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Ukwelashwa Kwe-Non-Hodgkin Lymphoma Treatment (®) -Patient Version

Imininingwane ejwayelekile Mayelana Ne-Childhood Non-Hodgkin Lymphoma

AMAPHUZU ASEMQOKA

• Ingane engeyona iHodgkin lymphoma yisifo lapho amangqamuzana abulalayo (umdlavuza) akha uhlelo lwe-lymph.

• Izinhlobo eziyinhloko ze-lymphoma yiHodgkin lymphoma ne-non-Hodgkin lymphoma.

• Kunezinhlobo ezintathu ezinkulu zobuntwana ezingezona iHodgkin lymphoma.

• I-B-cell evuthiwe engeyona iHodgkin lymphoma

• I-lymphoblastic lymphoma

• Anaplastic enkulu cell lymphoma

• Ezinye izinhlobo ze-non-Hodgkin lymphoma azivamile ezinganeni.

• Ukwelashwa kwangaphambilini komdlavuza nokuba namasosha omzimba abuthakathaka kuthinta ingozi yokuba nengane engeyona iHodgkin lymphoma.

• Izimpawu zobuntwana ezingezona iHodgkin lymphoma zifaka phakathi izinkinga zokuphefumula kanye nama-lymph node avuvukile.

• Ukuhlolwa okuhlola uhlelo lomzimba ne-lymph kusetshenziselwa ukuthola (ukuthola) nokuxilonga i-lymphoma yengane engeyona iHodgkin.

• I-biopsy yenziwa ukuxilonga ingane engeyona iHodgkin lymphoma.

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

Ingane engeyona iHodgkin lymphoma yisifo lapho amangqamuzana abulalayo (umdlavuza) akha uhlelo lwe-lymph.

Ingane engeyona iHodgkin lymphoma uhlobo lomdlavuza olwenzeka ohlelweni lwe-lymph, oluyingxenye yesistimu yomzimba yokuzivikela. 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.

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.

I-non-Hodgkin lymphoma ingaqala kuma-lymphocyte B, ama-T lymphocyte, noma amaseli okubulala emvelo. Ama-lymphocyte angatholakala egazini futhi aqoqwe kuma-lymph node, spleen, kanye ne-thymus.

Izicubu zomzimba zitholakala nakwezinye izingxenye zomzimba njengesisu, indlala yegilo, ubuchopho nesikhumba.

I-non-Hodgkin lymphoma ingenzeka kubantu abadala nasezinganeni. Ukwelashwa kwezingane kwehlukile kunokwelashwa kwabantu abadala. Bona izifinyezo ezilandelayo ze- ngolwazi mayelana nokwelashwa kwe-non-Hodgkin lymphoma kubantu abadala:

• I-Lymphoma yabantu abadala abangewona iHodgkin

• Ukwelashwa Kwe-CNS Lymphoma Eyinhloko

• Ukwelashwa kwe-Mycosis Fungoides (Kubandakanya i-Sezary Syndrome)

Izinhlobo eziyinhloko ze-lymphoma yiHodgkin lymphoma ne-non-Hodgkin lymphoma.

AmaLymphomas ahlukaniswe izinhlobo ezimbili ezijwayelekile: iHodgkin lymphoma kanye ne-non-Hodgkin lymphoma. Lesi sifinyezo simayelana nokwelashwa kwengane engeyona iHodgkin lymphoma. Bona isifinyezo se- ku-Childhood Hodgkin Lymphoma Treatment ukuze uthole ulwazi mayelana ne-Hodgkin lymphoma yobuntwana.

Kunezinhlobo ezintathu ezinkulu zobuntwana ezingezona iHodgkin lymphoma.

Uhlobo lwe-lymphoma lunqunywa ukuthi amaseli abukeka kanjani ngaphansi kwesibonakhulu. Izinhlobo ezintathu ezinkulu zobuntwana ezingezona iHodgkin lymphoma yilezi:

I-B-cell evuthiwe engeyona iHodgkin lymphoma

Ama-lymphomas avuthiwe we-B-cell non-Hodgkin afaka:

• IBurkitt neBurkitt-like lymphoma / leukemia: IBurkitt lymphoma kanye neBurkitt leukemia yizinhlobo ezahlukahlukene zesifo esifanayo. IBurkitt lymphoma / leukemia yisifo esinolaka (esikhula ngokushesha) sama-lymphocyte B esivame kakhulu ezinganeni nasebasha. Ingakha esiswini, iringi likaWaldeyer, amasende, ithambo, umnkantsha, isikhumba, noma uhlelo oluphakathi lwezinzwa (CNS). IBurkitt leukemia ingaqala kuma-lymph node njengeBurkitt lymphoma bese isakazeka egazini nasemnkantsheni wethambo, noma ingaqala egazini nasemnkantsheni wethambo ngaphandle kokwenza ama-lymph node kuqala.

Kokubili i-leukemia yeBurkitt neBurkitt lymphoma kuxhunyaniswe nokutheleleka ngegciwane le-Epstein-Barr (EBV), yize ukutheleleka nge-EBV kungenzeka kakhulu kwiziguli ezise-Afrika kunase-United States. IBurkitt neBurkitt-like lymphoma / leukemia kutholakala lapho kutholakala isampula lezicubu futhi kutholakala ushintsho oluthile kuhlobo lwe-MYC.

• Ukusabalalisa i-B-cell lymphoma enkulu : Ukusabalalisa i-B-cell lymphoma enkulu uhlobo oluvame kakhulu lwe-non-Hodgkin lymphoma. Luhlobo lwe-B-cell non-Hodgkin lymphoma ekhula ngokushesha kuma-lymph node. Ubende, isibindi, umnkantsha, noma ezinye izitho nazo ziyathinteka. Ukusabalalisa i-B-cell lymphoma enkulu kwenzeka kaningi ebusheni kunezingane.

• I-primary mediastinal B-cell lymphoma: Uhlobo lwe-lymphoma oluvela kumaseli e-B ku-mediastinum (indawo engemva kwesifuba sesifuba). Ingasakazeka ezithweni eziseduze kufaka phakathi amaphaphu kanye nesaka elizungeze inhliziyo. Ingasakazeka nakuma-lymph node nasezitho ezikude okubandakanya izinso. Ezinganeni nasebusheni, i-mediastinal primary B-cell lymphoma yenzeka kaningi ezinganeni esezikhulile.

I-lymphoblastic lymphoma

I-lymphoblastic lymphoma uhlobo lwe-lymphoma oluthinta kakhulu i-T-cell lymphocyte. Imvamisa yakha ku-mediastinum (indawo engemva kwesifuba sesifuba). Lokhu kudala inkinga yokuphefumula, isifuba, inkinga yokugwinya, noma ukuvuvukala kwekhanda nentamo. Ingasakazeka kuma-lymph node, ithambo, umnkantsha, isikhumba, i-CNS, izitho zesisu nezinye izindawo. I-lymphoblastic lymphoma ifana ne-acute lymphoblastic leukemia (YONKE).

Anaplastic enkulu cell lymphoma

I-Anaplastic large cell lymphoma uhlobo lwe-lymphoma oluthinta kakhulu i-T-cell lymphocyte. Imvamisa yakha ama-lymph node, isikhumba, noma ithambo, futhi kwesinye isikhathi yakheka emathunjini, amaphaphu, izicubu ezihlanganisa amaphaphu nemisipha. Iziguli ezine-anaplastic large cell lymphoma zine-receptor, ebizwa nge-CD30, ebusweni bamaseli azo angama-T. Ezinganeni eziningi, i-anaplastic large cell lymphoma imakwa ngoshintsho kuhlobo lwe-ALK olwenza iprotheni ebizwa nge-anaplastic lymphoma kinase. Udokotela wezifo ezihlola lezi zinguquko zeseli nezofuzo ukusiza ukuthola i-anaplastic large cell lymphoma.

Ezinye izinhlobo ze-non-Hodgkin lymphoma azivamile ezinganeni.

Ezinye izinhlobo zobuntwana ezingezona iHodgkin lymphoma azivamile kangako. Lokhu kufaka phakathi:

• Uhlobo lwezingane lwe-follicular lymphoma: Ezinganeni, i-follicular lymphoma yenzeka ikakhulu kwabesilisa. Kungenzeka ukuthi itholakale endaweni eyodwa futhi ingasabalali iye kwezinye izindawo emzimbeni. Imvamisa yakha emathanjeni nakuma-lymph node entanyeni, kepha futhi angakha kumasende, izinso, umgudu wamathumbu, kanye nendlala yamathe.

• I-Marginal zone lymphoma: I- Marginal zone lymphoma uhlobo lwe-lymphoma evame ukukhula nokusabalalisa kancane futhi ivame ukutholakala ekuqaleni. Ingatholwa kuma-lymph node noma ezindaweni ezingaphandle kwama-lymph node. I-Marginal zone lymphoma etholakala ngaphandle kwama-lymph node ezinganeni ibizwa ngokuthi izicubu ezihlobene ne-mucosa-associated lymphoid (MALT) lymphoma. I-MALT ingaxhunyaniswa nokutheleleka kwe-Helicobacter pylori yomgudu wamathumbu kanye nokutheleleka kweChlamydophila psittaci kolwelwesi lwe-conjunctival olugudla iso.

• Isistimu yezinzwa eyinhloko (CNS) lymphoma: I- CNS primary lymphoma ayivamile kakhulu ezinganeni.

• I-Peripheral T-cell lymphoma: I- Peripheral T-cell lymphoma iyi-lymphoma enolaka (ekhula ngokushesha) engeyona iHodgkin eqala kuma-lymphocyte avuthiwe. Ama-lymphocyte we-T avuthwa ku-thymus gland bese eya kwezinye izingxenye zohlelo lwe-lymph, njengama-lymph node, umnkantsha wethambo, nobende.

• I-T-cell lymphoma enqamulelayo : I-T-cell lymphoma ehlukanisiwe iqala esikhunjeni futhi ingadala ukuthi isikhumba sikhule noma sakhe isimila. Kuyaqabukela kakhulu ezinganeni, kepha kuvame kakhulu kwintsha nasebekhulile. Kunezinhlobo ezahlukahlukene ze-T-cell lymphoma enqunyiwe, njenge-cutaneous anaplastic large cell lymphoma, i-panniculitis enjenge-T-cell lymphoma, i-gamma-delta T-cell lymphoma, ne-mycosis fungoides. I-Mycosis fungoides kuyaqabukela ivela ezinganeni nasebusheni.

Ukwelashwa kwangaphambilini komdlavuza nokuba namasosha omzimba abuthakathaka kuthinta ingozi yokuba nengane engeyona iHodgkin lymphoma.

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.

Izici ezingaba yingozi yengane engeyona iHodgkin lymphoma zifaka okulandelayo:

• Ukwelashwa okwedlule komdlavuza.

• Ukutheleleka ngegciwane le-Epstein-Barr noma i-human immunodeficiency virus (HIV).

• Ukuba namasosha omzimba abuthakathaka ngemuva kokufakelwa noma emithini enikezwe ngemuva kokufakelwa kabusha.

• Ukuba nezifo ezithile ezizuzwe njengefa (njengama-syndromes wokulungisa ama-DNA afaka i-ataxia-telangiectasia, i-Nijmegen breakage syndrome, kanye nokuntuleka kokulungiswa kokungafani komthethosisekelo).

Uma isifo se-lymphoma noma se-lymphoproliferative sixhunyaniswa namasosha omzimba abuthakathaka asuka ezifweni ezithile ezizuzwe njengefa, ukutheleleka nge-HIV, ukufakelwa noma imithi enikezwe ngemuva kokufakelwa, lesi simo sibizwa ngokuthi yisifo se-lymphoproliferative esihambisana nokuqina komzimba. Izinhlobo ezahlukene zesifo se-lymphoproliferative esihambisana nokukhubazeka komzimba zihlanganisa:

• Isifo seLymphoproliferative esihlotshaniswa nokuqina komzimba okuyisisekelo.

• I-non-Hodgkin lymphoma ehlobene ne-HIV.

• Isifo se-post-transplant lymphoproliferative.

Izimpawu zobuntwana ezingezona iHodgkin lymphoma zifaka phakathi izinkinga zokuphefumula kanye nama-lymph node avuvukile.

Lezi kanye nezinye izimpawu zingabangelwa yi-non-Hodgkin lymphoma yobuntwana noma ngezinye izimo. Buza nodokotela wakho uma ingane yakho inokunye kwalokhu okulandelayo:

• Ukuphefumula kanzima.

• Ukuqhuma.

• Ukukhwehlela.

• Imisindo yokuphefumula ephezulu.

• Ukuvuvukala kwekhanda, intamo, umzimba ongaphezulu, noma izingalo.

• Inkinga yokugwinya.

• Ukuvuvukala okungenasici kwama-lymph node entanyeni, ngaphansi kwekhwapha, esiswini noma emgodini.

• Isigaxa esingenabuhlungu noma ukuvuvukala esendeni.

• Umkhuhlane ngaphandle kwesizathu esaziwayo.

• Ukwehla kwesisindo ngaphandle kwesizathu esaziwayo.

• Ukujuluka ebusuku.

Ukuhlolwa okuhlola uhlelo lomzimba ne-lymph kusetshenziselwa ukuthola (ukuthola) nokuxilonga i-lymphoma yengane engeyona iHodgkin.

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.

• Izifundo ze-chemistry yegazi: Inqubo lapho kuhlolwe khona isampula segazi ukukala inani lezinto ezithile ezikhishwe egazini ngezitho nezicubu emzimbeni, kufaka phakathi ama-electrolyte, i-lactate dehydrogenase (LDH), i-uric acid, i-blood urea nitrogen (BUN) , amanani we-creatinine, nokusebenza kwesibindi. Inani elingavamile (eliphakeme noma eliphansi kunokujwayelekile) lezinto kungaba uphawu lwesifo.

• Ukuhlolwa kokusebenza kwesibindi: Inqubo lapho kuhlolwe khona isampula segazi ukukala inani lezinto ezithile ezikhishwe egazini yisibindi. Inani eliphakeme kunelivamile lezinto kungaba uphawu lomdlavuza.

• I-CT scan (i-CAT scan): Inqubo eyenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi komzimba, ezithathwe 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.

Iskena se-computed tomography (CT) sesisu. Ingane ilele etafuleni elishibilika ngesithwebuli se-CT, esithatha izithombe ze-x-ray zangaphakathi kwesisu.

• 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. Kwesinye isikhathi kwenziwa i-PET scan ne-CT scan ngasikhathi sinye. Uma kukhona umdlavuza, lokhu kwandisa amathuba okuthi utholakale.

Ukuskena kwePositron emission tomography (PET). Ingane ilele phezu kwetafula elishibilika ngesithwebuli se-PET. Ukuphumula kwekhanda nomucu omhlophe kusiza ingane ukuba ilele inganyakazi. Inani elincane le-glucose enemisebe (ushukela) lifakwa emthanjeni wengane, futhi isithwebuli senza isithombe sokuthi i-glucose isetshenziswa kuphi emzimbeni. Amaseli womdlavuza avela ngokugqamile esithombeni ngoba athatha i-glucose eningi kunamaseli avamile.

• I-MRI (imaging resonance imaging): Inqubo esebenzisa uzibuthe, amagagasi omsakazo, nekhompyutha ukwenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi komzimba. Le nqubo ibizwa nangokuthi i-nuclear magnetic resonance imaging (i-NMRI).

I-Magnetic resonance imaging (MRI) yesisu. Ingane ilele etafuleni elingena kuskena seMRI, esithwebula izithombe zangaphakathi komzimba. Iphedi esiswini sengane isiza ukwenza izithombe zicace bha.

• 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. 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.

• 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.

• Ukuhlolwa kwe-Ultrasound: Inqubo lapho amaza omsindo wamandla aphezulu (i-ultrasound) ehlaselwa izicubu zangaphakathi noma izitho bese enza ama-echoes. Ama-echoes akha isithombe sezicubu zomzimba esibizwa nge-sonogram. Isithombe singaphrintwa ukuze sibhekwe ngokuhamba kwesikhathi.

I-ultrasound yesisu. I-ultrasound transducer exhunywe kwikhompyutha icindezelwa esikhunjeni sesisu. I-transducer igxilisa amaza omsindo ezithweni zangaphakathi nezicubu zayo ukuze yenze ama-echoes akha isithombe (sekhompyutha).

I-biopsy yenziwa ukuxilonga ingane engeyona iHodgkin lymphoma.

Amaseli nezicubu kuyasuswa ngesikhathi se-biopsy ukuze zibukwe ngaphansi kwesibonakhulu ngudokotela wezifo ukuze ahlole izimpawu zomdlavuza. Ngoba ukwelashwa kuncike ohlotsheni lwe-non-Hodgkin lymphoma, amasampula e-biopsy kufanele ahlolwe ngudokotela wezifo onolwazi lokuthola ukuthi yini engeyona iHodgkin lymphoma yobuntwana.

Olunye lwezinhlobo ezilandelayo ze-biopsies lungenziwa:

• I-Biopsy e-Excisional: Ukususwa kwe-lymph node yonke noma isigaxa sezicubu.

• I-incisional biopsy: Ukususwa kwengxenye yesigaxa, i-lymph node, noma isampula lezicubu.

• I-Core biopsy: Ukususwa kwezicubu noma ingxenye ye-lymph node kusetshenziswa inaliti ebanzi.

• I-Fine-needle aspiration (FNA) biopsy: Ukususwa kwezicubu noma ingxenye ye-lymph node kusetshenziswa inaliti ezacile.

Inqubo esetshenziselwa ukususa isampula lezicubu incike lapho isimila sikhona emzimbeni:

• Isifiso somnkantsha we-Bone kanye ne-biopsy: Ukususwa komnkantsha kanye nocezu oluncane lwethambo ngokufaka inaliti engenalutho ethangeni noma ethangeni lesifuba.

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-Mediastinoscopy: Inqubo yokuhlinza yokubheka izitho, izicubu, nama-lymph node phakathi kwamaphaphu ezindaweni ezingavamile. Kusikwa (ukusika) ngenhla kwesifuba sesifuba bese kufakwa i-mediastinoscope esifubeni. I-mediastinoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Futhi inethuluzi lokususa amasampula ezicubu noma ama-lymph node, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza.

• I-Anterior mediastinotomy: Inqubo yokuhlinzwa yokubheka izitho nezicubu eziphakathi kwamaphaphu naphakathi kwesifuba nenhliziyo yezindawo ezingavamile. Kusikwa (ukusika) eduze kwesifuba sesifuba bese kufakwa i-mediastinoscope esifubeni. I-mediastinoscope iyinsimbi encane, efana nethubhu enokukhanya nelensi yokubuka. Futhi inethuluzi lokususa amasampula ezicubu noma ama-lymph node, ahlolwe ngaphansi kwesibonakhulu ukuthola izimpawu zomdlavuza. Lokhu kubizwa nangokuthi inqubo yeChamberlain.

• I-Thoracentesis: Ukususwa koketshezi esikhaleni esiphakathi kolwelwesi lwesifuba kanye nephaphu, kusetshenziswa inaliti. Isazi sezifo sibheka uketshezi olungaphansi kwesibonakhulu ukubheka amangqamuzana omdlavuza.

Uma umdlavuza utholakala, izivivinyo ezilandelayo zingenziwa ukutadisha amangqamuzana omdlavuza:

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

• Flow cytometry: Isivivinyo selabhorethri esikala inani lamaseli esampula, iphesenti lamaseli aphilayo kusampula, nezici ezithile zamaseli, njengosayizi, umumo, nokuba khona komaka be-tumor (noma okunye) ubuso beseli. Amaseli avela kusampula yegazi lesiguli, umnkantsha, noma ezinye izicubu anamabala ombala we-fluorescent, afakwa kuketshezi, abese edluliswa ngalinye ngesikhathi emgqeni wokukhanya. Imiphumela yokuhlolwa isuselwa ekutheni amangqamuzana abenebala lodayi we-fluorescent asabela kanjani oshalweni lokukhanya. Lokhu kuhlolwa kusetshenziselwa ukuxilonga nokuphatha izinhlobo ezithile zomdlavuza, njenge-leukemia ne-lymphoma.

• 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 ku:

• Uhlobo lwe-lymphoma.

• Lapho isimila sikhona emzimbeni lapho kutholakala isimila.

• Isigaba somdlavuza.

• Ukuthi kunezinguquko ezithile yini kuma-chromosomes.

• Uhlobo lokwelashwa kokuqala.

• Ukuthi i-lymphoma isabele ekwelashweni kokuqala.

• Iminyaka yesiguli nempilo ejwayelekile.

Izigaba Zobuntwana Ezingezona IHodgkin Lymphoma

AMAPHUZU ASEMQOKA

• Ngemuva kokutholwa kwengane okungeyona i-Hodgkin lymphoma, kwenziwa ukuhlolwa ukuze kutholakale ukuthi amangqamuzana omdlavuza asakazekile ngaphakathi kohlelo lwe-lymph noma kwezinye izingxenye zomzimba.

• Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

• Lezi zigaba ezilandelayo zisetshenziselwa ingane engeyona iHodgkin lymphoma:

• Isiteji I

• Isigaba II

• Isigaba III

• Isigaba IV

Ngemuva kokutholwa kwengane okungeyona i-Hodgkin lymphoma, kwenziwa ukuhlolwa ukuze kutholakale ukuthi amangqamuzana omdlavuza asakazekile ngaphakathi kohlelo lwe-lymph noma kwezinye izingxenye zomzimba.

Inqubo esetshenziselwa ukuthola ukuthi umdlavuza ususabalele ngaphakathi kohlelo lwe-lymph noma kwezinye izingxenye zomzimba ibizwa nge-staging. Imiphumela yokuhlolwa kanye nezinqubo ezisetshenziselwa ukuxilonga i-non-Hodgkin lymphoma nayo ingasetshenziselwa ukwenza isiteji. Bheka isigaba solwazi jikelele ukuthola incazelo yalezi zivivinyo nezinqubo. Imininingwane eqoqwe kusuka kusistimu yesiteji inquma isigaba sesifo. Kubalulekile ukwazi isigaba ukuze uhlele ukwelashwa.

Inqubo elandelayo nayo ingasetshenziswa ukuthola isigaba:

• Ukuskena kwamathambo: Inqubo yokubheka ukuthi kunamaseli ahlukanisa ngokushesha yini, njengamaseli womdlavuza, ethanjeni. Inani elincane kakhulu lezinto ezinomsakazo lifakwa emthanjeni futhi lihambe phakathi kwegazi. Izinto ezinemisebe eqoqa emathanjeni ezinomdlavuza futhi zitholwa isithwebuli.

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 ingane engeyona iHodgkin lymphoma:

Isiteji I

Isigaba I ebuntwaneni esingeyona iHodgkin lymphoma. Umdlavuza utholakala eqenjini elilodwa lama-lymph node noma indawo eyodwa ngaphandle kwama-lymph node, kepha awukho umdlavuza otholakala esiswini noma kwi-mediastinum (indawo ephakathi kwamaphaphu).

Esigabeni I ebuntwaneni engeyona iHodgkin lymphoma, umdlavuza uyatholakala:

• eqenjini elilodwa lama-lymph node; noma

• endaweni eyodwa ngaphandle kwama-lymph node.

Awukho umdlavuza otholakala esiswini noma kwi-mediastinum (indawo ephakathi kwamaphaphu).

Isigaba II

Isigaba II sobuntwana esingeyona iHodgkin lymphoma. Umdlavuza utholakala endaweni eyodwa ngaphandle kwama-lymph node nakuma-lymph node aseduze (a); noma ezindaweni ezimbili noma ngaphezulu ngenhla (b) noma ngezansi (c) i-diaphragm; noma umdlavuza uqale esiswini, isithasiselo, noma emathunjini (d) futhi ungasuswa ngokuhlinzwa.

Esigabeni II ebuntwaneni esingeyona iHodgkin lymphoma, umdlavuza uyatholakala:

• endaweni eyodwa ngaphandle kwama-lymph node nakuma-lymph node aseduze; noma

• ezindaweni ezimbili noma ngaphezulu kungaba ngenhla noma ngaphansi kwe-diaphragm, futhi kungenzeka ukuthi kwasakazeka kuma-lymph node aseduze; noma

• ukuqala esiswini noma emathunjini futhi kungasuswa ngokuphelele ngokuhlinzwa. Umdlavuza kungenzeka usabalalele kuma-lymph node athile aseduze.

Isigaba III

Isigaba III sobuntwana esingeyona iHodgkin lymphoma. Umdlavuza utholakala okungenani endaweni eyodwa ngenhla nangaphansi kwe-diaphragm (a); noma umdlavuza uqale esifubeni (b); noma umdlavuza uqale esiswini bese usakazeka kuso sonke isisu (c); noma endaweni ezungeze umgogodla (engakhonjisiwe).

Esigabeni III sobuntwana esingeyona iHodgkin lymphoma, umdlavuza uyatholakala:

• okungenani endaweni eyodwa ngenhla kwedayaphragm futhi okungenani endaweni eyodwa ngaphansi kwe-diaphragm; noma

• ukuthi ngiqale esifubeni; noma

• ukuqala esiswini futhi kwasakazeka esiswini sonke; noma

• endaweni ezungeze umgogodla.

Isigaba IV

Isigaba IV sobuntwana esingeyona iHodgkin lymphoma. Umdlavuza utholakala emnkantsheni wethambo, ebuchosheni noma ku-cerebrospinal fluid (CSF). Umdlavuza ungatholakala nakwezinye izingxenye zomzimba.

Esigabeni IV ebuntwaneni esingeyona iHodgkin lymphoma, umdlavuza utholakala emnkantsheni wethambo, ebuchosheni noma ku-cerebrospinal fluid. Umdlavuza ungatholakala nakwezinye izingxenye zomzimba.

Ukuphindaphinda Kwezingane Okungeyona IHodgkin Lymphoma

Ukuphindaphinda kwengane okungeyona iHodgkin lymphoma ngumdlavuza ophindile (wabuya) ngemuva kokuphathwa. Ubuntwana obungeyona iHodgkin lymphoma bungabuya ohlelweni lwe-lymph noma kwezinye izingxenye zomzimba.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukahlukene zokwelashwa kwezingane ezine-non-Hodgkin lymphoma.

• Izingane ezine-non-Hodgkin lymphoma kufanele ukwelashwa kwazo kuhlelwe yiqembu lodokotela abangochwepheshe ekwelapheni umdlavuza wezingane.

• Ukwelashwa kwengane engeyona i-Hodgkin lymphoma kungadala imiphumela emibi.

• Izinhlobo eziyisithupha zokwelashwa okujwayelekile zisetshenzisiwe:

• Ukwelashwa ngamakhemikhali

• Ukwelashwa ngemisebe

• I-chemotherapy ephezulu ene-stem cell transplant

• Ukwelashwa okuhlosiwe

• Olunye ukwelashwa kwezidakamizwa

• I-Phototherapy

• 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-non-Hodgkin lymphoma.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezinganeni ezine-non-Hodgkin lymphoma. 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.

Ukubamba iqhaza esivivinyweni somtholampilo kufanele kubhekelwe kuzo zonke izingane ezine-non-Hodgkin lymphoma. Ezinye izivivinyo zokwelashwa zivulekele kuphela iziguli ezingakaqali ukwelashwa.

Izingane ezine-non-Hodgkin lymphoma kufanele ukwelashwa kwazo kuhlelwe yiqembu lodokotela abangochwepheshe ekwelapheni umdlavuza wezingane.

Ukwelashwa kuzobhekwa ngudokotela wezingane oncologist, udokotela ogxile ekwelapheni izingane ezinomdlavuza. I-oncologist yezingane isebenza nabanye abahlinzeki bezokunakekelwa kwempilo abangochwepheshe ekwelapheni izingane ezine-non-Hodgkin lymphoma futhi ezikhethekile ezindaweni ezithile zemithi. Lokhu kungafaka ongoti abalandelayo:

• Udokotela wezingane.

• I-radiation oncologist.

• I-hematologist yezingane.

• Udokotela ohlinzayo wezingane.

• Umhlengikazi ongumhlengikazi.

• Uchwepheshe wokuvuselelwa.

• Isazi sokusebenza kwengqondo.

• Usonhlala kahle.

Ukwelashwa kwengane engeyona i-Hodgkin lymphoma kungadala imiphumela emibi.

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

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 ukukhuluma nodokotela bengane yakho ngemiphumela yokwelashwa komdlavuza engaba nayo enganeni yakho. (Bheka isifinyezo se- ngemiphumela yamuva yokwelashwa komdlavuza wezingane ukuthola eminye imininingwane.)

Izinhlobo eziyisithupha zokwelashwa okujwayelekile 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. Inhlanganisela yamakhemikhali ukwelashwa kusetshenziswa imishanguzo emibili noma ngaphezulu ye-anticancer.

Indlela i-chemotherapy enikezwa ngayo incike ohlotsheni nesigaba somdlavuza owelashwa.

I-intrathecal chemotherapy ingasetshenziselwa ukwelapha ingane engeyona iHodgkin lymphoma esakaze, noma ingasakazeka, ebuchosheni. Lapho isetshenziselwa ukunciphisa umdlavuza wamathuba ozosabalala ungene ebuchosheni, ubizwa ngokuthi yi-CNS prophylaxis. I-intrathecal chemotherapy inikezwa ngaphezu kwe-chemotherapy ngomlomo noma ngomthambo. Ukweqiwa ngamakhemikhali okuphakeme kunokujwayelekile kungasetshenziswa njenge-CNS prophylaxis.

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 Kuvunyelwe i-Non-Hodgkin Lymphoma 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 kwemisebe enikezwa ngayo incike ohlotsheni lwe-non-Hodgkin lymphoma elashwa. Ukwelashwa kwemisebe yangaphandle kungasetshenziselwa ukwelapha ingane engeyona iHodgkin lymphoma esakaze, noma ingasakazeka, ebuchosheni nasemgogodleni. Ukwelashwa kwemisebe yangaphakathi akusetshenziswanga ukwelapha i-non-Hodgkin lymphoma.

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 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.

Bheka Izidakamizwa Kuvunyelwe i-Non-Hodgkin Lymphoma ukuthola eminye imininingwane.

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. Ama-antibody e-monoclonal, i-tyrosine kinase inhibitors, nama-immunotoxins yizinhlobo ezintathu zokwelashwa okuqondisiwe okusetshenziswayo noma okufundiswayo ekwelapheni i-lymph non-Hodgkin ebuntwaneni.

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. Zingasetshenziswa zodwa noma ukuphatha izidakamizwa, ubuthi, noma okokukhipha imisebe ngqo emangqamuzaneni omdlavuza.

• I-Rituximab isetshenziselwa ukwelapha izinhlobo eziningana zobuntwana ezingezona iHodgkin lymphoma.

• I-Pembrolizumab isetshenziselwa ukwelapha i-B-cell lymphoma eyinhloko engaphakathi engaphendulanga ekwelashweni noma ebuye yabuya (emuva) ngemuva kokwelashwa ngolunye uhlobo lokwelashwa. Ukwelashwa nge-pembrolizumab kufundwe kakhulu kubantu abadala.

• I-Brentuximab vedotin i-anti-monoclonal antibody ehlanganiswe nomuthi we-anticancer osetshenziselwa ukwelapha i-anaplastic large cell lymphoma.

I-bispecific monoclonal antibody yakhiwa ngama-antibodies amabili ahlukene we-monoclonal abopha izinto ezimbili ezihlukile futhi abulale amangqamuzana omdlavuza. I-Bispecific monoclonal antibody therapy isetshenziswa ekwelapheni iBurkitt neBurkitt-like lymphoma / leukemia futhi isabalalisa i-B-cell lymphoma enkulu.

Ama-Tyrosine kinase inhibitors (TKIs) avimba amasiginali ukuthi izimila zidinga ukukhula. Amanye ama-TKI abuye agcine izimila zingakhuli ngokuvimbela ukukhula kwemithambo yegazi emisha kuya kwizicubu. Ezinye izinhlobo ze-kinase inhibitors, njenge-crizotinib, zifundelwa ubuntwana obungeyona iHodgkin lymphoma.

Ama-Immunotoxin angabopha amangqamuzana omdlavuza futhi awabulale. I-Denileukin diftitox iyi-immunotoxin esetshenziselwa ukwelapha i-T-cell lymphoma enesikhumba.

Ukwelashwa okuhlosiwe kufundwa ukwelashwa kwengane engeyona iHodgkin lymphoma ebuye yabuya (buyela).

Bheka Izidakamizwa Kuvunyelwe i-Non-Hodgkin Lymphoma ukuthola eminye imininingwane.

Olunye ukwelashwa kwezidakamizwa

Ama-retinoid yizidakamizwa ezihlobene novithamini A. Ukwelashwa kwe-Retinoid nge-bexarotene kusetshenziselwa ukwelapha izinhlobo eziningana ze-T-cell lymphoma enqunyiwe.

Ama-steroid ngamahomoni enziwa ngokwemvelo emzimbeni. Futhi zingenziwa elebhu futhi zisetshenziswe njengezidakamizwa. Ukwelashwa kwe-steroid kusetshenziselwa ukwelapha i-T-cell lymphoma.

I-Phototherapy

I-Phototherapy yindlela yokwelashwa komdlavuza esebenzisa umuthi nohlobo oluthile lwe-laser light ukubulala amangqamuzana omdlavuza. Umuthi ongasebenzi kuze kube yilapho uvezwa ukukhanya ufakwa emthanjeni. Umuthi uqoqa okuningi kumaseli womdlavuza kunamaseli ajwayelekile. Ngomdlavuza wesikhumba esikhumbeni, ukukhanya kwe-laser kukhanya esikhunjeni futhi umuthi uyasebenza bese ubulala amangqamuzana omdlavuza. I-Phototherapy isetshenziswa ekwelapheni i-T-cell lymphoma enesikhumba.

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-biologic therapy.

I-Epstein-Barr virus (EBV) - ama-cytotoxic T-lymphocyte awuhlobo lweseli lomzimba elingabulala amaseli athile, kufaka phakathi amaseli angaphandle, amangqamuzana omdlavuza namaseli atheleleke nge-EBV. Ama-cytotoxic T-lymphocyte angahlukaniswa namanye amaseli egazi, akhule elebhu, bese anikezwa isiguli ukubulala amangqamuzana omdlavuza. Ama-cytotoxic T-lymphocyte aqondene ne-EBV afundelwa ukwelapha isifo se-post-transplant lymphoproliferative.

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 Zokwelapha Okwezingane Okungeyona IHodgkin Lymphoma

Kulesi Sigaba

• IBurkitt neBurkitt-efana ne-lymphoma / leukemia

• Izinketho zokwelashwa ze-Burkitt ne-Burkitt-like lymphoma / leukemia

• Izinketho zokwelashwa ze-Burkitt ne-Burkitt-like lymphoma / leukemia

• Ukusabalalisa i-B-cell lymphoma enkulu

• Izinketho zokwelashwa kwe-B-cell lymphoma enkulu esanda kutholakala

• Izinketho zokwelashwa zokusabalalisa okuphindwe kabili kwe-B-cell lymphoma

• I-Primary Mediastinal B-cell Lymphoma

• Izinketho zokwelashwa ze-B-cell lymphoma esanda kutholakala

• Izinketho zokwelashwa ze-B-cell lymphoma ephindaphindekayo

• I-Lymphoblastic Lymphoma

• Izinketho zokwelashwa ze-lymphoblastic lymphoma esanda kutholakala

• Izinketho zokwelashwa ze-lymphoblastic lymphoma ephindaphindiwe

• I-Anaplastic Large Cell Lymphoma

• Izinketho zokwelashwa zesandlastic lymphoma enkulu esanda kutholakala

• Izinketho zokwelashwa ze-anaplastic large cell lymphoma

• Isifo seLymphoproliferative Esihlotshaniswa Nokungasebenzi komzimba ezinganeni

• Izinketho zokwelashwa kwesifo se-lymphoproliferative esihambisana nokukhubazeka komzimba okuyisisekelo

• Izinketho zokwelashwa kwe-non-Hodgkin lymphoma ehlotshaniswa nama-syndromes wokulungiswa kwe-DNA

• Izinketho zokwelashwa ze-non-Hodgkin lymphoma ehlobene ne-HIV

• Izinketho zokwelashwa zesifo se-post-transplant lymphoproliferative

• I-NHL Engavamile Eyenzeka Ezinganeni

• Izinketho zokwelashwa zohlobo lwe-follicular lymphoma

• Izinketho zokwelashwa kwe-marginal zone lymphoma

• Izinketho zokwelashwa ze-CNS lymphoma eyinhloko

• Izinketho zokwelashwa kwe-peripheral T-cell lymphoma

• Izinketho zokwelashwa ze-T-cell lymphoma ezinqunyiwe

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

IBurkitt neBurkitt-efana ne-lymphoma / leukemia

Izinketho zokwelashwa ze-Burkitt ne-Burkitt-like lymphoma / leukemia

Izinketho zokwelashwa ze-Burkitt ne-Burkitt-like lymphoma / leukemia zingafaka:

• Ukuhlinzwa ukukhipha isimila ngangokunokwenzeka, kulandelwe inhlanganisela yamakhemikhali.

• Inhlanganisela yamakhemikhali noma ukwelashwa okuhlosiwe noma okungenakho (rituximab)

Izinketho zokwelashwa ze-Burkitt ne-Burkitt-like lymphoma / leukemia

Izinketho zokwelashwa zeBurkitt eziphindaphindayo neBurkitt-ezinjenge-non-Hodgkin lymphoma / leukemia zingafaka:

• Inhlanganisela yamakhemikhali noma ukwelashwa okuhlosiwe noma okungenakho (rituximab)

• Ukwelashwa ngamakhemikhali okuphezulu nge-stem cell ukufakelwa ngamaseli wesiguli noma amaseli avela kumnikeli.

• Ukwelashwa okuqondisiwe nge-antibody bispecific.

• Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

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.

Ukusabalalisa i-B-cell lymphoma enkulu

Izinketho zokwelashwa kwe-B-cell lymphoma enkulu esanda kutholakala

Izinketho zokwelashwa ze-B-cell lymphoma enkulu esanda kutholakala zingabandakanya:

• Ukuhlinzwa ukukhipha isimila ngangokunokwenzeka, kulandelwe inhlanganisela yamakhemikhali.

• Inhlanganisela yamakhemikhali noma ukwelashwa okuhlosiwe noma okungenakho (rituximab)

Izinketho zokwelashwa zokusabalalisa okuphindwe kabili kwe-B-cell lymphoma

Izinketho zokwelashwa zokusabalalisa okuphindwe kabili kwe-B-cell lymphoma zingafaka:

• Inhlanganisela yamakhemikhali noma ukwelashwa okuhlosiwe noma okungenakho (rituximab)

• Ukwelashwa ngamakhemikhali okuphezulu nge-stem cell ukufakelwa ngamaseli wesiguli noma amaseli avela kumnikeli.

• Ukwelashwa okuqondisiwe nge-antibody bispecific.

• Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

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.

I-Primary Mediastinal B-cell Lymphoma

Izinketho zokwelashwa ze-B-cell lymphoma esanda kutholakala

Izinketho zokwelashwa kwe-B-cell lymphoma esanda kutholakala eyinhloko ingafaka:

• Inhlanganisela yamakhemikhali nokwelashwa okuhlosiwe (rituximab).

Izinketho zokwelashwa ze-B-cell lymphoma ephindaphindekayo

Izinketho zokwelashwa ze-B-cell lymphoma eziphindaphindayo ezingaphakathi zingafaka:

• Ukwelashwa okuhlosiwe (pembrolizumab).

• Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

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.

I-Lymphoblastic Lymphoma

Izinketho zokwelashwa ze-lymphoblastic lymphoma esanda kutholakala

I-lymphoblastic lymphoma ingahlukaniswa njengesifo esifanayo ne-acute lymphoblastic leukemia (BONKE). Izinketho zokwelashwa ze-lymphoblastic lymphoma zingafaka:

• Inhlanganisela chemotherapy. I-CNS prophylaxis enokwelapha ngemisebe nayo inganikezwa uma umdlavuza usabalele ebuchosheni noma emgogodleni.

• Ukuhlolwa komtholampilo ngamakhemikhali anezinhlobo ezahlukene zemithi ye-CNS prophylaxis.

• Isivivinyo somtholampilo se-chemotherapy ehlanganisiwe noma ngaphandle kokwelashwa okuhlosiwe (bortezomib).

Izinketho zokwelashwa ze-lymphoblastic lymphoma ephindaphindiwe

Izinketho zokwelashwa ze-lymphoblastic lymphoma eziphindaphindiwe zingafaka:

• Ukwelashwa ngamakhemikhali.

• Ukwelashwa ngamakhemikhali okuphezulu nge-stem cell ukufakelwa namaseli avela kumnikeli.

• Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

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.

I-Anaplastic Large Cell Lymphoma

Izinketho zokwelashwa zesandlastic lymphoma enkulu esanda kutholakala

Izinketho zokwelashwa ze-anaplastic cell cell lymphoma zingafaka:

• Ukuhlinzwa kulandelwa inhlanganisela yamakhemikhali.

• Inhlanganisela chemotherapy.

• I-Intrathecal ne-systemic chemotherapy, yeziguli ezinomdlavuza ebuchosheni noma emgogodleni.

• Isivivinyo somtholampilo sokwelapha okubhekiswe kukho (i-crizotinib noma i-brentuximab) kanye nenhlanganisela yamakhemikhali.

Izinketho zokwelashwa ze-anaplastic large cell lymphoma

Izinketho zokwelashwa eziphindaphindayo zeseli lymphoma enkulu ingahle ifake:

• I-Chemotherapy, i-brentuximab, kanye / noma i-crizotinib.

• Ukufakelwa kwesitokisi samaseli ngamaseli wesiguli noma amaseli avela kumnikeli.

• Ukwelashwa ngemisebe noma i-chemotherapy ephezulu yokwelapha iziguli ezinesifo esidlulela ohlelweni lwezinzwa oluphakathi.

• Isivivinyo somtholampilo sokwelapha okubhekiswe kukho (i-crizotinib noma i-brentuximab) kanye nenhlanganisela yamakhemikhali.

• Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

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.

Isifo seLymphoproliferative Esihlotshaniswa Nokungasebenzi komzimba ezinganeni

Izinketho zokwelashwa kwesifo se-lymphoproliferative esihambisana nokukhubazeka komzimba okuyisisekelo

Izinketho zokwelashwa kwesifo se-lymphoproliferative ezinganeni nasebusheni ezinamasosha omzimba abuthakathaka zingafaka:

• I-Chemotherapy nge-rituximab noma ngaphandle kwayo.

• Ukufakelwa kwesitokisi samaseli ngamaseli avela kumnikeli.

Izinketho zokwelashwa kwe-non-Hodgkin lymphoma ehlotshaniswa nama-syndromes wokulungiswa kwe-DNA

Izinketho zokwelashwa ze-non-Hodgkin lymphoma ezihambisana ne-DNA yokulungisa ama-syndromes ezinganeni zingafaka:

• Ukwelashwa ngamakhemikhali.

Izinketho zokwelashwa ze-non-Hodgkin lymphoma ehlobene ne-HIV

Ukwelashwa nge-antiretroviral therapy noma i-HAART (inhlanganisela yemishanguzo) yehlisa ingozi ye-non-Hodgkin lymphoma ezigulini ezinegciwane lesandulela ngculaza (i-HIV).

Izinketho zokwelashwa ze-non-Hodgkin lymphoma (NHL) ezihlobene ne-HIV ezinganeni zingafaka:

• I-Chemotherapy nge-rituximab noma ngaphandle kwayo.

Ukwelashwa kwesifo esiphindaphindayo, izinketho zokwelashwa zincike ohlotsheni lwe-non-Hodgkin lymphoma.

Izinketho zokwelashwa zesifo se-post-transplant lymphoproliferative

Izinketho zokwelashwa zesifo se-post-transplant lymphoproliferative zingafaka:

• Ukuhlinzwa ukukhipha isimila. Uma kungenzeka, imithamo ephansi yemithi yokuvikela ukuzivikela ngemuva kokufakwa kwesitokisi noma ukufakelwa komzimba.

• Ukwelashwa okuhlosiwe (rituximab).

• I-Chemotherapy enokwelashwa okuhlosiwe noma okungenayo (rituximab).

• Ukwelashwa kwe-immunotherapy usebenzisa ama-lymphocyte anikelayo noma amaseli we-T wesiguli ukukhomba ukutheleleka kuka-Epstein-Barr kuyacwaningwa. Lokhu kwelashwa kutholakala kuphela ezikhungweni ezimbalwa e-United States.

I-NHL Engavamile Eyenzeka Ezinganeni

Izinketho zokwelashwa zohlobo lwe-follicular lymphoma

Izinketho zokwelashwa ze-follicular lymphoma ezinganeni zingabandakanya:

• Ukuhlinzwa.

• Inhlanganisela yamakhemikhali noma ngaphandle kwe-rituximab.

Ezinganeni ezinomdlavuza onezinguquko ezithile kuzakhi zofuzo, ukwelashwa kufana nalokhu okunikezwa abantu abadala abane-follicular lymphoma. Bona isigaba seFollicular Lymphoma kusifinyezo se- ku-Adult Non-Hodgkin Lymphoma ukuze uthole imininingwane.

Izinketho zokwelashwa kwe-marginal zone lymphoma

Izinketho zokwelashwa kwe-marginal zone lymphoma (kufaka phakathi izicubu ze-lymphoid ezihlobene ne-mucosa (MALT) lymphoma) ezinganeni zingafaka:

• Ukuhlinzwa.

• Ukwelashwa ngemisebe.

• I-Rituximab noma ngaphandle kwe-chemotherapy.

• Imithi elwa namagciwane, ye-MALT lymphoma.

Izinketho zokwelashwa ze-CNS lymphoma eyinhloko

Izinketho zokwelashwa ze-CNS lymphoma eyinhloko ezinganeni zingafaka:

• Ukwelashwa ngamakhemikhali.

Izinketho zokwelashwa kwe-peripheral T-cell lymphoma

Izinketho zokwelashwa kwe-peripheral T-cell lymphoma ezinganeni zingabandakanya:

• Ukwelashwa ngamakhemikhali.

• Ukwelashwa ngemisebe.

• Ukufakelwa kwesitokisi samaseli ngamaseli wesiguli noma amaseli avela kumnikeli.

Izinketho zokwelashwa ze-T-cell lymphoma ezinqunyiwe

Izinketho zokwelashwa ze-panniculitis ezinjenge-T-cell lymphoma ezinqamulelayo ezinganeni zingafaka:

• Ukulinda okulindile.

• Ama-steroids aphezulu.

• Ukwelashwa okubhekiswe (i-denileukin diftitox).

• Inhlanganisela chemotherapy.

• Ukwelashwa kwe-Retinoid.

• Ukufakelwa kwe-stem cell.

Izinketho zokwelashwa ze-anaplastic cell cell lymphoma enkulu zingafaka:

• Ukuhlinzwa, ukwelashwa ngemisebe, noma kokubili.

Ezinganeni, izinketho zokwelashwa kwe-mycosis fungoides zingafaka:

• Ama-steroid asetshenziswa esikhumbeni.

• Ukwelashwa kwe-Retinoid.

• Ukwelashwa ngemisebe.

• I-Phototherapy (ukwelashwa okulula usebenzisa imisebe ye-ultraviolet B).

Ukufunda Okwengeziwe Nge-Childhood Non-Hodgkin Lymphoma

Ngemininingwane engaphezulu evela ku-National Cancer Institute mayelana nengane engeyona iHodgkin lymphoma, bheka okulandelayo:

• I-Computed Tomography (CT) Iskena Nomdlavuza

• Izidakamizwa zivunyelwe i-Non-Hodgkin Lymphoma

• 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