Jiyya na yau da kullun game da CLL

Wadatacce

• Bayani
• Jiyya don ƙananan haɗarin CLL
• Jiyya don matsakaici- ko babban haɗari CLL
• Chemotherapy da immunotherapy
• Hanyoyin kwantar da hankali
• Karin jini
• Radiation
• Tantanin kwayar halitta da daskararren kashi
• Gwanin nasara
• Haɗuwa da ƙwayoyi
• CAR T-cell far
• Sauran kwayoyi da ake bincika
• Takeaway

Bayani

Ciwon leukemia na yau da kullun lymphocytic (CLL) shine ciwon daji mai saurin girma na tsarin garkuwar jiki. Saboda yana da saurin-girma, mutane da yawa tare da CLL ba za su buƙaci fara magani na shekaru da yawa bayan ganewar asali ba.

Da zarar ciwon daji ya fara girma, akwai zaɓuɓɓukan magani da yawa waɗanda zasu iya taimaka wa mutane su sami gafara. Wannan yana nufin mutane na iya fuskantar lokaci mai tsawo lokacin da babu alamar cutar kansa a jikinsu.

Ainihin zaɓi na jiyya da zaku karɓa ya dogara da dalilai daban-daban. Wannan ya hada da ko CLL dinka na nuna alamar ko a'a, matakin CLL ne bisa sakamakon gwajin jini da gwajin jiki, da shekarun ka da lafiyar ka gaba daya.

Duk da yake babu magani ga CLL har yanzu, abubuwan ci gaba a cikin filin suna kan sararin samaniya.

Jiyya don ƙananan haɗarin CLL

Doctors yawanci suna yin CLL ta amfani da tsarin da ake kira Rai. Riskananan haɗarin CLL yana bayanin mutanen da suka faɗi a cikin “mataki na 0” a ƙarƙashin tsarin Rai.

A mataki na 0, ƙwayoyin lymph, saifa, da hanta ba su faɗaɗa ba. Red cell cell da ƙididdigar platelet suma suna kusa da al'ada.

Idan kana da CLL mai ƙananan haɗari, likitanka (galibi masanin jini ne ko masanin ilimin kanjamau) mai yiwuwa zai baka shawara ka "jira ka kalli" don alamun. Wannan hanyar ana kiranta da lura da aiki.

Wani da ke da ƙananan haɗari na CLL bazai buƙatar ƙarin magani na shekaru ba. Wasu mutane ba za su taɓa buƙatar magani ba. Har yanzu kuna buƙatar ganin likita don binciken yau da kullun da gwaje-gwajen gwaje-gwaje.

Jiyya don matsakaici- ko babban haɗari CLL

Matsakaici-mai haɗari CLL ya bayyana mutane tare da mataki na 1 zuwa mataki na 2 CLL, bisa ga tsarin Rai. Mutanen da ke da mataki na 1 ko 2 CLL sun faɗaɗa ƙwayoyin lymph kuma suna iya faɗaɗa ƙwazo da hanta, amma kusa da ƙwayar jinin jini na yau da kullun da ƙarancin platelet.

Babban mai haɗari CLL ya bayyana marasa lafiya tare da mataki na 3 ko mataki na 4 kansar. Wannan yana nufin wataƙila ku sami ƙara girman ciki, hanta, ko ƙwayoyin lymph. Lowananan ƙarancin ƙwayoyin jinin jini ma na kowa ne. A cikin mataki mafi girma, ƙididdigar platelet zai zama ƙasa kazalika.

Idan kana da matsakaici- ko babban mai haɗari CLL, likitanka zai iya ba da shawarar cewa ka fara magani kai tsaye.

Chemotherapy da immunotherapy

A baya, daidaitaccen magani ga CLL ya haɗa da haɗuwa da chemotherapy da wakilan immunotherapy, kamar:

• fludarabine da kuma cyclophosphamide (FC)
• FC tare da maganin rigakafi na antibody wanda aka sani da rituximab (Rituxan) ga mutanen da shekarunsu suka gaza 65
• bendamustine (Treanda) da rituximab ga mutanen da suka girmi shekaru 65
• chemotherapy a haɗe tare da sauran magungunan rigakafi, kamar alemtuzumab (Campath), obinutuzumab (Gazyva), da ofatumumab (Arzerra). Ana iya amfani da waɗannan zaɓuɓɓuka idan zagaye na farko na jiyya ba ya aiki.

Hanyoyin kwantar da hankali

A cikin fewan shekarun da suka gabata, kyakkyawar fahimtar ilmin halitta na CLL ya haifar da ƙarin ƙarin hanyoyin kwantar da hankali. Wadannan kwayoyi ana kiran su hanyoyin kwantar da hankula saboda ana jagorantar su zuwa takamaiman sunadaran da ke taimakawa kwayoyin CLL suyi girma.

Misalan kwayoyi masu niyya don CLL sun haɗa da:

• ibrutinib (Imbruvica): yana niyya ne akan enzyme da aka sani da Bruton's tyrosine kinase, ko BTK, wanda ke da mahimmanci don rayuwar kwayar CLL
• venetoclax (Venclexta): yana ƙaddamar da furotin na BCL2, furotin da aka gani a cikin CLL
• idelalisib (Zydelig): yana toshe sinadarin kinase wanda ake kira PI3K kuma ana amfani dashi don sake komawa CLL
• duvelisib (Copiktra): kuma ana sa ran PI3K, amma yawanci ana amfani dashi ne kawai bayan wasu jiyya sun kasa
• acalabrutinib (Calquence): wani mai hana BTK ya amince a ƙarshen 2019 don CLL
• venetoclax (Venclexta) a hade tare da obinutuzumab (Gazyva)

Karin jini

Kila buƙatar karɓar ƙarin jini (IV) don ƙara ƙidayar ƙwayoyin jini.

Radiation

Radiation radiation yana amfani da ƙananan ƙwayoyin makamashi ko raƙuman ruwa don taimakawa kashe ƙwayoyin kansar kuma rage ƙin faɗaɗa ƙwayoyin lymph. Ba a amfani da maganin Radiation a cikin maganin CLL.

Tantanin kwayar halitta da daskararren kashi

Likitanku na iya bayar da shawarar dashen ƙwayar ƙwayar ƙwayar idan ciwon kansa ba ya amsa wasu jiyya. Tsarin daskararren kwayar halitta yana ba ka damar karɓar ƙwayoyi masu yawa na chemotherapy don kashe ƙarin ƙwayoyin kansar.

Doarin allurai na chemotherapy na iya haifar da lahani ga ƙashin kashin ka. Don maye gurbin waɗannan ƙwayoyin, zaku buƙaci karɓar ƙarin ƙwayoyin sel ko ƙashin kashin daga mai bayarwa mai lafiya.

Gwanin nasara

Ana gudanar da bincike mai yawa na hanyoyin magance mutane da CLL. Wasu sun sami amincewar kwanan nan ta Hukumar Abinci da Magunguna (FDA).

Haɗuwa da ƙwayoyi

A watan Mayu 2019, FDA ta yarda da venetoclax (Venclexta) a haɗe tare da obinutuzumab (Gazyva) don kula da mutane da CLL da ba a kula da su ba azaman zaɓi mara kyauta na chemotherapy.

A watan Agusta na 2019, masu bincike sun wallafa sakamako daga wani gwaji na asibiti na Phase III wanda ya nuna cewa hadewar rituximab da ibrutinib (Imbruvica) na hana mutane samun cuta tsawon lokaci fiye da yadda ake kulawa yanzu.

Waɗannan haɗuwa sun sa mutane da yawa za su iya yin ba tare da chemotherapy gaba ɗaya ba. Abubuwan da ba su da magani na chemotherapy suna da mahimmanci ga waɗanda ba za su iya jure mawuyacin sakamako masu illa da cutar sankara ba.

CAR T-cell far

Ofaya daga cikin zaɓuɓɓukan magani na gaba mai zuwa don CLL shine CAR T-cell therapy. CAR T, wanda ke wakiltar mai karɓar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta T-cell, yana amfani da ƙwayoyin ƙwayoyin jikin mutum don yaƙar kansa.

Hanyar ta haɗa da cirewa da canza ƙwayoyin garkuwar mutum don ganewa da lalata ƙwayoyin kansa. Daga nan sai a sake dawo da kwayoyin a cikin jiki don ninka tare da yaki da cutar kansa.

CAR T-cell hanyoyin kwantar da hankali suna da bege, amma suna da haɗari. Riskaya daga cikin haɗarin shine yanayin da ake kira cututtukan sakin cytokine. Wannan martani ne mai kumburi wanda aka haifar da ƙwayoyin C-T. Wasu mutane na iya fuskantar mummunan halayen da zai iya haifar da mutuwa idan ba a hanzarta magance su ba.

Sauran kwayoyi da ake bincika

Wasu wasu ƙwayoyi masu niyya a halin yanzu ana kimanta su a cikin gwajin asibiti don CLL sun haɗa da:

• zanubrutinib (BGB-3111)
• masarauta (GS-9973)
• tirabrutinib (ONO-4059 ko GS-4059)
• kwalliya (TGR-1202)
• cirmtuzumab (UC-961)
• ublituximab (TG-1101)
• marsajan (Keytruda)
• Nivolumab (Opdivo)

Da zarar an kammala gwajin asibiti, wasu daga waɗannan magungunan za a iya amincewa da su don magance CLL. Yi magana da likitanka game da shiga gwaji na asibiti, musamman idan zaɓuɓɓukan magani na yanzu ba su aiki a gare ku.

Gwajin gwaji na kimanta ingancin sababbin kwayoyi da haɗuwa da magungunan da aka riga aka amince dasu. Waɗannan sababbin jiyya na iya aiki da kyau a gare ku fiye da waɗanda ake da su a halin yanzu. A halin yanzu akwai daruruwan gwaji na asibiti masu gudana don CLL.

Takeaway

Mutane da yawa waɗanda aka bincikar su da CLL ba za su buƙaci fara farawa nan da nan ba. Da zarar cutar ta fara cigaba, kuna da hanyoyin samun magani da yawa. Har ila yau, akwai ɗakunan gwaje-gwaje masu yawa don zaɓar daga waɗanda ke bincika sababbin jiyya da haɗin hanyoyin haɗin gwiwa.