Izinhlobo / i-leukemia / isiguli / ingane-aml-treatment-pdq

Ubuntwana Obunzima beMyeloid Leukemia / Okunye Ukwelashwa Kwe-Myeloid Malignancies (®) –Patient Version

Imininingwane ejwayelekile Mayelana Nezingane Ezibucayi I-Myeloid Leukemia kanye Nezinye Izimpawu Ze-Myeloid

AMAPHUZU ASEMQOKA

• Ubuntwana obunzima be-myeloid leukemia (AML) uhlobo lomdlavuza lapho umnkantsha wenza inani elikhulu lamaseli egazi angajwayelekile.

• I-leukemia nezinye izifo zegazi nomnkantsha wamathambo kungathinta amangqamuzana abomvu egazi, amangqamuzana amhlophe egazi nama-platelet.

• Ezinye izifo ze-myeloid zingathinta igazi nomnkantsha wamathambo.

• I-myelopoiesis engajwayelekile (TAM)

• I-leukemia enamandla ye-promyelocytic (APL)

• I-juvenile myelomonocytic leukemia (JMML)

• I-leukemia engapheli (i-CML)

• I-Myelodysplastic syndromes (MDS)

• I-AML noma i-MDS kungenzeka ngemuva kokwelashwa ngemithi ethile yamakhemikhali kanye / noma ukwelashwa ngemisebe.

• Izici ezinobungozi be-AML yobuntwana, i-APL, i-JMML, i-CML, ne-MDS ziyefana.

• Izimpawu nezimpawu zobuntwana i-AML, i-APL, i-JMML, i-CML, noma i-MDS zifaka imfiva, ukuzwa ukhathele, ukopha okulula noma ukulimaza.

• Ukuhlolwa okuhlola igazi nomnkantsha kusetshenziselwa ukuthola (ukuthola) nokuhlola ubuntwana be-AML, TAM, APL, JMML, CML, ne-MDS.

• Izici ezithile zithinta ukubikezela (ithuba lokululama) kanye nezinketho zokwelashwa.

Ubuntwana obunzima be-myeloid leukemia (AML) uhlobo lomdlavuza lapho umnkantsha wenza inani elikhulu lamaseli egazi angajwayelekile.

Ubuntwana obunzima be-myeloid leukemia (AML) ngumdlavuza wegazi nomnkantsha wamathambo. I-AML ibizwa nangokuthi i-acute myelogenous leukemia, i-acute myeloblastic leukemia, i-acute granulocytic leukemia, kanye ne-acute nonlymphocytic leukemia. Umdlavuza onamandla uvame ukuba mubi ngokushesha uma ungelashwa. Umdlavuza ongalapheki uvame ukuba mubi kancane.

I-anatomy yethambo. Ithambo lakhiwa ithambo elihlangene, ithambo lesiponji nomnkantsha. Ithambo elihlangene lenza ungqimba lwangaphandle lwethambo. Ithambo le-Spongy litholakala kakhulu emaphethelweni amathambo futhi liqukethe umnkantsha obomvu. Umnkantsha wethambo utholakala maphakathi namathambo amaningi futhi unemithambo yegazi eminingi. Kunezinhlobo ezimbili zomnkantsha wethambo: obomvu nophuzi. Umnkantsha obomvu uqukethe amangqamuzana egazi angaba amaseli abomvu egazi, amangqamuzana amhlophe egazi, noma ama-platelets. Umnkantsha ophuzi wenziwa kakhulu ngamafutha.

I-leukemia nezinye izifo zegazi nomnkantsha wamathambo kungathinta amangqamuzana abomvu egazi, amangqamuzana amhlophe egazi nama-platelet.

Imvamisa, umnkantsha wenza amangqamuzana egazi (amaseli angavuthiwe) abe ngamaseli egazi avuthiwe ngokuhamba kwesikhathi. Iseli lesiqu segazi lingahle libe iseli le-myeloid noma iseli le-lymphoid stem. Iseli lesiqu le-lymphoid liba yiseli legazi elimhlophe.

Iseli le-myeloid stem liba ngolunye lwezinhlobo ezintathu zamaseli egazi avuthiwe:

• Amaseli abomvu egazi athwala umoya-mpilo nezinye izinto aya kuzo zonke izicubu zomzimba.

• Amaseli egazi amhlophe alwa nokutheleleka nezifo.

• Ama-platelet akha amahlule egazi ukumisa ukopha.

Ukuthuthukiswa kwamangqamuzana egazi. Iseli lesiqu segazi lidlula ezinyathelweni eziningana ukuze libe yiseli elibomvu, iplatelet, noma iseli elimhlophe.

Ku-AML, amaseli we-myeloid stem ngokuvamile aba uhlobo lwamaseli amhlophe angavuthiwe abizwa ngama-myeloblasts (noma ukuqhuma kwe-myeloid). Ama-myeloblasts, noma amangqamuzana e-leukemia, ku-AML ajwayelekile futhi awabi ngamaseli egazi amhlophe anempilo. Amaseli we-leukemia angakha egazini nasemnkantsheni wethambo ngakho-ke kukhona indawo encane yamaseli egazi amhlophe anempilo, amaseli abomvu egazi, nama-platelets. Uma lokhu kwenzeka, ukutheleleka, i-anemia, noma ukuphuma kalula kwegazi kungenzeka.

Amaseli we-leukemia angasakazeka ngaphandle kwegazi aye kwezinye izingxenye zomzimba, kufaka phakathi uhlelo lwezinzwa oluphakathi (ubuchopho nomgogodla), isikhumba nezinsini. Kwesinye isikhathi amaseli we-leukemia akha isimila esiqinile esibizwa nge-granulocytic sarcoma noma i-chloroma.

Ezinye izifo ze-myeloid zingathinta igazi nomnkantsha wamathambo.

I-myelopoiesis engajwayelekile (TAM)

I-TAM ukuphazamiseka komnkantsha wamathambo ongakhula ezinganeni ezisanda kuzalwa ezine-Down syndrome. Imvamisa iyazihambela yodwa phakathi nezinyanga ezintathu zokuqala zokuphila. Izinsana ezine-TAM zinamathuba andile okuthuthukisa i-AML ngaphambi kweminyaka yobudala emi-3. I-TAM ibizwa nangokuthi i-trousent myeloproliferative disorder noma i-leukemia yesikhashana.

I-leukemia enamandla ye-promyelocytic (APL)

I-APL iyi-subtype ye-AML. Ku-APL, ezinye izakhi zofuzo ezikwi-chromosome 15 zishintsha izindawo ezinezakhi zofuzo ezithile ku-chromosome 17 kanye nohlobo olungajwayelekile olubizwa nge-PML-RARA lwenziwa. Isakhi sofuzo se-PML-RARA sithumela umyalezo omisa ama-promyelocyte (uhlobo lwengqamuzana yegazi elimhlophe) ekuvuthweni. Ama-promyelocyte (amaseli we-leukemia) angakha egazini nasemnkantsheni wethambo ngakho-ke kukhona indawo encane yamaseli egazi amhlophe anempilo, amaseli abomvu egazi, nama-platelets. Izinkinga zokopha kakhulu kanye namahlule egazi kungenzeka futhi. Le yinkinga enkulu yezempilo edinga ukwelashwa ngokushesha okukhulu.

I-juvenile myelomonocytic leukemia (JMML)

I-JMML iwumdlavuza ongandile wezingane ovame kakhulu ezinganeni ezineminyaka yobudala engama-2 futhi uvame kakhulu kubafana. Ku-JMML, amangqamuzana amaningi egazi e-myeloid abe ama-myelocyte nama-monocyte (izinhlobo ezimbili zamaseli amhlophe egazi). Amanye alawa maseli we-myeloid egazi akaze abe ngamaseli amhlophe avuthiwe egazi. Lawa maseli angavuthiwe, abizwa ngokuthi ukuqhuma, ahluleka ukwenza umsebenzi wawo ojwayelekile. Ngokuhamba kwesikhathi, ama-myelocyte, ama-monocyte, nokuqhuma kugcwalisa amangqamuzana abomvu egazi nama-platelet emnkantsheni wethambo. Uma lokhu kwenzeka, ukutheleleka, i-anemia, noma ukuphuma kalula kwegazi kungenzeka.

I-leukemia engapheli (i-CML)

I-CML ivame ukuqala kumaseli egazi okuqala e-myeloid lapho kwenzeka ushintsho oluthile lofuzo. Isigaba sezakhi zofuzo, esifaka uhlobo lwe-ABL, ku-chromosome 9 sishintsha indawo nesigaba sezakhi zofuzo ku-chromosome 22, esine-BCR gene. Lokhu kwenza i-chromosome emfushane kakhulu engu-22 (ebizwa nge-chromosome yaseFiladelphia) ne-chromosome ende kakhulu. 9 Uhlobo olungajwayelekile lwe-BCR-ABL lwakhiwa nge-chromosome 22. Uhlobo lohlobo lwe-BCR-ABL lutshela amangqamuzana egazi ukuthi enze amaprotheni amaningi kakhulu abizwa nge-tyrosine kinase. I-Tyrosine kinase ibangela ukuthi kwenziwe amaseli amhlophe amaningi kakhulu egazi (amaseli we-leukemia) emnkantsheni wethambo. Amaseli we-leukemia angakha egazini nasemnkantsheni wethambo ngakho-ke kukhona indawo encane yamaseli egazi amhlophe anempilo, amaseli abomvu egazi, nama-platelets. Uma lokhu kwenzeka, ukutheleleka, i-anemia, noma ukuphuma kalula kwegazi kungenzeka. I-CML ayivamile ezinganeni.

I-chromosome yaseFiladelphia. Ucezu lwe-chromosome 9 nocezu lwe-chromosome 22 kuyaphuma kuthengiswe izindawo. Uhlobo lwe-BCR-ABL lwakhiwa nge-chromosome 22 lapho isiqeshana se-chromosome 9 sinamathela khona. I-chromosome eshintshiwe engu-22 ibizwa nge-chromosome yaseFiladelphia.

I-Myelodysplastic syndromes (MDS)

I-MDS yenzeka kancane ezinganeni kunabantu abadala. Ku-MDS, umnkantsha wenza amangqamuzana abomvu egazi ambalwa kakhulu, amangqamuzana amhlophe egazi nama-platelets. Lawa maseli egazi kungenzeka angavuthwa angene egazini. Uhlobo lwe-MDS luxhomeke ohlotsheni lweseli legazi elithintekile.

Ukwelashwa kwe-MDS kuncike ekutheni ziphansi kangakanani izinombolo zamaseli abomvu egazi, amaseli amhlophe egazi, noma amaplatelets. Ngokuhamba kwesikhathi, i-MDS ingaba yi-AML.

Lesi sifinyezo simayelana ne-AML yobuntwana, i-TAM, i-APL yobuntwana, i-JMML, i-CML yobuntwana, kanye ne-MDS yobuntwana. Bona isifinyezo se-Childhood Acute Lymphoblastic Leukemia Treatment ukuthola imininingwane mayelana nokwelashwa kwe-leukemia ebuntwaneni e-acute lymphoblastic.

I-AML noma i-MDS kungenzeka ngemuva kokwelashwa ngemithi ethile yamakhemikhali kanye / noma ukwelashwa ngemisebe.

Ukwelashwa komdlavuza ngemithi ethile yamakhemikhali kanye / noma ukwelashwa ngemisebe kungadala i-AML (t-AML) ehlobene nokwelashwa noma i-MDS (t-MDS) ehlobene nokwelashwa. Ingozi yalezi zifo ezihlobene nokwelashwa ezihlobene nokwelashwa incike kumthamo ophelele wemithi yokwelapha ngamakhemikhali esetshenzisiwe kanye nomthamo wemisebe nensimu yokwelashwa. Ezinye iziguli zinengcuphe ye-t-AML ne-t-MDS. Lezi zifo ezihlobene nokwelashwa zivame ukwenzeka kungakapheli iminyaka engu-7 ukwelashwa, kepha akuvamile ezinganeni.

Izici ezinobungozi be-AML yobuntwana, i-APL, i-JMML, i-CML, ne-MDS ziyefana.

Noma yini enyusa ubungozi bokuthola isifo ibizwa ngokuthi ingozi. Ukuba nengcuphe akusho ukuthi uzothola umdlavuza; ukungabi nezici zobungozi akusho ukuthi ngeke uthole umdlavuza. Khuluma nodokotela wengane yakho uma ucabanga ukuthi ingane yakho ingaba sengcupheni. Lezi nezinye izinto zingakhuphula ubungozi be-AML yobuntwana, i-APL, i-JMML, i-CML, ne-MDS:

• Ukuba nomfowenu noma udadewenu, ikakhulukazi iwele, one-leukemia.

• Ukuba yiSpanishi.

• Ukuvezwa intuthu kagwayi noma utshwala ngaphambi kokuzalwa.

• Ukuba nomlando womuntu siqu we-aplastic anemia.

• Ukuba nomlando womuntu siqu noma womndeni we-MDS.

• Ukuba nomlando womndeni we-AML.

• Ukwelashwa kwangaphambilini nge-chemotherapy noma i-radiation therapy.

• Ukuvezwa kwimisebe ye-ionizing noma amakhemikhali afana ne-benzene.

• Ukuba nama-syndromes athile noma ukuphazamiseka okuzuzwe njengefa:

• I-Down syndrome.

• I-aplastic anemia.

• I-Fanconi anemia.

• Uhlobo lwe-Neurofibromatosis 1.

• I-Noonan syndrome.

• Isifo se-Shwachman-Diamond.

• Isifo se-Li-Fraumeni.

Izimpawu nezimpawu zobuntwana i-AML, i-APL, i-JMML, i-CML, noma i-MDS zifaka imfiva, ukuzwa ukhathele, ukopha okulula noma ukulimaza.

Lezi kanye nezinye izimpawu nezimpawu zingadalwa yi-AML yobuntwana, i-APL, i-JMML, i-CML, noma i-MDS noma ezinye izimo. Buza nodokotela wakho uma ingane yakho inokunye kwalokhu okulandelayo:

• Imfiva noma ingenalo igciwane.

• Ukujuluka ebusuku.

• Ukuphelelwa umoya.

• Ubuthakathaka noma ukuzizwa ukhathele.

• Ukulinyazwa okulula noma ukopha.

• I-Petechiae (izindawo ezicabalele, ezikhomba ngaphansi kwesikhumba ezibangelwa ukopha).

• Ubuhlungu emathanjeni noma emalungeni.

• Ubuhlungu noma umuzwa wokugcwala ngaphansi kwezimbambo.

• Izigaxa ezingenantamo entanyeni, ngaphansi kwekhwapha, esiswini, emgodini, noma kwezinye izitho zomzimba. Ebuntwaneni i-AML, lezi zigaxa, ezibizwa ngokuthi i-leukemia

• i-cutis, ingahle ibe luhlaza okwesibhakabhaka noma nsomi.

• Izigaxa ezingenabuhlungu kwesinye isikhathi ezizungeze amehlo. Lezi zigaxa, ezibizwa ngokuthi ama-chloromas, kwesinye isikhathi zibonakala ebuntwaneni i-AML futhi zingaba luhlaza okwesibhakabhaka.

• Ukuqhuma kwesikhumba okufana ne-eczema.

Izimpawu nezimpawu ze-TAM zingafaka okulandelayo:

• Ukuvuvukala umzimba wonke.

• Ukuphelelwa umoya.

• Ukuphefumula kanzima.

• Ubuthakathaka noma ukuzizwa ukhathele.

• Ukopha kakhulu, ngisho nokusika okuncane.

• I-Petechiae (izindawo ezicabalele, ezikhomba ngaphansi kwesikhumba ezibangelwa ukopha).

• Ubuhlungu obungezansi kwezimbambo.

• Ukuqhuma kwesikhumba.

• I-jaundice (kuphuzi kwesikhumba nabamhlophe bamehlo).

• Ukuphathwa ikhanda, inkinga yokubona nokudideka.

Kwesinye isikhathi i-TAM ayibangeli zimpawu nhlobo futhi itholakala ngemuva kokuhlolwa kwegazi okujwayelekile.

Ukuhlolwa okuhlola igazi nomnkantsha kusetshenziselwa ukuthola (ukuthola) nokuhlola ubuntwana be-AML, TAM, APL, JMML, CML, ne-MDS. Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa:

• Ukuhlolwa komzimba kanye nomlando: Ukuhlolwa komzimba ukuhlola izimpawu ezijwayelekile zempilo, kufaka phakathi nokuhlola izimpawu zezifo, njengezigaxa noma yini enye ebonakala ingajwayelekile. Kuzothathwa nomlando wemikhuba yezempilo yesiguli kanye nokugula nokwelashwa kwangaphambilini.
• Qedela ukubalwa kwegazi (i-CBC) ngokuhluka: Inqubo lapho kukhishwa khona isampula yegazi futhi ihlolwe lokhu okulandelayo:

• Inani lamaseli abomvu nama-platelets.

• Inombolo nohlobo lwamaseli amhlophe egazi.

• Inani le-hemoglobin (iprotheni ethwala umoya-mpilo) kumaseli abomvu egazi.

• Ingxenye yesampula yegazi eyenziwe ngamaseli abomvu egazi.

Qedela ukubalwa kwegazi (CBC). Igazi liqoqwa ngokufaka inaliti emthanjeni bese livumela igazi ukuba ligelezele kushubhu. Isampuli yegazi ithunyelwa elabhorethri bese kubalwa amaseli abomvu egazi, amaseli amhlophe egazi, nama-platelets. I-CBC isetshenziselwa ukuhlola, ukuxilonga, nokuqapha izimo eziningi ezahlukahlukene.

Izifundo ze-chemistry yegazi: Inqubo lapho kuhlolwe khona isampula segazi ukukala inani lezinto ezithile ezikhishwe egazini ngezitho nezicubu zomzimba. Inani elingavamile (eliphakeme noma eliphansi kunokujwayelekile) lezinto kungaba uphawu lwesifo.

• I-x-ray yesifuba: I-x-ray yezitho namathambo ngaphakathi kwesifuba. I-x-ray uhlobo lwesigongolo samandla esingangena emzimbeni nasefilimini, lwenze isithombe sezindawo ezingaphakathi komzimba.

• I-Biopsy: Ukususwa kwamaseli noma izicubu ukuze kubhekwe ngaphansi kwesibonakhulu ngudokotela wezifo ukuhlola izimpawu zomdlavuza. Ama-biopsies angenziwa afaka okulandelayo:

• Isifiso somnkantsha we-Bone kanye ne-biopsy: Ukususwa komnkantsha wethambo, igazi, nocezu oluncane lwethambo ngokufaka inaliti engenalutho ethangeni noma emathanjeni esifuba.

Ukufiswa komnkantsha we-Bone kanye ne-biopsy. Ngemuva kokuthi indawo encane yesikhumba iboshwe, kufakwa inaliti yomnkantsha ethanjeni lesinqe sengane. Amasampula egazi, amathambo, nomnkantsha uyasuswa ukuze kuhlolwe ngaphansi kwesibonakhulu.

• I-tumor biopsy: I-biopsy ye-chloroma ingenziwa.

• I-lymph node biopsy: Ukususwa kwakho konke noma ingxenye ye-lymph node.

• I-Immunophenotyping: Isivivinyo selabhorethri esisebenzisa amasosha omzimba ukukhomba amangqamuzana omdlavuza asuselwa ezinhlotsheni zama-antigen noma omaka ebusweni bamaseli. Lokhu kuhlolwa kusetshenziselwa ukuxilonga izinhlobo ezithile ze-leukemia.

• Ukuhlaziywa kwe-cytogenetic: Ukuhlolwa kwelabhoratri lapho ama-chromosomes wamaseli esampula yegazi noma umnkantsha abalwa futhi ahlolwe noma yiziphi izinguquko, njengama-chromosomes aphukile, alahlekile, ahlelwe kabusha, noma amanye. Izinguquko kuma-chromosomes athile kungaba luphawu lomdlavuza. Ukuhlaziywa kwe-cytogenetic kusetshenziselwa ukuxilonga umdlavuza, ukuhlela ukwelashwa, noma ukuthola ukuthi ukwelashwa kusebenza kahle kangakanani.

Ukuhlolwa okulandelayo uhlobo lokuhlaziywa kwe-cytogenetic:

• I-FISH (i-fluorescence in situ hybridization): Ukuhlolwa kwaselebhu okusetshenziselwa ukubuka nokubala izakhi zofuzo noma ama-chromosomes kumaseli nezicubu. Izingcezu ze-DNA ezinodayi we-fluorescent zenziwa elabhoratri bese zengezwa kusampula yamaseli noma izicubu zesiguli. Lapho lezi zingcezu zeDNA ezidayiwe zinamathela kuzakhi zofuzo ezithile noma ezindaweni ezithile zama-chromosomes kusampula, ziyakhanya lapho zibhekwa ngaphansi kwesibonakhulu se-fluorescent. Ukuhlolwa kwe-FISH kusetshenziselwa ukusiza ukuthola umdlavuza nokusiza ukuhlela ukwelashwa.

• Ukuhlolwa kwamangqamuzana: Ukuhlolwa kwelabhorathri ukubheka izakhi zofuzo ezithile, amaprotheni, noma amanye ama-molecule kusampula yegazi noma umnkantsha Ukuhlolwa kwamangqamuzana kubheka nezinguquko ezithile kuhlobo noma i-chromosome engadala noma ithinte ithuba lokuthuthukisa i-AML. Ukuhlolwa kwamangqamuzana kungasetshenziselwa ukuhlela ukwelashwa, ukuthola ukuthi ukwelashwa kusebenza kanjani kahle, noma ukubikezela.

• Ukubhoboza i-Lumbar: Inqubo esetshenziselwa ukuqoqa isampula le-cerebrospinal fluid (CSF) kusuka kukholamu lomgogodla. Lokhu kwenziwa ngokubeka inaliti phakathi kwamathambo amabili emgogodleni naku-CSF ezungeze umgogodla nokususa isampula loketshezi. Isampula le-CSF lihlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zokuthi amaseli we-leukemia asabalele ebuchosheni nasentanyeni yomgogodla. Le nqubo ibizwa nangokuthi i-LP noma umpompi womgogodla.

Ukubhoboza i-lumbar. Isiguli silele endaweni esigoqiwe etafuleni. Ngemuva kokuthi indawo encane engezansi ingemuva, inaliti yomgogodla (inaliti ende, ezacile) ifakwa engxenyeni engezansi yekholomu lomgogodla ukususa i-cerebrospinal fluid (CSF, ekhonjiswe ngombala oluhlaza okwesibhakabhaka). Uketshezi lungathunyelwa elabhorethri ukuze ihlolwe.

Izici ezithile zithinta ukubikezela (ithuba lokululama) kanye nezinketho zokwelashwa.

Isibikezelo (ithuba lokululama) kanye nezinketho zokwelashwa kwe-AML yobuntwana zincike kokulandelayo:

• Iminyaka yengane lapho kutholakala umdlavuza.

• Uhlanga noma iqembu lesizwe lengane.

• Ukuthi ingane ikhuluphele ngokweqile yini.

• Inani lamaseli amhlophe egazi egazini lapho exilongwa.

• Ukuthi i-AML yenzeke ngemuva kokwelashwa komdlavuza kwangaphambilini.

• Uhlobo olungaphansi lwe-AML.

• Ukuthi kunezinguquko ezithile ze-chromosome noma zofuzo kumaseli we-leukemia.

• Ukuthi ingane ine-Down syndrome yini. Iningi lezingane ezine-AML ne-Down syndrome zingelashwa ku-leukemia yazo.

• Ukuthi i-leukemia isesimisweni sezinzwa esiyinhloko (ubuchopho nomgogodla).

• I-leukemia iphendula ngokushesha kangakanani ekwelashweni.

• Ukuthi i-AML isanda kutholakala yini (ingalashwa) noma iphinde yabuya ngemuva kokwelashwa.

• Ubude besikhathi selokhu ukwelashwa kuphelile, nge-AML ephindaphindekile.

Isibikezelo se-APL yobuntwana sincike kulokhu okulandelayo:

• Inani lamaseli amhlophe egazi egazini lapho exilongwa.

• Ukuthi kunezinguquko ezithile ze-chromosome noma zofuzo kumaseli we-leukemia.

• Ukuthi i-APL isanda kutholakala yini (ingalashwa) noma iphinde yabuya ngemuva kokwelashwa.

Izinketho zokubikezela nokwelashwa kwe-JMML zincike kokulandelayo:

• Iminyaka yengane lapho kutholakala umdlavuza.

• Uhlobo lohlobo oluthintekile nenani lezakhi zofuzo ezinoshintsho.

• Mangaki ama-monocyte (uhlobo lwamaseli amhlophe egazi) asegazini.

• Ingakanani i-hemoglobin esegazini.

• Noma ngabe i-JMML isanda kutholakala (ayelashwa) noma iphinde yabuya ngemuva kokwelashwa.

Izinketho zokubikezela nokwelashwa kwe-CML yobuntwana zincike kokulandelayo:

• Sekuyisikhathi esingakanani isiguli sitholakele.

• Mangaki amaseli wokuqhuma asegazini.

• Kungabe amaseli wokuqhuma anyamalala ngokuphelele egazini nakumnkantsha wamathambo ngemuva kokuqala ukwelashwa.

• Ukuthi i-CML isanda kutholakala yini (ingalashwa) noma iphinde yabuya ngemuva kokwelashwa.

Izinketho zokubikezela nokwelashwa kwe-MDS zincike kokulandelayo:

• Ukuthi ngabe i-MDS ibangelwe ukwelashwa komdlavuza kwangaphambilini.

• Ziphansi kangakanani izinombolo zamaseli abomvu egazi, amaseli amhlophe egazi, noma amaplatelets.

• Ukuthi ngabe i-MDS isanda kutholakala (ayelashwa) noma iphinde yabuya ngemuva kokwelashwa.

Izigaba Zobuntwana Ezibucayi I-Myeloid Leukemia kanye Nezinye Izimpawu Ze-Myeloid

AMAPHUZU ASEMQOKA

• Lapho kutholakala ukuthi ingane i-acute myeloid leukemia (AML) ebuntwaneni, kwenziwa ukuhlolwa ukuthola ukuthi umdlavuza ususabalele yini kwezinye izingxenye zomzimba.

• Alukho uhlelo olujwayelekile lokubeka izigaba lwe-AML yobuntwana, i-leukemia ebuntwaneni eyingozi ye-promyelocytic (APL), i-juvenile myelomonocytic leukemia (JMML), i-leukemia engapheli yengane (CML), noma i-myelodysplastic syndromes (MDS).

• I-AML yasebuntwaneni ephindaphindayo ibuyile ngemuva kokuthi yelashwe.

Lapho kutholakala ukuthi ingane i-acute myeloid leukemia (AML) ebuntwaneni, kwenziwa ukuhlolwa ukuthola ukuthi umdlavuza ususabalele yini kwezinye izingxenye zomzimba.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa ukuthola ukuthi i-leukemia isakazekile yini isuka egazini iye kwezinye izingxenye zomzimba:

• Ukubhoboza i-Lumbar: Inqubo esetshenziselwa ukuqoqa isampula le-cerebrospinal fluid (CSF) kusuka kukholamu lomgogodla. Lokhu kwenziwa ngokubeka inaliti phakathi kwamathambo amabili emgogodleni naku-CSF ezungeze umgogodla nokususa isampula loketshezi. Isampula le-CSF lihlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zokuthi amaseli we-leukemia asabalele ebuchosheni nasentanyeni yomgogodla. Le nqubo ibizwa nangokuthi i-LP noma umpompi womgogodla.

• I-biopsy yamasende, ama-ovari, noma isikhumba: Ukususwa kwamaseli noma izicubu kumasende, ama-ovari, noma isikhumba ukuze kubhekwe ngaphansi kwesibonakhulu ukuhlola izimpawu zomdlavuza. Lokhu kwenziwa kuphela uma kutholakala okuthile okungajwayelekile ngamasende, amaqanda, noma isikhumba ngesikhathi sokuhlolwa komzimba.

Alukho uhlelo olujwayelekile lokubeka izigaba lwe-AML yobuntwana, i-leukemia ebuntwaneni eyingozi ye-promyelocytic (APL), i-juvenile myelomonocytic leukemia (JMML), i-leukemia engapheli yengane (CML), noma i-myelodysplastic syndromes (MDS).

Izinga noma ukusabalala komdlavuza kuvame ukuchazwa njengezigaba. Esikhundleni sezigaba, ukwelashwa kwe-AML yobuntwana, i-APL yobuntwana, i-JMML, i-CML yobuntwana, kanye ne-MDS kusekelwe kokukodwa noma ngaphezulu kokulandelayo:

• Uhlobo lwesifo noma uhlobo olungaphansi lwe-AML.

• Ukuthi i-leukemia isabalale ngaphandle kwegazi nomnkantsha.

• Kungakhathaliseki ukuthi lesi sifo sisanda kutholakala, sikhululiwe, noma siyenzeka kabusha.

Isanda kutholakala ukuthi i-AML yobuntwana

I-AML esanda kutholakala yobuntwana ayilashwa ngaphandle kokunciphisa izimpawu nezimpawu ezifana nomkhuhlane, ukopha, noma ubuhlungu, kanti okunye kwalokhu okulandelayo kuyatholakala:

• Ngaphezu kwama-20% wamaseli emnkantsheni wethambo ukuqhuma (amaseli we-leukemia).

noma

• Ngaphansi kwama-20% wamaseli emnkantsheni wethambo aqhuma futhi kukhona ushintsho oluthile ku-chromosome.

Ubuntwana be-AML ekuxolelweni

Ebuntwaneni i-AML ekuxolelweni, lesi sifo sesilashiwe futhi okulandelayo kuyatholakala:

• Ukubalwa kwegazi okuphelele kucishe kujwayelekile.

• Ngaphansi kuka-5% wamaseli emnkantsheni wethambo ukuqhuma (amaseli we-leukemia).

• Azikho izimpawu noma izimpawu ze-leukemia ebuchosheni, emgogodleni, noma kwezinye izingxenye zomzimba.

I-AML yasebuntwaneni ephindaphindayo ibuyile ngemuva kokuthi yelashwe.

Ebuntwaneni obujwayelekile be-AML, umdlavuza ungabuya egazini nasemnkantsheni wethambo noma kwezinye izingxenye zomzimba, njengohlelo oluphakathi lwezinzwa (ubuchopho nomgogodla).

Ebuntwaneni obuphikisayo, i-AML, umdlavuza awuphenduli ekwelashweni.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukahlukene zokwelashwa kwezingane ezine-AML, TAM, APL, JMML, CML, ne-MDS.

• Ukwelashwa kuhlelwa yithimba labahlinzeki bezempilo abangochwepheshe ekwelapheni i-leukemia yezingane nezinye izifo zegazi.

• Ukwelashwa kwe-leukemia ye-myeloid ebuntwaneni kungadala imiphumela emibi.

• Ukwelashwa kwe-AML yobuntwana kuvame ukuba nezigaba ezimbili.

• Izinhlobo eziyisikhombisa zokwelashwa okujwayelekile zisetshenziselwa i-AML yobuntwana, i-TAM, i-APL yobuntwana, i-JMML, i-CML yobuntwana, ne-MDS.

• Ukwelashwa ngamakhemikhali

• Ukwelashwa ngemisebe

• Ukufakelwa kwe-stem cell

• Ukwelashwa okuhlosiwe

• Olunye ukwelashwa kwezidakamizwa

• Ukulinda okulindile

• Ukunakekelwa okusekelayo

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• I-Immunotherapy

• Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

• Iziguli zingangena ezivivinyweni zokwelashwa ngaphambi, ngesikhathi, noma ngemuva kokuqala ukwelashwa kwazo komdlavuza.

• Ukuhlolwa kokulandelela kungadingeka.

Kunezinhlobo ezahlukahlukene zokwelashwa kwezingane ezine-AML, TAM, APL, JMML, CML, ne-MDS.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezinganeni ezine-acute myeloid leukemia (AML), i-myelopoiesis engavamile (TAM), i-acute promyelocytic leukemia (APL), i-juvenile myelomonocytic leukemia (JMML), i-leukemia engapheli (CML), ne-myelodysplastic syndromes (MDS) . Ezinye izindlela zokwelapha zijwayelekile (indlela esetshenziswa njengamanje), kanti ezinye ziyahlolwa ezivivinyweni zokwelashwa. Isivivinyo somtholampilo wokwelashwa isifundo socwaningo esihloselwe ukusiza ukuthuthukisa ukwelashwa kwamanje noma ukuthola ulwazi ngezindlela ezintsha zokwelapha iziguli ezinomdlavuza. Lapho izivivinyo zomtholampilo zikhombisa ukuthi ukwelashwa okusha kungcono kunokwelashwa okujwayelekile, ukwelashwa okusha kungaba ukwelashwa okujwayelekile.

Ngoba i-AML nezinye izifo ze-myeloid azivamile ezinganeni, ukubamba iqhaza esivivinyweni somtholampilo kufanele kubhekwe. Ezinye izivivinyo zokwelashwa zivulekele kuphela iziguli ezingakaqali ukwelashwa.

Ukwelashwa kuhlelwa yithimba labahlinzeki bezempilo abangochwepheshe ekwelapheni i-leukemia yezingane nezinye izifo zegazi.

Ukwelashwa kuzobhekwa ngudokotela wezingane oncologist, udokotela ogxile ekwelapheni izingane ezinomdlavuza. I-oncologist yezingane isebenza nabanye abahlinzeki bezempilo abangongoti ekwelapheni izingane ezine-leukemia futhi abagxile ezindaweni ezithile zemithi. Lokhu kungafaka ongoti abalandelayo:

• Udokotela wezingane.

• Udokotela wezifo zengqondo.

• I-oncologist yezokwelapha.

• Udokotela ohlinzayo wezingane.

• I-radiation oncologist.

• Isazi sezinzwa.

• Isazi se-Neuropathologist.

• Isazi se-Neuroradiologist.

• Umhlengikazi ongumhlengikazi.

• Usonhlala kahle.

• Uchwepheshe wokuvuselelwa.

• Isazi sokusebenza kwengqondo.

Ukwelashwa kwe-leukemia ye-myeloid ebuntwaneni kungadala imiphumela emibi.

Ngemininingwane ngemiphumela emibi eqala ukwelashwa komdlavuza, bheka ikhasi lethu le-Side Effects.

Ukuhlolwa okulandelwa njalo kubaluleke kakhulu. Imiphumela emibi yokwelashwa komdlavuza eqala ngemuva kokwelashwa futhi iqhubeke izinyanga noma iminyaka ibizwa ngemiphumela ephuzile. Imiphumela yamuva yokwelashwa komdlavuza ingafaka okulandelayo:

• Izinkinga zomzimba.

• Izinguquko zemizwa, imizwa, ukucabanga, ukufunda, noma inkumbulo.

• Umdlavuza wesibili (izinhlobo ezintsha zomdlavuza).

Eminye imiphumela yesikhashana ingalashwa noma ilawulwe. Kubalulekile ukuthi abazali bezingane ezelashwa i-AML noma ezinye izifo zegazi bakhulume nodokotela bezingane zabo ngemiphumela ukwelashwa komdlavuza okungaba nayo enganeni yabo. (Bheka isifinyezo se- ngemiphumela yamuva yokwelashwa komdlavuza wezingane ukuthola eminye imininingwane).

Ukwelashwa kwe-AML yobuntwana kuvame ukuba nezigaba ezimbili.

Ukwelashwa kwe-AML yobuntwana kwenziwa ngezigaba:

• Ukwelashwa kokungeniswa: Lesi isigaba sokuqala sokwelapha. Umgomo ukubulala amangqamuzana e-leukemia egazini nasemnkantsheni wethambo. Lokhu kufaka i-leukemia ekuxolelweni.

• Ukwelashwa kokuqinisa / ukuqinisa: Lesi yisigaba sesibili sokwelapha. Iqala uma i-leukemia isesixolelweni. Umgomo wokwelashwa ukubulala noma yimaphi amaseli we-leukemia asele afihliwe futhi angahle angasebenzi kepha angaqala ukubuyela futhi abangele ukubuyela emuva.

Ukwelashwa okubizwa ngokuthi yi-central nervous system (CNS) prophylaxis therapy kunganikezwa ngesikhathi sesigaba sokwelashwa. Ngoba imithamo ejwayelekile yokwelashwa ngamakhemikhali ingahle ingafiki kumaseli we-leukemia ku-CNS (ubuchopho nomgogodla), amaseli we-leukemia akwazi ukucasha ku-CNS. I-Intrathecal chemotherapy iyakwazi ukufinyelela kumaseli we-leukemia ku-CNS. Kunikezwa ukubulala amangqamuzana e-leukemia nokunciphisa amathuba okuthi i-leukemia ibuye (ibuye).

Izinhlobo eziyisikhombisa zokwelashwa okujwayelekile zisetshenziselwa i-AML yobuntwana, i-TAM, i-APL yobuntwana, i-JMML, i-CML yobuntwana, ne-MDS.

Ukwelashwa ngamakhemikhali

I-Chemotherapy yindlela yokwelapha umdlavuza esebenzisa izidakamizwa ukuvimba ukukhula kwamangqamuzana omdlavuza, kungaba ngokubulala amaseli noma ngokuwavimba ekuhlukaniseni. Lapho i-chemotherapy ithathwa ngomlomo noma ifakwa emthanjeni noma emisipheni, izidakamizwa zingena egazini futhi zingafinyelela kumaseli womdlavuza emzimbeni wonke (systemic chemotherapy). Lapho i-chemotherapy ifakwa ngqo kwi-cerebrospinal fluid (i-intrathecal chemotherapy), isitho, noma umgodi womzimba njengesisu, izidakamizwa zithinta kakhulu amangqamuzana omdlavuza kulezo zindawo (i-chemotherapy yesifunda). Inhlanganisela yamakhemikhali ukwelashwa kusetshenziswa imithi engaphezu kweyodwa yamakhemikhali.

Indlela i-chemotherapy enikezwa ngayo incike ohlotsheni lomdlavuza olashwa. Ku-AML, kusetshenziswa i-chemotherapy enikezwa ngomlomo, i-vein, noma ku-cerebrospinal fluid.

Ku-AML, amaseli we-leukemia angasakazeka ebuchosheni kanye / noma entanjeni yomgogodla. Ukwelashwa ngamakhemikhali okunikezwa ngomlomo noma emthanjeni ukwelapha i-AML kungahle kunganqamuli isithiyo segazi-sobuchopho ukuze singene kuketshezi oluzungeze ubuchopho nomgogodla. Esikhundleni salokho, i-chemotherapy ijojowe esikhaleni esigcwele uketshezi ukubulala amangqamuzana e-leukemia okungenzeka asakazeke lapho (i-intrathecal chemotherapy).

Ukwelashwa ngamakhemikhali kwe-Intrathecal. Izidakamizwa ze-anticancer zifakwa esikhaleni se-intrathecal, okuyisikhala esiphethe i-cerebrospinal fluid (CSF, ekhonjiswe ngombala oluhlaza okwesibhakabhaka). Kunezindlela ezimbili ezihlukile zokwenza lokhu. Enye indlela, ekhonjiswe engxenyeni ephezulu yesibalo, ukujova izidakamizwa echibini lase-Ommaya (isitsha esimise okwedome esifakwa ngaphansi kwesikhumba lapho uhlinzwa; ibamba izidakamizwa njengoba zingena ngepayipi elincane zingena ebuchosheni ). Enye indlela, ekhonjiswe engxenyeni engezansi yesibalo, ukujova izidakamizwa ngqo kwi-CSF engxenyeni engezansi yekholomu lomgogodla, ngemuva kokuthi indawo encane engezansi ingemuva.

Bheka Izidakamizwa Ezamukelwe i-Acute Myeloid Leukemia ukuthola eminye imininingwane.

Ukwelashwa ngemisebe

Ukwelashwa ngemisebe ukwelashwa komdlavuza okusebenzisa amandla amakhulu ama-x-ray noma ezinye izinhlobo zemisebe ukubulala amangqamuzana omdlavuza noma ukuwagcina ekukhuleni. Kunezinhlobo ezimbili zokwelashwa ngemisebe:

• Ukwelashwa kwemisebe kwangaphandle kusebenzisa umshini ongaphandle komzimba ukuthumela imisebe ebheke emdlavuzeni.

• Ukwelashwa kwemisebe kwangaphakathi kusebenzisa into enemisebe eboshwe ngezinaliti, izimbewu, izintambo, noma ama-catheters abekwe ngqo noma eduze komdlavuza.

Indlela yokwelashwa ngemisebe enikezwa ngayo incike ohlotsheni lomdlavuza olashwa. Ebuntwaneni i-AML, ukwelashwa ngemisebe kwangaphandle kungasetshenziswa ukwelapha i-chloroma engaphenduli ekhemotherapy.

Ukufakelwa kwe-stem cell

I-Chemotherapy inikezwa ukubulala amangqamuzana omdlavuza noma amanye amangqamuzana egazi angajwayelekile. Amaseli aphilile, kufaka phakathi amaseli akha igazi, nawo abhujiswa ukwelashwa komdlavuza. Ukufakelwa kwe-stem cell ukwelashwa ukufaka amaseli akha igazi. Ama-stem cells (amangqamuzana egazi angavuthiwe) ayasuswa egazini noma emnkantsheni wethambo wesiguli noma womnikeli futhi afriziwe futhi agcinwe. Ngemuva kokuthi isiguli siqede i-chemotherapy, amangqamuzana eziqu agciniwe ancibilika abuyiselwa esigulini ngokumnika. Lawa maseli wesiqu abuyisiwe akhula abe (futhi abuyisele) amangqamuzana egazi omzimba.

Ukufakelwa kwe-stem cell. (Isinyathelo 1): Igazi lithathwa emthanjeni osengalweni yomnikeli. Isiguli noma omunye umuntu kungaba umnikeli. Igazi ligeleza ngomshini osusa ama-stem cells. Ngemuva kwalokho igazi libuyiselwa kumnikeli ngomthambo okwenye ingalo. (Isinyathelo 2): Isiguli sithola i-chemotherapy yokubulala amaseli akha igazi. Isiguli singathola ukwelashwa ngemisebe (okungakhonjisiwe). (Isinyathelo 3): Isiguli sithola ama-stem cells nge-catheter efakwa emthanjeni wegazi esifubeni.

Ukwelashwa okuhlosiwe

Ukwelashwa okuhlosiwe uhlobo lokwelashwa olusebenzisa izidakamizwa noma ezinye izinto ukukhomba nokuhlasela amangqamuzana omdlavuza athile ngaphandle kokulimaza amaseli ajwayelekile. Izinhlobo zokwelashwa okuhlosiwe zifaka okulandelayo:

• Ukwelashwa kweTyrosine kinase inhibitor: Ukwelashwa kweTyrosine kinase inhibitor (TKI) kuvimba amasiginali adingekayo ukuze izicubu zikhule. Ama-TKI avimba i-enzyme (tyrosine kinase) ebangela ukuthi ama-stem cells abe ngamaseli egazi amhlophe (ukuqhuma) kunalokho okudingwa ngumzimba. Ama-TKI angasetshenziswa ngemithi yokwelapha ngamakhemikhali njenge-adjuvant therapy (ukwelashwa okunikezwe ngemuva kokwelashwa kokuqala, ukwehlisa ubungozi bokuthi umdlavuza uzobuya).

• I-Imatinib, i-dasatinib, ne-nilotinib izinhlobo zama-TKIs asetshenziselwa ukwelapha i-CML yobuntwana.

• I-Sorafenib ne-trametinib ziyafundwa ekwelapheni i-leukemia yengane.

• Ukwelashwa kwe-monoclonal antibody: Ukwelashwa kwe- monoclonal antibody isebenzisa amasosha omzimba enziwe elebhu, kusuka ohlotsheni olulodwa lwamaseli omzimba. La ma-antibody angakhomba izinto kumaseli womdlavuza noma ezintweni ezijwayelekile ezingasiza amangqamuzana omdlavuza ukuthi akhule. Amasosha omzimba anamathela ezintweni futhi abulale amangqamuzana omdlavuza, avimbe ukukhula kwawo, noma awagcine ekusakazekeni. Ama-antibody e-monoclonal anikezwa ngokumnika. Zingasetshenziswa zodwa noma ukuphatha izidakamizwa, ubuthi, noma okokukhipha imisebe ngqo emangqamuzaneni omdlavuza.

• IGemtuzumab wuhlobo lwe-anti-monoclonal antibody enamathiselwe kumuthi wamakhemikhali. Isetshenziswa ekwelapheni i-AML.

I-Selinexor ngumuthi wokwelapha ohlosiwe ofundelwa ukwelapha i-AML yobuntwana ephikisayo noma ephindaphindayo.

Bheka Izidakamizwa ezivunyelwe i-Leukemia ukuthola eminye imininingwane.

Olunye ukwelashwa kwezidakamizwa

I-Lenalidomide ingasetshenziselwa ukunciphisa isidingo sokumpontshelwa kweziguli ezine-myelodysplastic syndromes ezibangelwa ushintsho oluthile lwe-chromosome. Kuphinde kufundwe ekwelapheni izingane ezine-AML eziphindaphindayo neziphikisayo.

I-Arsenic trioxide nayo yonke i-trans retinoic acid (ATRA) yimithi ebulala izinhlobo ezithile zamaseli we-leukemia, imisa amaseli we-leukemia ekuhlukaneni, noma isize amangqamuzana e-leukemia avuthwe abe ngamaseli amhlophe egazi. Le mithi isetshenziswa ekwelapheni i-acute promyelocytic leukemia.

Bheka Izidakamizwa Ezamukelwe i-Acute Myeloid Leukemia ukuthola eminye imininingwane.

Ukulinda okulindile

Ukulinda ngokuqapha kusibhekisisa isimo sesiguli ngaphandle kokunikeza ukwelashwa kuze kuvele izimpawu noma izimpawu. Kwesinye isikhathi kusetshenziselwa ukwelapha i-MDS noma i-myelopoiesis engajwayelekile (TAM).

Ukunakekelwa okusekelayo

Ukunakekelwa kokusekelwa kunikezwa ukunciphisa izinkinga ezibangelwa yisifo noma ukwelashwa kwaso. Zonke iziguli ezine-leukemia zithola ukwelashwa okunakekelayo. Ukunakekelwa okusekelayo kungafaka okulandelayo:

• Ukwelashwa kokumpontshelwa: Indlela yokunikeza amangqamuzana abomvu egazi, amaseli amhlophe egazi, noma ama-platelets okuzothatha indawo yamaseli egazi abhujiswe izifo noma ukwelashwa komdlavuza. Igazi linganikelwa ngomunye umuntu noma kungenzeka ukuthi belithathwe esigulini phambilini futhi ligcinwe kuze kudingeke.

• Ukwelashwa kwezidakamizwa, njengama-antibiotics noma ama-antifungal agents.

• Leukapheresis: Inqubo lapho kusetshenziswa khona umshini okhethekile ukukhipha amangqamuzana amhlophe egazi egazini. Igazi lithathwa esigulini bese lifakwa kusihlukanisi samaseli egazi lapho kususwa khona amaseli amhlophe egazi. Lonke elinye igazi liyabuyiselwa egazini lesiguli. I-Leukapheresis isetshenziselwa ukwelapha iziguli ezinezibalo zamaseli amhlophe aphezulu kakhulu.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Lesi sigaba esifingqiwe sichaza izindlela zokwelashwa ezicwaningwa ekuhlolweni kwemitholampilo. Kungenzeka kungasho yonke imishanguzo emisha efundwayo. Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

I-Immunotherapy

I-Immunotherapy yimithi esebenzisa amasosha omzimba esiguli ukulwa nomdlavuza. Izinto ezenziwe ngumzimba noma ezenziwe elabhoratri zisetshenziselwa ukukhulisa, ukuqondisa, noma ukubuyisa izivikelo zemvelo zomzimba kumdlavuza. Lolu hlobo lokwelashwa komdlavuza lubizwa nangokuthi i-biotherapy noma i-biological therapy.

Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

Kwezinye iziguli, ukubamba iqhaza esivivinyweni somtholampilo kungaba yindlela engcono kakhulu yokwelashwa. Ukuhlolwa kwemitholampilo kuyingxenye yenqubo yocwaningo lomdlavuza. Ukuhlolwa komtholampilo kuyenziwa ukuthola ukuthi ngabe ukwelashwa komdlavuza okusha kuphephile futhi kuyasebenza yini noma kungcono kunokwelashwa okujwayelekile.

Eziningi zezindlela zokwelashwa ezijwayelekile zomdlavuza zisuselwa ekuhlolweni kokuqala komtholampilo. Iziguli ezibamba iqhaza esivivinyweni somtholampilo zingathola ukwelashwa okujwayelekile noma zibe phakathi kwabokuqala ukuthola ukwelashwa okusha.

Iziguli ezibamba iqhaza ezivivinyweni zokwelashwa zisiza nokwenza ngcono indlela umdlavuza ozophathwa ngayo ngokuzayo. Noma izilingo zomtholampilo zingaholeli ekwelashweni okusha okusebenzayo, zivame ukuphendula imibuzo ebalulekile futhi zisize ukuqhubela phambili ucwaningo.

Iziguli zingangena ezivivinyweni zokwelashwa ngaphambi, ngesikhathi, noma ngemuva kokuqala ukwelashwa kwazo komdlavuza. Ezinye izivivinyo zokwelashwa zifaka kuphela iziguli ezingakatholi ukwelashwa. Ezinye izilingo zivivinya ukwelashwa kweziguli ezinomdlavuza ongakabi ngcono. Kukhona nokuhlolwa komtholampilo okuhlola izindlela ezintsha zokunqanda umdlavuza ukuthi ungaphindi (ubuye) noma kunciphise imiphumela emibi yokwelashwa komdlavuza.

Ukuhlolwa kwemitholampilo kuyenzeka ezingxenyeni eziningi zezwe. Imininingwane mayelana nokuhlolwa kwemitholampilo esekelwa yi-NCI ingatholakala ekhasini lewebhu le-NCI lokuhlolwa kokuhlolwa kwemitholampilo. Izivivinyo zomtholampilo ezisekelwa ezinye izinhlangano zingatholakala kuwebhusayithi yeClinicalTrials.gov.

Ukuhlolwa kokulandelela kungadingeka.

Olunye uvivinyo olwenziwe ukuxilonga umdlavuza noma ukuthola isigaba somdlavuza lungaphindwa. Olunye uvivinyo luzophindwa ukuze kubonakale ukuthi umuthi usebenza kanjani. Izinqumo mayelana nokuthi uqhubeke, ushintshe, noma umise ukwelashwa zingasuselwa emiphumeleni yalezi zivivinyo.

Ezinye zezivivinyo zizoqhubeka ukwenziwa ngezikhathi ezithile ngemuva kokuphela kokwelashwa. Imiphumela yalezi zivivinyo ingakhombisa ukuthi ngabe isimo sengane yakho sishintshile noma uma umdlavuza ubuyile (buyela emuva). Lezi zivivinyo kwesinye isikhathi zibizwa ngokuthi izivivinyo zokulandelela noma ukuhlolwa.

Izinketho Zokwelashwa Kwe-Acute Myeloid Leukemia

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwe-myeloid leukemia esanda kutholakala ebuntwaneni (AML) ngesikhathi sesigaba sokungeniswa kungafaka okulandelayo:

• Inhlanganisela chemotherapy.

• Ukwelashwa okuqondisiwe nge-anti-monoclonal antibody (gemtuzumab).

• Ukwelashwa kwe-central nervous system prophylaxis nge-intrathecal chemotherapy.

• Ukwelashwa ngemisebe, kweziguli ezine-granulocytic sarcoma (chloroma) uma i-chemotherapy ingasebenzi.

• Ukufakelwa kwe-stem cell, kweziguli ezine-AML ehlobene nokwelashwa.

Ukwelashwa kwe-AML yobuntwana ngesikhathi sesigaba sokuxolelwa (ukuqinisa / ukuqinisa ukwelashwa) kuncike ohlotsheni lwe-AML futhi kungafaka okulandelayo:

• Inhlanganisela chemotherapy.

• Ukwelashwa ngamakhemikhali okuphezulu okulandelwa ukufakelwa kwe-stem cell kusetshenziswa amaseli egazi avela kumnikeli.

Ukwelashwa kwe-AML yobuntwana obuphikisayo kungafaka okulandelayo:

• Ukwelashwa kweLenalidomide.

• Isivivinyo somtholampilo se-chemotherapy kanye nokwelashwa okuhlosiwe (selinexor).

• Uhlobo olusha lwenhlanganisela yamakhemikhali.

Ukwelashwa kwe-AML ephindaphindwayo yobuntwana kungafaka okulandelayo:

• Inhlanganisela chemotherapy.

• Inhlanganisela yamakhemikhali kanye nokufakelwa kwe-stem cell, kweziguli ezithole ukuxolelwa okuphelele kwesibili.

• Ukufakelwa kwesibili kwe-stem cell, kweziguli isifo sazo esibuye emuva kokufakelwa kokuqala kwe-stem cell.

• Isivivinyo somtholampilo se-chemotherapy kanye nokwelashwa okuhlosiwe (selinexor).

Izinketho Zokwelashwa zeMyelopoiesis Engajwayelekile noma Yezingane ezine-Down Syndrome ne-AML

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

I-myelopoiesis engajwayelekile (TAM) evame ukuhamba yodwa. Kwi-TAM engahambi yodwa noma edala ezinye izinkinga zempilo, ukwelashwa kungafaka okulandelayo:

• Ukunakekelwa okusekelayo, kufaka phakathi ukwelashwa ngokumpontshelwa igazi noma i-leukapheresis.

• Ukwelashwa ngamakhemikhali.

Ukwelashwa kwe-acute myeloid leukemia (AML) ezinganeni ezineminyaka engama-4 noma ngaphansi ezine-Down syndrome kungafaka okulandelayo:

• Inhlanganisela ye-chemotherapy kanye ne-central system ye-prophylaxis therapy ne-intrathecal chemotherapy.

• Isivivinyo somtholampilo sohlobo olusha lwe-chemotherapy regimen oluncike ekutheni ingane isabela kanjani ekhemotherapy yokuqala.

Ukwelashwa kwe-AML ezinganeni ezineminyaka engaphezu kwengu-4 ezine-Down syndrome kungafana nokwelashwa kwezingane ezingenayo i-Down syndrome.

Izinketho zokwelashwa ze-Acute Promyelocytic Leukemia

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwe-leukemia esanda kutholakala ye-acute promyelocytic leukemia (APL) kungafaka okulandelayo:

• I-all-trans retinoic acid (ATRA) kanye ne-chemotherapy.

• Ukwelashwa kwe-Arsenic trioxide.

• Isivivinyo somtholampilo se-ATRA ne-arsenic trioxide therapy nge-chemotherapy noma ngaphandle kwayo.

Ukwelashwa kwe-APL yobuntwana ngesikhathi sesigaba sokuxolelwa (ukuqinisa / ukuqinisa ukwelashwa) kungafaka okulandelayo:

• I-all-trans retinoic acid (ATRA) kanye ne-chemotherapy.

Ukwelashwa kwengane ephindaphindwayo i-APL kungafaka okulandelayo:

• Ukwelashwa kwe-Arsenic trioxide.

• I-All-trans retinoic acid therapy (ATRA) kanye ne-chemotherapy.

• Ukwelashwa okuqondisiwe nge-anti-monoclonal antibody (gemtuzumab).

• Ukufakelwa kwe-stem cell usebenzisa ama-stem stem egazi kusuka esigulini noma kumnikeli.

Izinketho Zokwelapha I-Juvenile Myelomonocytic Leukemia

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwe-juvenile myelomonocytic leukemia (JMML) kungafaka okulandelayo:

• Inhlanganisela yamakhemikhali elandelwa ukufakelwa kwe-stem cell. Uma i-JMML ibuyela emuva ngemuva kokufakelwa kwe-stem cell, ukufakelwa kwesibili kwe-stem cell kungenziwa.

Ukwelashwa kwe-JMML yobuntwana obuphikisayo noma ephindaphindayo kungafaka okulandelayo:

• Isivivinyo somtholampilo sokwelapha okuhlosiwe nge-tyrosine kinase inhibitor (trametinib).

Izinketho Zokwelashwa Kwe-Leukemia Engapheli Yezingane

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwe-leukemia engapheli emithanjeni yegazi (CML) kungafaka okulandelayo:

• Ukwelashwa okuhlosiwe nge-tyrosine kinase inhibitor (imatinib, dasatinib, noma i-nilotinib).

Ukwelashwa kwe-CML ebuntwaneni ephikisayo noma ephindaphindwayo kungafaka okulandelayo:

• Ukwelashwa okuqondisiwe nge-tyrosine kinase inhibitor (dasatinib noma i-nilotinib).

• Ukufakelwa kwe-stem cell usebenzisa ama-stem stem egazi kusuka kumnikeli.

Izinketho Zokwelapha Zezingane I-Myelodysplastic Syndromes

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ukwelashwa kwama-syndromes we-myelodysplastic ebuntwaneni (MDS) kungafaka okulandelayo:

• Ukufakelwa kwe-stem cell usebenzisa ama-stem stem egazi kusuka kumnikeli.

• Ukunakekelwa okusekelayo, kufaka phakathi ukwelashwa ngokumpontshelwa nemithi elwa namagciwane.

• Ukwelashwa kweLenalidomide, kweziguli ezinezinguquko ezithile zofuzo.

• Isivivinyo somtholampilo sokwelapha okubhekiswe kukho.

Uma i-MDS iba i-acute myeloid leukemia (AML), ukwelashwa kuzofana nokwelashwa kwe-AML esanda kutholakala.

Ukufunda Okwengeziwe Nge-Acute Myeloid Leukemia kanye Nezinye Izimpawu Ze-Myeloid

Ngemininingwane engaphezulu evela ku-National Cancer Institute mayelana nengane ebukhali i-myeloid leukemia nezinye izifo ezimbi ze-myeloid, bona okulandelayo:

• Izidakamizwa zivunyelwe i-Acute Myeloid Leukemia

• Izidakamizwa zivunyelwe i-Myeloproliferative Neoplasms

• Ukufakelwa Kwama-Stem Cell Stem

• Izindlela Zokwelapha Zomdlavuza

Ngemininingwane eminingi yomdlavuza wezingane nezinye izinsiza zomdlavuza ezijwayelekile, bheka okulandelayo:

• Mayelana Nomdlavuza

• Umdlavuza Wezingane

• I-CureSearch ye-Cancer YezinganePhuma Ukuzikhulula

• Imiphumela Emuva Yokwelapha Yomdlavuza Wezingane

• Intsha kanye nabantu abadala abancane abaneCancer

• Izingane Ezinomdlavuza: Umhlahlandlela Wabazali

• Umdlavuza Ezinganeni Nasebusheni

• Isiteji

• Ukubhekana Nomdlavuza

• Imibuzo Ongayibuza Udokotela Wakho mayelana Nomdlavuza

• Kwabasindile Nabanakekeli