe njengesifo esifanayo ne-leukemia ye-lymphoblastic leukemia (BONKE). Izinketho zonyango lwe-lymphoblastic lymphoma zingabandakanya:

• Ukudibanisa i-chemotherapy. I-CNS prophylaxis enonyango ngemitha inokunikwa kwakhona ukuba umhlaza unwenwele kwingqondo okanye kwintambo yomqolo.

• Uvavanyo lweklinikhi lwe-chemotherapy eneerejimeni ezahlukeneyo ze-CNS prophylaxis.

• Uvavanyo lweklinikhi lokudibanisa i-chemotherapy kunye okanye ngaphandle kwonyango ekujoliswe kulo (bortezomib).

Ukhetho kunyango lwe-lymphoblastic lymphoma

Izinketho zonyango lwe-lymphoblastic lymphoma ingaquka:

• Unyango ngamayeza.

• I-chemotherapy yedosi ephezulu kunye nokutshintshwa kweseli yeseli kunye neeseli ezivela kulowo unikelayo.

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

I-Anaplastic enkulu yeLymphoma yeseli

Ukhetho kunyango lwe-lymphoma enkulu yesifo esandula ukufunyanwa

Ukhetho kunyango lwe-anaplastic cell cell enkulu inokubandakanya:

• Ugqirha lulandelwa ngokudityaniswa kwekhemotherapy.

• Ukudibanisa i-chemotherapy.

• I-Intrathecal kunye ne-systemic chemotherapy, kwizigulana ezinomhlaza kwingqondo okanye kwintambo yomqolo.

• Uvavanyo lweklinikhi yonyango ekujoliswe kulo (i-crizotinib okanye i-brentuximab) kunye nokudibanisa i-chemotherapy.

Unyango olunokukhethwa kunyango oluphindaphindayo lwe-cell enkulu ye-lymphoma

Unyango olunokukhethwa kunyango oluphindaphindiweyo lwe-cell cell enkulu inokubandakanya:

• I-Chemotherapy, i-brentuximab, kunye / okanye i-crizotinib.

• Ukufakelwa kweseli kwintsholongwane kunye neeseli zomguli okanye iiseli ezivela kumnikeli.

• Unyango lwe-radiation okanye unyango lwe-chemotherapy ephezulu kwizigulana ezinesifo esiqhubela phambili kwinkqubo ye-nervous system.

• Uvavanyo lweklinikhi yonyango ekujoliswe kulo (i-crizotinib okanye i-brentuximab) kunye nokudibanisa i-chemotherapy.

• Uvavanyo lweklinikhi olujonga isampulu yethumba lesigulana kutshintsho oluthile kwimfuza. Uhlobo lonyango ekujoliswe kulo oluya kunikwa isigulana luxhomekeke kuhlobo lotshintsho lwemfuza.

Sebenzisa uvavanyo lwethu lweklinikhi ukufumana ulingo lweklinikhi oluxhaswayo lwekliniki olwamkela izigulana. Unokukhangela izilingo ngokusekwe kuhlobo lomhlaza, ubudala besigulana, kwaye nokuba zenziwa phi izilingo. Ulwazi ngokubanzi malunga novavanyo lweklinikhi luyafumaneka.

Isifo seLymphoproliferative esinxulunyaniswa nokungasebenzi kakuhle kwaBantwana

Unyango ukhetho lwesifo se-lymphoproliferative esinxulunyaniswa nokungasebenzi kakuhle komzimba

Ukhetho kunyango lwe-lymphoproliferative isifo ebantwaneni nakwishumi elivisayo abanamajoni omzimba abuthathaka anokubandakanya:

• I-Chemotherapy kunye okanye ngaphandle kwe-rituximab.

• Ukufakelwa kweseli kwistem kunye neeseli ezivela kulowo unikelayo.

Izinketho zonyango lwe-non-Hodgkin lymphoma ehambelana ne-DNA yokulungisa i-syndromes yesiphene

Izinketho zonyango lwe-non-Hodgkin lymphoma ehambelana ne-DNA yokulungisa i-syndromes yabantwana ingabandakanya:

• Unyango ngamayeza.

Izinketho zonyango kwi-HIV engeyiyo iHodgkin lymphoma

Unyango olunonyango olusebenzayo lwe-antiretroviral okanye i-HAART (indibaniselwano yamachiza ee-antiretroviral) yehlisa umngcipheko we-non-Hodgkin lymphoma kwizigulana ezinentsholongwane yintsholongwane kaGawulayo.

Izinketho zonyango lwe-HIV engeyi-Hodgkin lymphoma (NHL) kubantwana inokubandakanya:

• I-Chemotherapy kunye okanye ngaphandle kwe-rituximab.

Unyango lwezifo eziphindaphindayo, ukhetho kunyango luxhomekeke kuhlobo lwe-non-Hodgkin lymphoma.

Unyango ukhetho lwasemva kwesifo se-lymphoproliferative isifo

Unyango olunokukhethwa kunyango lwe-lymphoproliferative yesifo sasemva kwexesha sinokubandakanya:

• Utyando lokususa ithumba. Ukuba kunokwenzeka, iidosi ezisezantsi zamachiza okunyanga ukugonyelwa emva kokufakwa kweseli okanye ukufakelwa kwamalungu.

• Unyango ekujoliswe kulo (rituximab).

• I-Chemotherapy kunye okanye ngaphandle kwonyango ekujoliswe kulo (rituximab).

• Unyango lwe-immunotherapy usebenzisa i-lymphocyte yomnikeli okanye iiseli ze-T zesigulana ukujolisa kusulelo lwe-Epstein-Barr kuyafundwa. Olu nyango lufumaneka kuphela kumaziko ambalwa eMelika.

RHL yeNHL eyenzeka kuBantwana

Unyango olunokukhethwa kunyango lwe-follicular lymphoma

Ukhetho kunyango lwe-follicular lymphoma ebantwaneni inokubandakanya:

• Ugqirha.

• Ukudibanisa i-chemotherapy kunye okanye ngaphandle kwe-rituximab.

Kubantwana abanomhlaza onotshintsho oluthile kwimfuza, unyango luyafana nolo lunikwa abantu abadala abane-follicular lymphoma. Jonga icandelo leFollicular Lymphoma kwisishwankathelo se kwiLymphoma yabantu abadala engekho kwiHodgkin ngolwazi.

Izinketho zonyango kummandla we-lymphoma

Ukhetho lwonyango lwe-lymphoma yendawo engaphantsi (kubandakanywa nezicubu ze-lymphoid ezinxulumene ne-mucosa (MALT) i-lymphoma) kubantwana zingabandakanya:

• Ugqirha.

• Unyango ngemitha.

• I-Rituximab kunye okanye ngaphandle kwe-chemotherapy.

• Unyango lwe-Antibiotic, ye-MALT lymphoma.

Ukhetho kunyango lwe-CNS lymphoma

Ukhetho kunyango lwe-CNS ye-lymphoma ebantwaneni inokubandakanya:

• Unyango ngamayeza.

Unyango ukhetho lweparipheral T-cell lymphoma

Izinketho zonyango kwi-T-cell lymphoma yomda kubantwana zingabandakanya:

• Unyango ngamayeza.

• Unyango ngemitha.

• Ukufakelwa kweseli kwintsholongwane kunye neeseli zomguli okanye iiseli ezivela kumnikeli.

Izinketho zonyango lwe-T-cell lymphoma

Izinketho zonyango lwe-panniculitis engaphantsi kwe-T-cell lymphoma kubantwana inokubandakanya:

• Ukulinda ulindile.

• Idosi ephezulu yedosi.

• Unyango olujolisiweyo (denileukin diftitox).

• Ukudibanisa i-chemotherapy.

• Unyango lweRetinoid.

• Ukufakelwa kweseli.

Ukhetho kunyango lwe-cellular lymphoma enkulu ye-anaplastic inokubandakanya:

• Ugqirha, unyango ngemitha, okanye zombini.

Kubantwana, ukhetho lwezonyango lwe-mycosis fungoides lunokubandakanya:

• I-Steroids ifakwe kulusu.

• Unyango lweRetinoid.

• Unyango ngemitha.

• I-Phototherapy (unyango olulula usebenzisa i-radiation ye-ultraviolet B).

Ukuze ufunde okungakumbi malunga ne-Non-Hodgkin Lymphoma yobuntwana

Ngolwazi oluthe kratya kwiZiko leSizwe loMhlaza malunga ne-non-Hodgkin lymphoma yabantwana, bona oku kulandelayo:

• Ikhompyuter yeTomography (CT) kunye noMhlaza

• Iziyobisi ezivunyiweyo ze-Non-Hodgkin Lymphoma

• Utyando lweSeli oluQulunqwe ngegazi

• Iithagethi zoMhlaza ezijolise kuko

Ngolwazi oluthe kratya lomhlaza wabantwana kunye nezinye izixhobo zomhlaza ngokubanzi, jonga oku kulandelayo:

• Malunga noMhlaza

• Umhlaza wabantwana

• Unyango lokuKhangela uMhlaza waBantwanaPhuma kwiNgcazelo yokuzihlangula

• Iziphumo zokugqibela zonyango lweCancer yoMntwana

• Abafikisayo kunye naBantu abaDala abaDala abanomhlaza

• Abantwana abanomhlaza: Isikhokelo sabazali

• Umhlaza kuBantwana nakwishumi elivisayo

• Ukuqokelela

• Ukujamelana noMhlaza

• Imibuzo yokubuza ugqirha wakho malunga neCancer

• Abasindileyo kunye nabaNonopheli