Nā mālama i kēia manawa a me breakthrough no CLL

Anter

• Hōʻike Overview
• Nā mālama ʻana no CLL makaʻu haʻahaʻa
• Nā mālama ʻana no CLL waena a i ʻole pilikia kiʻekiʻe
• Chemotherapy a me ka immunotherapy
• Nā therapies pahuhopu
• Hoʻopili ke koko
• Pāhawewe
• ʻO nā transplant cell a me ka iwi iwi
• Nā kūkaʻi breakthrough
• Hoʻohui lāʻau
• CAR T-cell therapy
• Nā lāʻau ʻē aʻe e nānā ʻia ana
• ʻO ka lawe lawe ʻana

Hōʻike Overview

ʻO ka leukemia lymphocytic mau (CLL) kahi maʻi maʻi lohi o ka ʻōnaehana pale. Ma muli o ka lohi o ka ulu ʻana, ʻaʻole nui ka poʻe me CLL e pono e hoʻomaka i ka mālama ʻana no nā makahiki he nui ma hope o kā lākou hōʻoia.

Ke hoʻomaka ka ulu ʻana o ka maʻi ʻaʻai, nui nā koho lapaʻau i loaʻa e hiki ke kōkua i ka poʻe e hoʻokō i ke kala. ʻO kēia ka hiki i ka poʻe ke ʻike i nā wā lōʻihi ke ʻaʻohe hōʻailona o ka maʻi ʻaʻai i loko o ko lākou kino.

ʻO ke koho lapaʻau pololei āu e loaʻa ai ma muli o nā ʻano like ʻole. Hoʻopili pū kēia inā he hōʻailona kāu CLL, ʻaʻole ke kahua o ka CLL e pili ana i nā hopena o nā hoʻokolohua koko a me kahi hoʻokolohua kino, a me kou makahiki a me ke olakino holoʻokoʻa.

ʻOiai ʻaʻohe mea hoʻōla no CLL i kēia manawa, aia nā breakthroughs i ke kahua i ka pae.

Nā mālama ʻana no CLL makaʻu haʻahaʻa

Hoʻokomo pinepine nā kauka iā CLL me ka hoʻohana ʻana i kahi ʻōnaehana i kapa ʻia ʻo Rai. Hōʻike ka CLL haʻahaʻa haʻahaʻa i ka poʻe i hāʻule i ka "pae 0" ma lalo o ka ʻōnaehana Rai.

I ke kahua 0, ʻaʻole hoʻonui ʻia nā lymph node, spleen, a me ke akepaʻa. ʻO nā helu o ke koko ʻulaʻula a me nā helu platelet kahi kokoke i ka maʻamau.

Inā loaʻa iā CLL ka makaʻu haʻahaʻa, e aʻoaʻo paha kāu kauka (ʻo ka maʻamau he hematologist a i ʻole oncologist) iā ʻoe e "kali a kiaʻi" no nā ʻōuli. Kapa ʻia kēia ala i luna ke nānā aku.

ʻAʻole pono i kekahi mea me ka CLL haʻahaʻa haʻahaʻa i ka lāʻau hou no nā makahiki he nui. ʻAʻole makemake kekahi poʻe i ka lāʻau. Pono nō ʻoe e ʻike i ke kauka no nā loiloi maʻamau a me nā hoʻokolohua lab.

Nā mālama ʻana no CLL waena a i ʻole pilikia kiʻekiʻe

Hōʻike ka CLL waena pilikia i ka poʻe me ka pae 1 a i ka pae 2 CLL, e like me ka ʻōnaehana Rai. ʻO ka poʻe me ka pae 1 a i ʻole 2 CLL ua hoʻonui i nā nēpē lymph a me ka ʻāpala a me ke ake ākea paha, akā kokoke i nā helu ʻulaʻula a me nā helu platelet.

Hōʻike ʻo CLL i ka makaʻu kiʻekiʻe i nā mea maʻi me ka maʻi ʻehā a pae 4 paha. ʻO kēia ke loaʻa paha iā ʻoe kahi spleen, ate, a i ʻole nā ​​lymph node i hoʻonui ʻia. ʻO ka helu maʻamau o ke koko ʻulaʻula haʻahaʻa ka mea maʻamau. I ke kahua kiʻekiʻe loa, e haʻahaʻa hoʻi nā helu platelet.

Inā loaʻa iā CLL waena a i ʻole pilikia kiʻekiʻe, e paipai paha kāu kauka e hoʻomaka koke ʻoe i ka mālama ʻana.

Chemotherapy a me ka immunotherapy

I ka wā ma mua, ʻo ka mālama maʻamau no CLL kahi i hui pū ʻia me nā chemotherapy a me nā mea pale maʻi immunotherapy, e like me:

• fludarabine a me cyclophosphamide (FC)
• ʻO FC me kahi immunotherapy antibody i kapa ʻia ʻo rituximab (Rituxan) no ka poʻe ma mua o 65
• bendamustine (Treanda) a me rituximab no ka poʻe ma mua o 65
• chemotherapy me ka hoʻohui pū me nā immunotherapies, e like me alemtuzumab (Campath), obinutuzumab (Gazyva), a me ofatumumab (Arzerra). Hiki ke hoʻohana ʻia kēia mau koho inā ʻaʻole holo ka mua o ka mālama.

Nā therapies pahuhopu

I loko o nā makahiki i hala iho nei, ua alakaʻi ka ʻike ʻoi aku ka maikaʻi o ka biology o CLL i kahi ʻano o nā hoʻoponopono i hoʻomākaukau ʻia. Kāhea ʻia kēia mau lāʻau i nā therapies i hoʻokumu ʻia no ka mea ua kuhikuhi ʻia lākou i nā protein ponoʻī e kōkua i nā hunaola CLL e ulu.

ʻO nā laʻana o nā lāʻau i kuhi ʻia no CLL me:

• ibrutinib (Imbruvica): hoʻokumu i ka enzyme i kapa ʻia ʻo Bruton's tyrosine kinase, a i ʻole BTK, he mea nui ia no ke ola ʻana o ka cell CLL
• venetoclax (Venclexta): pahuhopu i ka protein BCL2, kahi protein i ʻike ʻia ma CLL
• idelalisib (Zydelig): ālai i ka protein kinase i kapa ʻia ʻo PI3K a hoʻohana ʻia no CLL relapsed
• duvelisib (Copiktra): hoʻokumu pū kekahi iā PI3K, akā hoʻohana wale ʻia ma hope o ka holo pono ʻole ʻana o nā lāʻau ʻē aʻe
• acalabrutinib (Calquence): kekahi mea hoʻopae BTK i ʻae ʻia i ka hopena o 2019 no CLL
• venetoclax (Venclexta) i hui pū ʻia me obinutuzumab (Gazyva)

Hoʻopili ke koko

Pono ʻoe e loaʻa i nā transfusions intravenous (IV) e hoʻonui i ka helu o ke kahe o ke koko.

Pāhawewe

Hoʻohana ka radiation radiation i nā kinikona kiʻekiʻe a i ʻole nalu e kōkua i ka pepehi ʻana i nā hunaola maʻi ʻaʻa a hoʻoliʻiliʻi i nā lymph node i hoʻonui ʻia. ʻAʻole hoʻohana pinepine ʻia ka radiation radiation i ka lāʻau CLL.

ʻO nā transplant cell a me ka iwi iwi

Hiki i kāu kauka ke koi aku i kahi transplant cell stem inā ʻaʻole pane kāu maʻi ʻaʻa i nā ʻano lāʻau ʻē aʻe. Hāʻawi kahi transplant cell stem iā ʻoe e loaʻa i nā koina kiʻekiʻe o ka chemotherapy e pepehi i nā hunaola maʻi ʻē aʻe.

Hiki i nā koina kiʻekiʻe o ka chemotherapy ke hōʻino i kāu iwi iwi. I mea e hoʻololi ai i kēia mau hunaola, pono ʻoe e loaʻa i nā hunaola a i ʻole ka iwi iwi mai kahi mea hāʻawi maikaʻi.

Nā kūkaʻi breakthrough

Ke nānā ʻia nei kahi helu nui o nā ala e mālama ai i ka poʻe me CLL. Ua ʻae ʻia kekahi e ka Food and Drug Administration (FDA).

Hoʻohui lāʻau

I ka Mei 2019, ua ʻae ka FDA i ka venetoclax (Venclexta) i hui pū ʻia me obinutuzumab (Gazyva) e mālama i ka poʻe me CLL i mālama ʻole ʻia ma ke ʻano he koho chemotherapy-ʻole.

I ʻAukake 2019, ua paʻi nā mea noiʻi i nā hopena mai kahi hoʻokolohua hoʻokolohua Phase III e hōʻike ana i ka hui ʻana o rituximab a me ibrutinib (Imbruvica) mālama i nā kānaka mai ka maʻi no ka lōʻihi ma mua o ka maʻamau o ka mālama maʻamau.

ʻO kēia mau hui ʻana i hiki i ka poʻe ke hana me ka ʻole o ka chemotherapy i ka wā e hiki mai ana. Pono nā regimens lapaʻau non-chemotherapy no ka poʻe hiki ʻole ke hoʻomanawanui i nā hopena ʻino e pili ana i ka chemotherapy.

CAR T-cell therapy

ʻO kekahi o nā koho lapaʻau e hiki mai ana i mua no CLL ʻo CAR T-cell therapy. ʻO CAR T, ka mea kū i ka chimeric antigen receptor T-cell therapy, e hoʻohana i nā hunaola ʻōnaehana ponoʻī o kekahi kanaka e kaua i ka maʻi ʻaʻai.

Hoʻopili ke kaʻina hana i ka unuhi a me ka hoʻololi ʻana i nā hunaola o ke kanaka e ʻike maikaʻi ai a luku ai i nā hunaola maʻi ʻaʻai. Hoʻokomo ʻia nā pūnaewele i loko o ke kino e hoʻonui a kaua aku i ka maʻi ʻaʻai.

Ke hoʻohiki nei ʻo CAR T-cell therapies, akā hāpai lākou i nā pilikia. ʻO kahi pilikia kahi kūlana i kapa ʻia ʻo cytokine hoʻokuʻu Syndrome. ʻO kēia kahi pane hoʻoweliweli i hoʻokumu ʻia e nā CAR T-cells i hoʻopili ʻia. Hiki i kekahi poʻe ke ʻike i nā hopena koʻikoʻi e hiki ai i ka make ke mālama ʻole ʻia.

Nā lāʻau ʻē aʻe e nānā ʻia ana

ʻO kekahi mau lāʻau i mākaukau ʻia e loiloi ʻia nei i nā hoʻokolohua hoʻokolohua no CLL e komo pū ana:

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

Ke pau nā hoʻokolohua hoʻokolohua, hiki i kekahi o kēia mau lāʻau ke ʻae ʻia no ka mālama ʻana iā CLL. E kamaʻilio me kāu kauka e pili ana i ke komo ʻana i kahi hoʻokolohua hoʻokolohua, keu hoʻi inā ʻaʻole e hana nā koho lapaʻau o kēia manawa no ʻoe.

Loiloi nā hoʻokolohua hoʻokolohua i ka pono o nā lāʻau hou a me nā hui pū ʻana o nā lāʻau i ʻae ʻia. ʻOi aku paha ka maikaʻi o kēia mau hoʻoponopono hou ʻana iā ʻoe ma mua o nā mea i loaʻa i kēia manawa. I kēia manawa aia mau haneli o nā hoʻokolohua hoʻokolohua e hoʻomau nei no CLL.

ʻO ka lawe lawe ʻana

ʻAʻole pono ka poʻe he nui i ʻike ʻia me CLL e hoʻomaka koke i ka mālama ʻana. Ke hoʻomaka nei ka maʻi e holomua, loaʻa iā ʻoe nā koho lapaʻau he nui i loaʻa. Aia kekahi ākea ākea o nā hoʻokolohua hoʻokolohua e koho ai mai ka ʻimi ʻana i nā lāʻau hou a me nā laulima hoʻohui.