Daaweynta hadda iyo Horumarka loogu talagalay CLL

Qanacsan

• Guudmarka
• Daaweynta loogu talagalay CLL-da halista yar
• Daaweynta CLL-dhexe ama khatar sare
• Chemotherapy iyo difaaca jirka
• Daaweynta la bartilmaameedsaday
• Dhiiga lagu shubo
• Shucaac
• Qalliinka unugyada jirrada iyo dhuuxa lafta
• Daaweynta Horumar
• Isku darka dawooyinka
• CAR T-cell therapy
• Daawooyinka kale ee baaritaanku ku socdo
• Qaadashada

Guudmarka

Cudurka 'lymphocytic leukemia' (CLL) waa kansar si tartiib tartiib ah u koraya oo ku dhaca nidaamka difaaca jirka. Sababtoo ah waa tartiib tartiib tartiib tartiib tartiib tartiib tartiib ah, dad badan oo qaba CLL uma baahna inay bilaabaan daaweyn sanado badan kadib ogaanshahooda.

Marka kansarku bilaabo inuu koro, waxaa jira fursado daaweyn oo badan oo la heli karo kuwaas oo ka caawin kara dadka inay gaaraan cafiska. Tani waxay ka dhigan tahay in dadku la kulmi karaan waqti dheer marka aysan jirin wax calaamado kansar ah oo jirkooda ku jira.

Xulashada daaweynta saxda ah ee aad heli doonto waxay kuxirantahay arrimo kala duwan. Tan waxaa ka mid ah in CLL-gaagu yahay astaamo iyo in kale, heerka CLL oo ku saleysan natiijooyinka baaritaanka dhiigga iyo baaritaanka jirka, iyo da'daada iyo caafimaadkaaga guud.

In kasta oo aysan jirin wax daawo ah oo loo yaqaan 'CLL' weli, guulaha laga gaadhay berrinka ayaa ku soo dhowaanaya.

Daaweynta loogu talagalay CLL-da halista yar

Dhakhaatiirtu caadi ahaan waxay qabtaan CLL iyagoo adeegsanaya nidaam loo yaqaan Rai system. Khatarta-yar ee CLL waxay sharraxaysaa dadka ku dhaca "marxaladda 0" ee nidaamka Rai.

Marxaladda 0, qanjidhada qanjidhada, beeryarada, iyo beerka ma weynaadaan. Qiyaasta unugyada dhiigga cas iyo platelet-ka sidoo kale waxay ku dhow yihiin caadi.

Haddii aad qabtid halista CLL, dhakhtarkaaga (badanaa dhakhtarka dhiigga ama kansarka) ayaa laga yaabaa inuu kugula taliyo inaad "sugto oo aad daawato" calaamadaha. Habkan waxaa sidoo kale loo yaqaan ilaalin firfircoon.

Qofka qaba halista CLL ee halista yar waxaa laga yaabaa inuusan u baahnayn daaweyn dheeraad ah sanado badan. Dadka qaarkood weligood daaweyn uma baahnaan doonaan. Waxaad weli u baahan doontaa inaad u tagto dhakhtar baaritaanno joogto ah iyo baaritaanno shaybaar.

Daaweynta CLL-dhexe ama khatar sare

InterLate-risk CLL wuxuu sharxayaa dadka leh marxaladda 1 illaa heerka 2 CLL, sida uu qabo nidaamka Rai. Dadka qaba marxaladda 1 ama 2 CLL waxay ballaariyeen qanjidhada qanjidhada oo laga yaabo inay yeeshaan beeryaro iyo beerka weynaaday, laakiin waxay ku dhow yihiin unugyada dhiigga cas ee caadiga ah iyo platelet.

Khatarta sare ee CLL waxay sharraxaysaa bukaanada qaba heerka 3 ama kansarka marxaladda 4. Tani waxay ka dhigan tahay inaad yeelan karto muruqyada beerka oo weynaada, beerka, ama qanjidhada qanjidhada. Tirada unugyada dhiigga cas oo hooseeya ayaa sidoo kale caan ah. Marxaladda ugu sareysa, tirinta platelet-ka sidoo kale way hooseysaa.

Haddii aad leedahay CLL-dhexe ama khatar sare ah, dhakhtarkaagu wuxuu kugula talin doonaa inaad bilowdo daaweynta isla markiiba.

Chemotherapy iyo difaaca jirka

Waagii hore, daaweynta caadiga ah ee CLL waxaa ka mid ahaa isku darka kiimoteraabiga iyo wakiilada difaaca jirka, sida:

• fludarabine iyo cyclophosphamide (FC)
• FC oo lagu daro antibody immunotherapy loo yaqaan rituximab (Rituxan) oo loogu talagalay dadka da'doodu ka yar tahay 65
• bendamustine (Treanda) oo lagu daray rituximab oo loogu talagalay dadka ka weyn 65
• kemotherabi oo ay weheliso kuwa kale ee difaaca jirka, sida alemtuzumab (Campath), obinutuzumab (Gazyva), iyo ofatumumab (Arzerra). Fursadahaan waa la isticmaali karaa haddii wareegga koowaad ee daaweynta uusan shaqeyn.

Daaweynta la bartilmaameedsaday

Dhowrkii sano ee la soo dhaafay, faham wanaagsan oo ku saabsan cilmiga bayoolojiga ee CLL ayaa horseeday tiro daaweyn badan oo bartilmaameed ah. Daawooyinkaan waxaa loogu yeeraa daaweyn la bartilmaameedsaday maxaa yeelay waxaa loogu talagalay borotiinno gaar ah oo caawiya koritaanka unugyada CLL.

Tusaalooyinka daroogada lala beegsaday ee CLL waxaa ka mid ah:

• ibrutinib (Imbruvica): wuxuu bartilmaameedsanayaa enzyme-ka loo yaqaan Bruton's tyrosine kinase, ama BTK, taas oo muhiim u ah badbaadada unugyada CLL
• venetoclax (Venclexta): wuxuu bartilmaameedsanayaa borotiinka BCL2, oo ah borotiin lagu arkay CLL
• idelalisib (Zydelig): wuxuu xiraa borotiinka kinase ee loo yaqaan PI3K waxaana loo isticmaalaa dib u soo noqoshada CLL
• duvelisib (Copiktra): sidoo kale wuxuu bartilmaameedsadaa PI3K, laakiin sida caadiga ah waxaa loo isticmaalaa oo keliya marka daaweyntyada kale ay ku fashilmaan
• acalabrutinib (Calquence): kale BTK inhibitor ayaa loo ansixiyay dabayaaqadii 2019 CLL
• venetoclax (Venclexta) oo lagu daro obinutuzumab (Gazyva)

Dhiiga lagu shubo

Waxaad u baahan kartaa in lagaa shubo xididdada (IV) dhiig si loo kordhiyo tirada unugyada dhiigga.

Shucaac

Daaweynta shucaaca waxay isticmaashaa walxaha tamarta sare leh ama mowjadaha si ay uga caawiso dilka unugyada kansarka una yaraato qanjidhada qanjidhada oo xanuun badan. Daaweynta shucaaca si dhif ah ayaa loogu isticmaalaa daaweynta CLL.

Qalliinka unugyada jirrada iyo dhuuxa lafta

Dhakhtarkaagu wuxuu kugula talin karaa unugista unugyada unugyada asliga ah haddii kansarkaagu uusan ka jawaabin daaweynta kale. Beerista unugyada jirku waxay kuu oggolaaneysaa inaad hesho qiyaaso badan oo kiimiko ah si loo dilo unugyo badan oo kansar ah.

Qiyaaso badan oo kiimiko ah ayaa waxyeelo u geysan kara dhuuxa laftaada. Si aad u bedesho unugyadan, waxaad u baahan doontaa inaad ka hesho unugyo jirid dheeraad ah ama dhuuxa lafta deeq bixiye caafimaad qaba.

Daaweynta Horumar

Tiro badan oo habab ah ayaa lagu baarayaa si loogu daaweeyo dadka qaba CLL. Qaarkood waxaa dhowaan ansixiyay Maamulka Cuntada iyo Dawooyinka (FDA).

Isku darka dawooyinka

Bishii Maajo 2019, FDA waxay ansixisay venetoclax (Venclexta) oo ay weheliso obinutuzumab (Gazyva) si loogu daaweeyo dadka aan horay loo daaweynin CLL sida ikhtiyaar ikhtiyaar la'aan ah.

Bishii Ogosto 2019, cilmi baarayaashu waxay daabaceen natiijooyin ka soo baxay tijaabada caafimaad ee Wejiga III oo muujineysa in iskudhafka 'rituximab' iyo 'ibrutinib' (Imbruvica) ay dadka ka ilaalinayaan cudur muddo ka dheer heerka daryeelka hadda jira.

Isku-darkaani waxay u badan tahay inay dadku awoodi doonaan inay sameeyaan daaweyn kiimiko ah gebi ahaanba mustaqbalka. Nidaamyada daaweynta aan daaweynta kiimikada ah ayaa muhiim u ah kuwa aan u dulqaadan karin dhibaatooyinka soo raaca ee kiimoteraabiga.

CAR T-cell therapy

Mid ka mid ah fursadaha daaweynta mustaqbalka leh ee loogu talagalay CLL waa daaweynta CAR T-cell. CAR T, oo u taagan chimeric antigen receptor T-cell therapy, waxay isticmaashaa unugyada habka difaaca jirka ee qofka si loola dagaallamo kansarka.

Nidaamku wuxuu ku lug leeyahay soo saarida iyo beddelka unugyada difaaca jirka si loo aqoonsado loona baabi'iyo unugyada kansarka. Unugyada ayaa dib loogu celiyaa jirka si ay u tarmaan oo ay ula dagaallamaan kansarka.

Daaweynta T-cell ee CAR waa rajo, laakiin waxay leeyihiin khataro. Hal hal ayaa ah xaalad loo yaqaan 'cytokine release syndrome'. Tani waa jawaab xanuun leh oo ay sababeen unugyada CAR T-ga ee la shubay. Dadka qaarkood waxay la kulmi karaan fal-celin daran oo u horseedi kara dhimasho haddii aan si dhakhso ah loo daweyn.

Daawooyinka kale ee baaritaanku ku socdo

Qaar ka mid ah daawooyinka kale ee la bartilmaameedsaday ee hadda lagu qiimeeyo tijaabooyinka bukaan socodka ee CLL waxaa ka mid ah:

• zanubrutinib (BGB-3111)
• entospletinib (GS-9973)
• tirabrutinib (ONO-4059 ama GS-4059)
• umbralisib (TGR-1202)
• cirmtuzumab (UC-961)
• ublituximab (TG-1101)
• pembrolizumab (Keytruda)
• nivolumab (Opdivo)

Marka tijaabooyinka caafimaad la dhammeeyo, qaar ka mid ah daawooyinkan ayaa loo oggolaan karaa daaweynta CLL. Kala hadal dhakhtarkaaga ku biirista tijaabada caafimaadka, gaar ahaan haddii xulashooyinka daaweynta ee hadda aysan adiga kuu shaqeyneyn.

Tijaabooyinka caafimaad waxay qiimeeyaan waxtarka daawooyinka cusub iyo sidoo kale isku darka daawooyinka horey loo ansixiyay. Daaweyntan cusub ayaa laga yaabaa inay si fiican kuugu shaqeeyaan marka loo eego kuwa hadda jira. Hadda waxaa jira boqolaal tijaabo caafimaad ah oo u socda CLL.

Qaadashada

Dad badan oo laga helo CLL dhab ahaan uma baahna inay bilaabaan daaweyn isla markaaba. Mar alla markii cudurku bilaabmo inuu horumariyo, waxaad haysataa fursado daaweyn oo badan oo aad heli karto. Waxaa sidoo kale jira tijaabooyin fara badan oo daaweyn ah oo laga kala dooran karo kuwaas oo baaraya daaweynta cusub iyo daaweynta isku dhafan.