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Ukwelashwa Okuhlobene Nengculazi (®) –Patient Version

Imininingwane Jikelele Nge-Lymphoma Ehlobene Nengculazi

AMAPHUZU ASEMQOKA

• I-lymphoma ehlobene nengculazi yisifo lapho amangqamuzana amabi (umdlavuza) akha khona ohlelweni lwe-lymph lweziguli ezithole i-immunodeficiency syndrome (i-AIDS).

• Kunezinhlobo eziningi ze-lymphoma.

• Izimpawu ze-lymphoma ehlobene nengculazi zifaka ukwehla kwesisindo, umkhuhlane nokujuluka ebusuku.

• Izivivinyo ezihlola uhlelo lwe-lymph nezinye izingxenye zomzimba zisetshenziselwa ukusiza ukuthola (ukuthola) nokuthola i-lymphoma ehlobene nengculaza.

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

I-lymphoma ehlobene nengculazi yisifo lapho amangqamuzana amabi (umdlavuza) akha khona ohlelweni lwe-lymph lweziguli ezithole i-immunodeficiency syndrome (i-AIDS).

Ingculazi idalwa yigciwane lengculazi, elihlasela futhi lenze buthaka amasosha omzimba. Amasosha omzimba abuthaka ahluleka ukulwa nokutheleleka nezifo. Abantu abanesifo se-HIV banengozi eyengeziwe yokutheleleka kanye ne-lymphoma noma ezinye izinhlobo zomdlavuza. Umuntu one-HIV nezinhlobo ezithile zokutheleleka noma umdlavuza, njenge-lymphoma, kutholakala ukuthi une-AIDS. Ngezinye izikhathi, abantu batholakala ukuthi bane-AIDS kanye ne-lymphoma ehlobene ne-AIDS ngasikhathi sinye. Ngemininingwane nge-AIDS kanye nokwelashwa kwayo, sicela ubheke iwebhusayithi ye-AIDSinfo.

I-lymphoma ehlobene nengculaza uhlobo lomdlavuza oluthinta uhlelo lwe-lymph. I-lymph system iyingxenye yamasosha omzimba. Kuyasiza ukuvikela umzimba ekutheleleni nasezifweni.

I-lymph system yakhiwa yilokhu okulandelayo:

• I-Lymph: I-fluid engenambala, engenamanzi ehamba emithanjeni ye-lymph futhi ephethe ama-lymphocyte ka-T no-B. Ama-lymphocyte awuhlobo lwamaseli amhlophe egazi.

• Imikhumbi yeLymph: Inethiwekhi yamashubhu amancane aqoqa i-lymph ezingxenyeni ezihlukene zomzimba bese eyibuyisela egazini.

• Ama-lymph node: Izakhiwo ezincane, ezimise ubhontshisi ezihlunga i-lymph bese zigcina amaseli amhlophe egazi asiza ukulwa nokutheleleka nezifo. Ama-lymph node atholakala kwinethiwekhi yemikhumbi ye-lymph kuwo wonke umzimba. Amaqembu ama-lymph node atholakala entanyeni, ngaphansi kwekhwapha, i-mediastinum, isisu, i-pelvis, ne-groin.

• Ubende: Isitho esenza ama-lymphocyte, sigcine amangqamuzana abomvu egazi nama-lymphocyte, sihlunge igazi, futhi sibhubhise amangqamuzana egazi amadala. Ubende lusehlangothini lwesobunxele sesisu eduze kwesisu.

• I-Thymus: Isitho lapho ama-T lymphocyte akhula futhi anda khona. I-thymus isesifubeni ngemuva kwethambo lesifuba.

• Amathani: Izixuku ezimbili ezincane zezicubu zomzimba ngemuva komphimbo. Kukhona i-tonsil eyodwa ohlangothini ngalunye lomphimbo.

• Umnkantsha wamathambo: Izicubu ezithambile, ezinesiponji maphakathi namathambo athile, njengethambo le-hip kanye nethambo lesifuba. Amaseli egazi amhlophe, amangqamuzana abomvu egazi, nama-platelets enziwa emnkantsheni wethambo.

Izicubu zomzimba ziyatholakala nakwezinye izingxenye zomzimba njengobuchopho, isisu, indlala yegilo, nesikhumba.

Kwesinye isikhathi i-lymphoma ehlobene nengculaza ivela ngaphandle kwama-lymph node emnkantsheni wethambo, isibindi, ama-meninges (ulwelwesi oluncane olumboza ubuchopho) nomgudu wamathumbu. Ngaphansi kakhulu, kungenzeka ku-anus, inhliziyo, i-bile duct, i-gingiva, nemisipha.

I-anatomy yesistimu ye-lymph, ekhombisa izitsha ze-lymph nezitho ze-lymph kufaka phakathi ama-lymph node, amalaka, i-thymus, ubende nomnkantsha wethambo. I-Lymph (i-fluid ecacile) nama-lymphocyte ahamba ngemithambo ye-lymph angene kuma-lymph node lapho ama-lymphocyte ecekela phansi izinto eziyingozi. I-lymph ingena egazini ngomthambo omkhulu oseduze kwenhliziyo.

Kunezinhlobo eziningi ze-lymphoma.

AmaLymphomas ahlukaniswe izinhlobo ezimbili ezijwayelekile:

• IHodgkin lymphoma.

• I-non-Hodgkin lymphoma.

Kokubili i-non-Hodgkin lymphoma neHodgkin lymphoma kungenzeka kwiziguli ezine-AIDS, kepha i-non-Hodgkin lymphoma ivame kakhulu. Lapho umuntu one-AIDS ene-non-Hodgkin lymphoma, ibizwa ngokuthi i-lymphoma ehlobene nengculaza. Lapho i-lymphoma ehlobene nengculaza ivela ohlelweni lwezinzwa oluphakathi (CNS), ibizwa ngokuthi i-CNS lymphoma ehlobene nengculaza.

Ama-non-Hodgkin lymphomas ahlukaniswe ngendlela amaseli awo abukeka ngayo ngaphansi kwemicroscope. Zingaba ngamavila (zikhula kancane) noma zinolaka (zikhula ngokushesha). Ama-lymphomas ahlobene nengculazi anolaka. Kunezinhlobo ezimbili eziyinhloko ze-non-Hodgkin lymphoma ehlobene nengculazi:

• Ukusabalalisa i-B-cell lymphoma enkulu (kufaka phakathi i-B-cell immunoblastic lymphoma).

• IBurkitt noma iBurkitt-like lymphoma.

Ukuze uthole olunye ulwazi mayelana nomdlavuza ohlobene ne-lymphoma noma i-AIDS, bheka izifinyezo ezilandelayo ze-:

• Ukwelashwa Kwe-Adult Non-Hodgkin Lymphoma

• Ukwelashwa Kwe-Non-Hodgkin Lymphoma Treatment

• Ukwelashwa Kwe-CNS Lymphoma Eyinhloko

• Ukwelashwa kweKaposi Sarcoma

Izimpawu ze-lymphoma ehlobene nengculazi zifaka ukwehla kwesisindo, umkhuhlane nokujuluka ebusuku.

Lezi kanye nezinye izimpawu nezimpawu zingabangelwa yi-lymphoma ehlobene nengculaza noma ezinye izimo. Buza nodokotela wakho uma unokunye kwalokhu okulandelayo:

• Ukwehla kwesisindo noma umkhuhlane ngaphandle kwesizathu esaziwayo.

• Ukujuluka ebusuku.

• Ama-lymph node angenabuhlungu, avuvukile entanyeni, esifubeni, ekhwapheni, noma emgodini.

• Umuzwa wokugcwala ngaphansi kwezimbambo.

Izivivinyo ezihlola uhlelo lwe-lymph nezinye izingxenye zomzimba zisetshenziselwa ukusiza ukuthola (ukuthola) nokuthola i-lymphoma ehlobene nengculaza.

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 wezempilo yesiguli, kubandakanya umkhuhlane, ukujuluka ebusuku, ukwehla kwesisindo, imikhuba yezempilo, nokugula nokwelashwa kwangaphambilini.

• Qedela ukubalwa kwegazi (i-CBC): Inqubo lapho kukhishwa khona isampula legazi futhi lihlolwe lokhu okulandelayo:

• Inani lamaseli abomvu egazi, amaseli amhlophe egazi, nama-platelets.

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

• Ingxenye yesampula 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.

• Ukuhlolwa kwe-LDH: Inqubo lapho kuhlolwe khona isampula segazi ukukala inani le-lactic dehydrogenase. Inani elinyukile le-LDH egazini kungaba uphawu lokulimala kwezicubu, i-lymphoma, noma ezinye izifo.

• Ukuhlolwa kwe-Hepatitis B ne-hepatitis C: Inqubo lapho kuhlolwe khona isampula yegazi ukukala inani lama-antigen aqondene ne-hepatitis B kanye / noma ama-antibodies kanye namanani ama-antibodies aqondene ne-hepatitis C. Lawa ma-antigen noma ama-antibodies abizwa ngokuthi omaka. Omaka abahlukene noma inhlanganisela yomaka isetshenziselwa ukunquma ukuthi ngabe isiguli sine-hepatitis B noma i-C ukutheleleka, ngabe sike sathola ukutheleleka noma umuthi wokugoma ngaphambili, noma kungenzeka sitheleleke.

• Ukuhlolelwa i-HIV: Isivivinyo sokulinganisa izinga lama-antibodies e-HIV kusampula yegazi. Ama-antibody enziwa ngumzimba lapho ehlaselwa yinto yangaphandle. Izinga eliphezulu lama-antibodies e-HIV kungasho ukuthi umzimba utheleleke nge-HIV.

• I-CT scan (i-CAT scan): Inqubo eyenza uchungechunge lwezithombe eziningiliziwe zezindawo ezingaphakathi komzimba, ezifana nentamo, isifuba, isisu, i-pelvis, nama-lymph node, athathwe ezinhlangothini ezahlukene. Izithombe zenziwa yikhompyutha exhunywe kumshini we-x-ray. Idayi ingajovwa emthanjeni noma igwinywe ukusiza izitho noma izicubu zivele kahle. Le nqubo ibizwa nangokuthi i-computed tomography, i-computerized tomography, noma i-computer axial tomography.

• I-PET scan (i-positron emission tomography scan): Inqubo yokuthola amangqamuzana abulalayo omzimba emzimbeni. Inani elincane le-glucose enemisebe (ushukela) lifakwa emthanjeni. Isithwebuli se-PET sizungeza umzimba futhi senze isithombe lapho i-glucose isetshenziswa khona emzimbeni. Amaseli amathumba amabi abonakala ekhanya esithombeni ngoba ayasebenza futhi athatha i-glucose eningi kunamaseli avamile.

• Isifiso somnkantsha we-Bone kanye ne-biopsy: Ukususwa komnkantsha kanye nocezu oluncane lwethambo ngokufaka inaliti engenalutho ethangeni noma ethangeni lesifuba. Isazi sezifo sibheka umnkantsha nethambo ngaphansi kwemicroscope ukubheka izimpawu zomdlavuza.

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

• I-lymph node biopsy: Ukususwa kwakho konke noma ingxenye ye-lymph node. Isazi sezifo sibheka izicubu ngaphansi kwesibonakhulu ukubheka amangqamuzana omdlavuza. Olunye lwezinhlobo ezilandelayo ze-biopsies lungenziwa:

• I-Biopsy e-Excisional: Ukususwa kwayo yonke i-lymph node.

• I-incisional biopsy: Ukususwa kwengxenye ye-lymph node.

• I-Core biopsy: Ukususwa kwezicubu ku-lymph node kusetshenziswa inaliti ebanzi.

Ezinye izindawo zomzimba, njengesibindi, amaphaphu, ithambo, umnkantsha nobuchopho, nazo zingasuswa isampula lesicubu bese lihlolwa ngudokotela wezifo ukuthola izimpawu zomdlavuza.

Uma umdlavuza utholakala, izivivinyo ezilandelayo zingenziwa ukutadisha amangqamuzana omdlavuza:

• I-Immunohistochemistry: Isivivinyo selabhorethri esisebenzisa amasosha omzimba ukubheka ama-antigen (amakaki) athile kusampula yezicubu zesiguli. Amasosha omzimba avamise ukuhlanganiswa ne-enzyme noma udayi we-fluorescent. Ngemuva kokuthi ama-antibody abophele kwi-antigen ethile kusampula yezicubu, i-enzyme noma idayi iyasebenza, bese kuthi i-antigen ibonakale ngaphansi kwesibonakhulu. Lolu hlobo lokuhlola lusetshenziselwa ukuxilonga umdlavuza nokusiza ukutshela uhlobo oluthile lomdlavuza kolunye uhlobo lomdlavuza.

• 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.

• 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.

• 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-lymphoma.

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

Isibikezelo (ithuba lokululama) nezinketho zokwelashwa zincike kokulandelayo:

• Isigaba somdlavuza.

• Iminyaka yesiguli.

• Inani lama-lymphocyte e-CD4 (uhlobo lweseli elimhlophe) egazini.

• Inani lezindawo emzimbeni we-lymphoma litholakala ngaphandle kohlelo lwe-lymph.

• Ukuthi isiguli sinomlando wokusetshenziswa kwezidakamizwa ngemithambo (IV).

• Amandla wesiguli okwenza imisebenzi ejwayelekile yansuku zonke.

Izigaba zeLymphoma Ehlobene Nengculazi

AMAPHUZU ASEMQOKA

• Ngemuva kokutholakala kwe-lymphoma ehlobene nengculazi, kwenziwa ukuhlolwa ukuthola ukuthi amangqamuzana omdlavuza asakazekile ngaphakathi kohlelo lwe-lymph noma kwezinye izingxenye zomzimba.

• Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

• Lezi zigaba ezilandelayo zisetshenziselwa i-lymphoma ehlobene nengculazi:

• Isiteji I

• Isigaba II

• Isigaba III

• Isigaba IV

• Ukwelashwa, ama-lymphomas ahlobene nengculazi aqoqiwe ngokususelwa lapho aqala khona emzimbeni, ngokulandelayo:

• I-Peripheral / systemic lymphoma

• I-CNS primary lymphoma

Ngemuva kokutholakala kwe-lymphoma ehlobene nengculazi, kwenziwa ukuhlolwa ukuthola ukuthi amangqamuzana omdlavuza asakazekile ngaphakathi kohlelo lwe-lymph noma kwezinye izingxenye zomzimba.

Inqubo esetshenziselwa ukuthola ukuthi ngabe amangqamuzana omdlavuza asakazekile ngaphakathi kohlelo lwe-lymph noma kwezinye izingxenye zomzimba ibizwa nge-staging. Imininingwane eqoqwe kusuka kusistimu yesiteji inquma isigaba sesifo. Kubalulekile ukwazi isigaba ukuze uhlele ukwelashwa, kepha i-lymphoma ehlobene nengculazi ivame ukuthuthuka lapho itholakala.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa kunqubo yokubeka iziteji:

• I-MRI (imaging resonance imaging) ene-gadolinium: Inqubo esebenzisa uzibuthe, amagagasi omsakazo, nekhompyutha ukwenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi komzimba, njengobuchopho nomgogodla. Into ebizwa ngokuthi i-gadolinium ijojowe esigulini ngomthambo. I-gadolinium iqoqa izungeze amangqamuzana omdlavuza ukuze akhanye ngokugqamile esithombeni. Le nqubo ibizwa nangokuthi i-nuclear magnetic resonance imaging (i-NMRI).

• Ukubhoboza i-Lumbar: Inqubo esetshenziselwa ukuqoqa i-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 umdlavuza ususabalele ebuchosheni nasentanyeni yomgogodla. Isampuli nayo ingahlolwa igciwane le-Epstein-Barr. 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.

Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

Umdlavuza ungasakazeka ngezicubu, uhlelo lwe-lymph, kanye negazi:

• Izicubu. Umdlavuza usakazeka lapho uqale khona ngokukhulela ezindaweni eziseduze.

• Uhlelo lweLymph. Umdlavuza usakazeka lapho uqale khona ngokungena ohlelweni lwe-lymph. Umdlavuza udabula imithambo ye-lymph uye kwezinye izingxenye zomzimba.

• Igazi. Umdlavuza usakazeka lapho uqale khona ngokungena egazini. Umdlavuza uhamba ngemithambo yegazi uye kwezinye izingxenye zomzimba.

Lezi zigaba ezilandelayo zisetshenziselwa i-lymphoma ehlobene nengculazi:

Isiteji I

Isigaba I-lymphoma yabantu abadala. Umdlavuza utholakala ku-lymph node eyodwa noma ngaphezulu eqenjini lama-lymph node noma, ezimweni ezingavamile, umdlavuza utholakala endandeni kaWaldeyer, i-thymus, noma ubende. Esigabeni IE (asikhonjisiwe), umdlavuza usabalalele endaweni eyodwa engaphandle kohlelo lwe-lymph.

I-lymphoma ehlobene ne-AIDS eSiteji I ihlukaniswe ngezigaba mina no-IE.

• Esigabeni I, umdlavuza utholakala kwenye yezindawo ezilandelayo ohlelweni lwe-lymph:

• I-lymph node eyodwa noma ngaphezulu eqenjini lama-lymph node.

• Indandatho kaWaldeyer.

• Thymus.

• Ubende.

• Esigabeni IE, umdlavuza utholakala endaweni eyodwa engaphandle kohlelo lwe-lymph.

• Isigaba II

• I-lymphoma ehlobene ne-AIDS yesigaba II ihlukaniswe ngezigaba II no-IIE.

• Esigabeni II, umdlavuza utholakala emaqenjini amabili noma ngaphezulu ama-lymph node angaphezulu kwesifafazi noma ngaphansi kwesifafazi.

Isigaba II se-lymphoma yabantu abadala. Umdlavuza utholakala emaqenjini amabili noma ngaphezulu ama-lymph node angaphezulu kwesifafazi noma ngaphansi kwesifafazi.

• Esigabeni IIE, umdlavuza usabalale wasuka eqenjini lama-lymph node waya endaweni eseduze engaphandle kohlelo lwe-lymph. Umdlavuza kungenzeka usabalalele nakwamanye amaqembu e-lymph node ohlangothini olufanayo lwe-diaphragm.

Isigaba IIE i-lymphoma yabantu abadala. Umdlavuza usabalale kusuka eqenjini lama-lymph node waya endaweni eseduze engaphandle kohlelo lwe-lymph. Umdlavuza kungenzeka usabalalele nakwamanye amaqembu e-lymph node ohlangothini olufanayo lwe-diaphragm.

Esigabeni II, igama elithi bulky disease lisho isisu esikhulu. Ubukhulu besisindo se-tumor esibizwa ngokuthi yisifo esinamandla buyahluka ngokuya ngohlobo lwe-lymphoma.

Isigaba III

Isigaba III se-lymphoma yabantu abadala. Umdlavuza utholakala ngamaqembu ama-lymph node womabili ngenhla nangaphansi kwe-diaphragm; noma eqenjini lama-lymph node ngaphezulu kwe-diaphragm nasesipeleni.

Esigabeni III i-lymphoma ehlobene nengculazi, umdlavuza uyatholakala:

• emaqenjini ama-lymph node ngenhla nangaphansi kwe-diaphragm; noma

• kuma-lymph node ngaphezulu kwe-diaphragm nasesipilini.

Isigaba IV

Isigaba IV sabantu abadala i-lymphoma. Umdlavuza (a) usabalale ezithweni zonke noma ngaphezulu ngaphandle kohlelo lwe-lymph; noma (b) sitholakala emaqenjini amabili noma ngaphezulu ama-lymph node angaphezulu kwesithsaba noma ngaphansi kwesifafazi nakulungu elilodwa elingaphandle kohlelo lwe-lymph hhayi eduze kwama-lymph node athintekile; noma (c) sitholakala emaqenjini ama-lymph node ngenhla kovalo nangaphansi kwesifafazi nakunoma yisiphi isitho esingaphandle kohlelo lwe-lymph; noma (d) sitholakala esibindi, emnkantsheni wethambo, endaweni engaphezu kweyodwa emaphashini, noma ku-cerebrospinal fluid (CSF). Umdlavuza awusabalalanga ngqo esibindini, emnkantsheni, emaphashini, noma ku-CSF kusuka kuma-lymph node aseduze.

Esigabeni IV i-lymphoma ehlobene nengculaza, umdlavuza:

• isabalale ezithweni zonke noma ngaphezulu ngaphandle kohlelo lwe-lymph; noma

• itholakala emaqenjini amabili noma ngaphezulu ama-lymph node angaphezulu kwesifafazi noma ngaphansi kwesifafazi nakulungu elilodwa elingaphandle kohlelo lwe-lymph hhayi eduze kwama-lymph node athintekile; noma

• itholakala emaqenjini ama-lymph node womabili ngenhla nangaphansi kwe-diaphragm nakunoma yisiphi isitho esingaphandle kwesistimu ye-lymph; noma

• itholakala esibindini, emnkantsheni wethambo, ngaphezu kwendawo eyodwa emaphashini, noma i-cerebrospinal fluid (CSF). Umdlavuza awusabalalanga ngqo esibindini, emnkantsheni, emaphashini, noma ku-CSF kusuka kuma-lymph node aseduze.

Iziguli ezitheleleke ngegciwane le-Epstein-Barr noma i-lymphoma yazo ehlobene nengculaza ethinta umongo wethambo zisengozini enkulu yokuba umdlavuza usabalalele ohlelweni lwezinzwa oluphakathi (CNS).

Ukwelashwa, ama-lymphomas ahlobene nengculazi aqoqiwe ngokususelwa lapho aqala khona emzimbeni, ngokulandelayo:

I-Peripheral / systemic lymphoma

I-Lymphoma eqala ohlelweni lwe-lymph noma kwenye indawo emzimbeni, ngaphandle kobuchopho, ibizwa nge-peripheral / systemic lymphoma. Ingasakazeka emzimbeni wonke, kufaka phakathi ubuchopho noma umnkantsha. Kuvame ukutholakala kusigaba esithuthukile.

I-CNS primary lymphoma

I-CNS primary lymphoma iqala ohlelweni oluphakathi lwezinzwa (ubuchopho nomgogodla). Ixhunyaniswe negciwane le-Epstein-Barr. I-Lymphoma eqala kwenye indawo emzimbeni futhi isabalale iye ohlelweni oluphakathi lwezinzwa akuyona i-CNS lymphoma eyinhloko.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukene zokwelashwa kweziguli ezine-lymphoma ehlobene nengculazi.

• Ukwelashwa kwe-lymphoma ehlobene nengculazi kuhlanganisa ukwelashwa kwe-lymphoma nokwelashwa kwengculaza.

• Izinhlobo ezine zokwelashwa ezijwayelekile zisetshenzisiwe:

• Ukwelashwa ngamakhemikhali

• Ukwelashwa ngemisebe

• I-chemotherapy ephezulu ene-stem cell transplant

• Ukwelashwa okuhlosiwe

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• Ukwelashwa kwe-lymphoma ehlobene nengculaza kungadala imiphumela emibi.

• Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

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

• Ukuhlolwa kokulandelela kungadingeka.

Kunezinhlobo ezahlukene zokwelashwa kweziguli ezine-lymphoma ehlobene nengculazi.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezigulini ezine-lymphoma ehlobene nengculazi. 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 zokwelashwa ezintsha zeziguli ezinomdlavuza. Lapho izivivinyo zokwelashwa zibonisa ukuthi ukwelashwa okusha kungcono kunokwelashwa okujwayelekile, ukwelashwa okusha kungaba ukwelashwa okujwayelekile. Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo. Ezinye izivivinyo zokwelashwa zivulekele kuphela iziguli ezingakaqali ukwelashwa.

Ukwelashwa kwe-lymphoma ehlobene nengculazi kuhlanganisa ukwelashwa kwe-lymphoma nokwelashwa kwengculaza.

Iziguli ezine-AIDS zenze buthaka amasosha omzimba futhi ukwelashwa kungadala ukuthi amasosha omzimba abe buthakathaka nakakhulu. Ngalesi sizathu, ukwelapha iziguli ezine-lymphoma ehlobene nengculazi kunzima futhi ezinye iziguli zingaphathwa ngemithamo ephansi yezidakamizwa kuneziguli ze-lymphoma ezingenayo i-AIDS.

Imithi elwa nezidambisigciwane kakhulu (HAART) isetshenziselwa ukunciphisa umonakalo emasosheni omzimba abangelwa yi-HIV. Ukwelashwa nge-HAART kungavumela ezinye iziguli ezine-lymphoma ehlobene nengculaza ukuthi zithole ngokuphepha imishanguzo yokulwa nomdlavuza kumazinga ajwayelekile noma aphezulu. Kulezi ziguli, ukwelashwa kungasebenza njengoba kusebenza kwiziguli ze-lymphoma ezingenayo i-AIDS. Imithi yokuvikela nokwelapha izifo, engaba yimbi, nayo iyasetshenziswa.

Ukuthola eminye imininingwane nge-AIDS kanye nokwelashwa kwayo, sicela ubheke iwebhusayithi ye-AIDSinfo.

Izinhlobo ezine zokwelashwa ezijwayelekile zisetshenzisiwe:

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 izidakamizwa ezingaphezu kwesisodwa ze-anticancer.

Indlela i-chemotherapy enikezwa ngayo incike lapho umdlavuza wakhe khona. I-intrathecal chemotherapy ingasetshenziswa ezigulini ezinamathuba amaningi okuba ne-lymphoma ohlelweni lwezinzwa oluphakathi (CNS).

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.

I-Chemotherapy isetshenziswa ekwelapheni i-peripheral / systemic lymphoma ehlobene nengculazi. Akukaziwa ukuthi kungcono yini ukunikeza i-HAART ngasikhathi sinye njenge-chemotherapy noma ngemuva kokuphela kwe-chemotherapy.

Izici ezivuselela i-Colony kwesinye isikhathi zinikezwa kanye ne-chemotherapy. Lokhu kusiza ukunciphisa imiphumela emibi i-chemotherapy engaba nayo emnkantsheni wethambo.

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 lapho umdlavuza wakhe khona. Ukwelashwa kwemisebe yangaphandle kusetshenziselwa ukwelapha i-CNS lymphoma eyinhloko ehlobene nengculaza.

I-chemotherapy ephezulu ene-stem cell transplant

Imithamo ephezulu yokwelashwa ngamakhemikhali inikezwa ukubulala amangqamuzana omdlavuza. 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 lesiguli 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.

Ukwelashwa okuhlosiwe

Ukwelashwa okuhlosiwe uhlobo lokwelashwa olusebenzisa izidakamizwa noma ezinye izinto ukukhomba nokuhlasela amangqamuzana omdlavuza athile ngaphandle kokulimaza amaseli ajwayelekile. Ukwelashwa kwe-monoclonal antibody uhlobo lwezokwelapha ezihlosiwe.

I-monoclonal antibody therapy iyindlela yokwelapha umdlavuza esebenzisa amasosha omzimba enziwe elebhu evela 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. Lezi zingasetshenziswa zodwa noma ukuphatha izidakamizwa, ubuthi, noma okokukhipha imisebe ngqo emangqamuzaneni omdlavuza. I-Rituximab isetshenziswa ekwelapheni i-peripheral / systemic lymphoma ehlobene nengculazi.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

Ukwelashwa kwe-lymphoma ehlobene nengculaza kungadala imiphumela emibi.

Ngemininingwane ngemiphumela engemihle ebangelwe ukwelashwa komdlavuza, bheka ikhasi lethu le-Side Effects.

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 sakho sishintshile noma uma umdlavuza ubuyile (buyela emuva). Lezi zivivinyo kwesinye isikhathi zibizwa ngokuthi izivivinyo zokulandelela noma ukuhlolwa.

Izinketho Zokwelapha I-Lymphoma Ehlobene Nengculazi

Kulesi Sigaba

• I-Peripheral / I-Systemic Lymphoma Ehlobene Nengculaza

• Uhlelo Olwesabekayo Oluhlobene Nengculaza Lymphoma

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

I-Peripheral / I-Systemic Lymphoma Ehlobene Nengculaza

Ukwelashwa kwe-peripheral / systemic lymphoma ehlobene nengculaza kungafaka okulandelayo:

• Inhlanganisela yamakhemikhali noma ukwelashwa okuhlosiwe noma ngaphandle.

• I-chemotherapy ephezulu kanye ne-stem cell transplant, ye-lymphoma engaphendulanga ekwelashweni noma ebuyile.

• I-intrathecal chemotherapy ye-lymphoma engase isabalale ohlelweni lwezinzwa oluphakathi (CNS).

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

Uhlelo Olwesabekayo Oluhlobene Nengculaza Lymphoma

Ukwelashwa kwesistimu eyinhloko ehlobene nengculazi i-lymphoma ingafaka okulandelayo:

• Ukwelashwa kwemisebe yangaphandle.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

Ukufunda Kabanzi Nge-Lymphoma Ehlobene Nengculazi

Ukuze uthole olunye ulwazi oluvela ku-National Cancer Institute mayelana ne-lymphoma ehlobene ne-AIDS, bheka okulandelayo:

• Ukufakelwa Kwama-Stem Cell Stem

• Izindlela Zokwelapha Zomdlavuza

Ngemininingwane ejwayelekile yomdlavuza nezinye izinsiza ezivela ku-National Cancer Institute, bheka okulandelayo:

• Mayelana Nomdlavuza

• Isiteji

• I-Chemotherapy kanye Nawe: Ukusekelwa Kwabantu Abanomdlavuza

• Ukwelashwa Kwemisebe Nawe: Ukusekelwa Kwabantu Abanomdlavuza

• Ukubhekana Nomdlavuza

• Imibuzo Ongayibuza Udokotela Wakho mayelana Nomdlavuza

• Kwabasindile Nabanakekeli