Acute Myeloid Leukemia (AML): he aha ia, nā ʻōuli a me nā lāʻau

Anter

• Nā hōʻailona nui
• ʻIke a me ka hoʻonohonoho ʻana
• Pehea e hana ai i ka lāʻau
• 1. ʻO Chemotherapy
• 2. Radiotherapy
• 3. Ka hoʻoneʻe iwi ʻana o ka iwi
• 4. Target therapy a me ka immunotherapy
• 5. Kelepona T-Cell gen therapy

ʻO ka leukemia myeloid huehue, i ʻike ʻia ʻo AML, kahi ʻano maʻi ʻaʻai e hoʻopili ai i nā hunaola koko a hoʻomaka i ka iwi iwi, ʻo ia ka lālā i kuleana no ka hana ʻana o nā hunaola koko. Loaʻa i kēia ʻano maʻi ʻaʻai ka manawa kūpono o ka hōʻola ke ʻike ʻia i kāna pae mua, ke ʻaʻohe metastasis a kumu i nā ʻōuli e like me ka pohō kaumaha a me ka pehu o nā alelo a me ka ʻōpū, no ka laʻana.

Hoʻonui koke ka leukemia myeloid nui a hiki ke hiki i nā poʻe o nā makahiki āpau, akā ʻoi aku ka pinepine i nā mākua, ʻoiai e hōʻiliʻili ʻia nā hunaola maʻi ʻaʻai i loko o ka iwi iwi a hoʻokuʻu ʻia i ke kahe o ke koko, kahi e hoʻouna ʻia ai i nā mea ʻē aʻe., E like me ke ake. , ʻōlapa a i ʻole kikowaena ʻōnaehana ʻōnaehana, kahi e hoʻomau ai lākou e ulu a ulu.

ʻO ka mālama ʻana i ka leukemia myeloid koʻikoʻi hiki ke hana ʻia ma ka haukapila maʻi ʻaʻai a ikaika loa ia i loko o nā mahina 2 mua, a ma ka liʻiliʻi he 1 mau makahiki hou aʻe e pono ai ka maʻi e hoʻōla ʻia.

Nā hōʻailona nui

ʻO nā ʻōuli maʻamau o ka leukemia myeloid koʻikoʻi me:

• ʻO Anemia, ka mea i hōʻike ʻia e ka hōʻemi o ka nui o ka hemoglobin;
• Ka manaʻo o ka nāwaliwali a me nā malaise ākea;
• Pallor a me ka ʻeha poʻo i hoʻokumu ʻia e ka anemia;
• Hoʻomaopopo pinepine ʻia ke kahe ʻana o ke kahe e ka ihu maʻalahi a hoʻonui ʻia ka menstruation;
• Ka hanana o nā palapū nui a ʻoiai i nā kaha liʻiliʻi;
• Loaʻa ka ʻai ʻole a me ka pohō kaumaha me ke kumu ʻole;
• Kūleʻa a ʻeha nā alelo, ʻoi aku i ka ʻāʻī a me ke aʻa;
• Nā maʻi pinepine;
• ʻEha i nā iwi a me nā hono;
• Fiva;
• Ka liʻiliʻi o ka hanu a me ke kahe;
• ʻO ka hou o ka hou i ka pō, kahi e pulu ai kou kapa;
• Hōʻoluʻolu ka ʻōpū ma muli o ka pehu ʻana o ke ake a me nā ʻāpala.

ʻO ka leukemia myeloid ākea kahi ʻano o ka maʻi ʻaʻai koko e pili pinepine i nā mākua a hiki ke hana i kāna kuhi ma hope o nā hoʻokolohua koko, ka lumbar puncture a me ka biopsy iwi o ka iwi.

ʻIke a me ka hoʻonohonoho ʻana

Hoʻokumu ʻia ke kuhi o ka leukemia myeloid koʻikoʻi ma luna o nā ʻōuli i hōʻike ʻia e ke kanaka a me nā hopena o nā hoʻokolohua, e like me ka helu ʻana o ke koko, ka hōʻiliʻili ʻana o ka iwi iwi a me nā hoʻokolohua moleola a me ka immunohistochemical. Ma o ka helu ʻana o ke koko, hiki ke nānā i ka hoʻemi ʻana o ka nui o nā hunaola keokeo, ke kū ʻana o nā keena keʻokeʻo keʻokeʻo oʻo ʻole a me kahi haʻahaʻa o nā hunaola ʻulaʻula a me nā platelet. No ka hōʻoia ʻana i ke kuhi, he mea nui ka myelogram e hana ai, kahi e hana ʻia ai mai ke kuʻi ʻia a me ka hōʻiliʻili ʻana o kahi ʻōiwi iwi, i kālailai ʻia i ka hale hana. Hoʻomaopopo pehea e hana ʻia ai ka myelogram.

I mea e ʻike ai i ke ʻano o ka leukemia myeloid koʻikoʻi, he mea nui e hana ʻia nā hoʻokolohua molekole a me nā immunohistochemical e ʻike ai i nā ʻano o nā hunaola i loaʻa i ke koko i ʻano o ka maʻi, he mea nui kēia ʻike e hoʻoholo ai i ka wānana o ka maʻi a no ka kauka e hōʻike i ka lapaʻau kūpono loa.

Ke ʻike ʻia ke ʻano o ka AML, hiki i ke kauka ke hoʻoholo i ka wānana a hoʻokumu i nā manawa o ka hoʻōla. Hiki ke hoʻokaʻawale ʻia ka AML i kekahi mau subtypes, ʻo ia:

Pehea e hana ai i ka lāʻau

Pono e hōʻike ʻia ka mālama ʻana no ka leukemia myeloid nui (AML) e kahi oncologist a i ʻole hematologist a hiki ke hana ʻia ma o nā ʻano hana, e like me chemotherapy, lāʻau a i ʻole transplantation iwi iwi:

1. ʻO Chemotherapy

Hoʻomaka ka mālama ʻana no ka leukemia myeloid huipū me kahi ʻano chemotherapy i kapa ʻia ʻo induction, kahi e manaʻo ai i ke kala ʻana o ka maʻi ʻaʻai, ʻo ia hoʻi ka hōʻemi ʻana i nā hunaola maʻi a ʻike ʻole ʻia lākou i nā hoʻokolohua koko a i ʻole ka myelogram, ʻo ia ka hoʻokolokolo ʻana i ke koko i ʻohiʻohi ʻia. pololei mai ka momona o ka iwi.

Hōʻike ʻia kēia ʻano lapaʻau e ka hematologist, hana ʻia i loko o kahi haukapila maʻi o kahi haukapila a lawe ʻia e ka hoʻopili ʻana i nā lāʻau i ke aʻa, ma o kahi catheter i kau ʻia ma ka ʻaoʻao ʻākau o ka pahu i kapa ʻia he port-a-cath a i ʻole ma ke komo ʻana i kahi aa o ka lima.

I ka hapanui o nā hihia o ka leukemia myeloid koʻikoʻi, ua paipai ke kauka e loaʻa i ke kanaka kahi ʻano o nā lāʻau like ʻole, i kapa ʻia he protocols, i hoʻokumu nui ʻia i ka hoʻohana ʻana i nā lāʻau e like me cytarabine a me idarubicin, no ka laʻana. Hana ʻia kēia mau kuʻina i nā ʻāpana, me nā lā o ka lapaʻau koʻikoʻi a me kekahi mau lā hoʻomaha, e ʻae ai i ke kino o ke kanaka e ola, a ʻo ka helu o nā manawa e hana ʻia ai ka nui o ka AML.

ʻO kekahi o nā lāʻau lapaʻau maʻamau e mālama ai i kēia ʻano leukemia, hiki i:

Hiki paha i ke kauka ke koi aku i ka hoʻohana ʻana i nā corticosteroids, e like me prednisone a i ʻole dexamethasone, ma ke ʻano he ʻāpana o ka lāʻau lapaʻau no ka leukemia myeloid koʻikoʻi. Ke hoʻomohala ʻia nei kekahi mau noiʻi no laila hoʻohana ʻia nā lāʻau hou e like me capecitabine, lomustine a me guadecitabine e mālama ai i kēia maʻi.

Eia hou, ma hope o ke kala ʻia ʻana o ka maʻi me ka chemotherapy, hiki i ke kauka ke hōʻike i nā ʻano lapaʻau hou, i kapa ʻia he consolidation, kahi e mālama ai i ka hoʻopau ʻia ʻana o nā hunaola maʻi ʻaʻai mai ke kino. Hiki ke hana i kēia consolidation ma o ka chemotherapy kiʻekiʻe a me ka hoʻohuli iwi.

ʻO ka mālama ʻana no ka leukemia myeloid huikau me ka chemotherapy e hōʻemi ai i ka nui o nā hunaola keʻokeʻo i loko o ke koko, ʻo ia hoʻi nā pale pale o ke kino, a he haʻahaʻa ka palekana o ke kanaka, e maʻalahi ana i nā maʻi. No laila, i kekahi mau hihia, pono e hoʻokomo i ke kanaka i kahi haukapila i ka wā o ka mālama ʻana a pono e hoʻohana i nā lāʻau ʻaloʻalo, antivirals a me nā antifungals e pale i nā maʻi mai ke ala aʻe. Eia nō naʻe, he mea maʻamau ka ʻike ʻia o nā ʻōuli ʻē aʻe, e like me ka nalo ʻana o ka lauoho, ka pehu ʻana o ke kino a me ka ʻili me nā kiko. E aʻo e pili ana i nā hopena ʻē aʻe o ka chemotherapy.

2. Radiotherapy

ʻO Radiotherapy kekahi ʻano lapaʻau e hoʻohana ana i ka mīkini e hoʻokuʻu i ka radiation i loko o ke kino e pepehi i nā pūnaʻi maʻi kanesa, akā naʻe, ʻaʻole hoʻohana ākea ʻia kēia lapaʻau no ka leukemia myeloid koʻikoʻi a hoʻopili wale ʻia i nā hihia kahi i laha ʻia ka maʻi i nā mea ʻē aʻe, e like me ka lolo a me ka testis, e hoʻohana ʻia ma mua o ka hoʻoneʻe ʻana o ka iwi iwi a i ʻole e hōʻoluʻolu i ka ʻeha ma kahi iwi i hoʻouka ʻia e leukemia.

Ma mua o ka hoʻomaka ʻana i nā kau radiotherapy, hana kahi kauka i kahi hoʻolālā, e nānā ana i nā kiʻi o ka tomography i helu ʻia i mea e wehewehe ʻia ai kahi kikoʻī e pono ai ka pā ʻana i ke kino a laila, hana ʻia nā kaha ma ka ʻili, me kahi peni kikoʻī. e kuhikuhi i ke kūlana kūpono ma ka mīkini radiotherapy a no laila aia mau nā kau āpau i ka wahi i kahakaha ʻia.

E like me ka chemotherapy, hiki i kēia ʻano lapaʻau ke hopena i nā hopena ʻaoʻao, e like me ka māluhiluhi, nalo o ka makemake ʻole, nausea, ʻeha ka ʻāʻī a me nā ʻili e like me ka lā. E aʻo hou aʻe e pili ana i ka mālama pono e pono ai i ka wā o ka radiotherapy.

3. Ka hoʻoneʻe iwi ʻana o ka iwi

ʻO ka hoʻoneʻe iwi iwi kahi ʻano o ka hoʻoliʻiliʻi koko i hana ʻia mai nā hunaola hematopoietic i lawe pololei ʻia mai ka iwi iwi o kahi mea hāʻawi manawaleʻa, ma o ka ʻoki koko aspiration mai ka pūhaka a i ʻole ma o ka apheresis, kahi mīkini e hoʻokaʻawale i nā hunaola koko ma o ka catheter i ka aa koko.

Hana pinepine ʻia kēia ʻano transplant ma hope o ka hana ʻia ʻana o nā lāʻau kiʻekiʻe o chemotherapy a i ʻole radiotherapy a ma hope wale nō o ka ʻike ʻole ʻia o nā hunaola maʻi ʻaʻai i loko o nā hōʻike. Nui a hewahewa nā transplants, e like me ka autologous a me ka allogeneic, a ua hana ʻia ka hōʻailona e ka hematologist e like me nā ʻano o ka leukemia myeloid koʻikoʻi o ke kanaka. E ʻike hou aʻe e pili ana i ka hana ʻia ʻana o ka iwi iwi a me nā ʻano like ʻole.

4. Target therapy a me ka immunotherapy

ʻO ka therapy target kahi ʻano o ka lapaʻau e hoʻohana i nā lāʻau e hōʻeha i nā hunaola me ka leukemia me nā loli kūlohelohe, e hōʻemi ana i nā hopena ʻē aʻe ma mua o chemotherapy. ʻO kekahi o kēia mau lāʻau i hoʻohana ʻia:

• Nā mea kūloko FLT3: i kuhikuhi ʻia no ka poʻe me ka leukemia myeloid koʻikoʻi me ka hoʻololi ʻana i ka ʻāpanaFLT3 aʻo kekahi o kēia mau lāʻau i midostaurin a me gilteritinib, ʻaʻole i ʻae ʻia no ka hoʻohana ma Brazil;
• Nā mea kāohi HDI: paipai ʻia e ke kauka no ka hoʻohana ʻana i ka poʻe me ka leukemia me ka hoʻololi ʻana o nā keikiIDH1 a i ʻoleIDH2, ka mea e pale ai i ke ʻano kūpono ʻana o nā hunaola. Hiki i nā mea hoʻopale HDI, e like me enasidenib a me ivosidenib, ke kōkua i nā huna leukemia e oʻo i nā huna koko maʻamau.

Hoʻohui ʻia, hoʻohana ʻia nā lāʻau ʻē aʻe i hana i nā genes kikoʻī ma ke ʻano he mea kāohi i ke ʻano BCL-2, e like me venetoclax, no ka laʻana. Eia nō naʻe, ʻo nā lāʻau ʻē aʻe e pili ana i ke kōkua ʻana i ka ʻōnaehana pale pale i nā leukemia cell, i ʻike ʻia he immunotherapy, ua paipai nui ʻia e nā hematologists.

ʻO nā monoclonal antibodies he mau lāʻau immunotherapy i hana ʻia ma ke ʻano he protein o ka ʻōnaehana paleʻea e hana ma ke hoʻopili ʻana iā lākou iho i ka paia o nā pūnaewele AML a laila luku iā lākou. ʻO ka lāʻau gemtuzumab kēia ʻano lāʻau i koi nui ʻia e nā kauka e mālama i kēia ʻano leukemia.

5. Kelepona T-Cell gen therapy

ʻO ka gen therapy me ka hoʻohana ʻana i ke kaʻa ʻo T-Cell kahi koho lapaʻau no nā poʻe me ka leukemia myeloid koʻikoʻi e pili ana i ka lawe ʻana i nā pūnaewele mai ka ʻōnaehana pale, i ʻike ʻia ʻo nā pūnaewele T, mai ke kino o ke kanaka a laila hoʻouna iā lākou i ka hale hana. I loko o ke keʻena hoʻokolohua, ua hoʻololi ʻia kēia mau pūnaewele a hoʻolauna ʻia nā mea i kapa ʻia ʻo CARs i hiki ai iā lākou ke hoʻouka i nā hunaola maʻi ʻaʻai.

Ma hope o ka mālama ʻia ʻana i loko o ke keʻena hoʻokolohua, ua hoʻololi ʻia nā pūnaewele T i ke kanaka me ka leukemia no laila, ke hoʻololi ʻia, luku lākou i nā hunaola me ka maʻi ʻaʻai. Ke aʻo ʻia nei kēia ʻano lapaʻau a ʻaʻole i loaʻa iā SUS. E nānā hou aʻe e pili ana i ka hopena o ka hana ʻana o ka T-Cell car a me ka mea hiki ke mālama ʻia.

E ʻike i kahi wikiō e pili ana i ka hopena o ka hopena o ka maʻi ʻaʻai.