I-Graft versus host disease (GvHD), umphumela ongaseceleni ongenzeka ngemva kwe- ukufakelwa kwe-allogeneic.
Kuyini isifo se-graft versus host (GvHD)?
I-Graft versus host disease (GvHD) iyinkinga evamile yokufakelwa kwe-stem cell allogeneic. Kwenzeka lapho ama-T-cell amasosha omzimba amasha, ebona amangqamuzana owamukelayo njengangaphandle, futhi awahlasele. Lokhu kubangela impi phakathi 'kwe-graft' kanye 'nomsingathi'.
Kubizwa ngokuthi i-graft versus host, ngoba 'i-graft' iyisistimu yokuzivikela yomzimba enikelwe, futhi 'umsingathi' yisiguli esithola amaseli anikelwe.
I-GvHD iyinkinga engenzeka kuphela kuyo ukufakelwa kwe-allogeneic. Ukufakelwa kwe-allogenic kuhilela ama-stem cells anikelwe ukuze isiguli siwathole.
Uma umuntu efakelwa omunye umuntu lapho ethola khona ama-stem cells, lokhu kubizwa ngokuthi i- ukufakelwa kwe-autologous. I-GvHD akuyona inkinga engenzeka kubantu abathola ukuphinda bafakwe amaseli abo.
Udokotela uzohlola iziguli ze-GvHD njalo njengengxenye yokunakekelwa kokulandelela ngemva kokuhlinzwa ukufakelwa kwe-allogeneic. Engxenyeni ngayinye yomzimba ethintwe yi-GvHD engapheli, amaphuzu aphakathi kuka-0 (akukho mthelela) no-3 (umthelela onzima) anikezwa. Amaphuzu asekelwe emthelela izimpawu ezinawo ekuphileni kwansuku zonke futhi lokhu kusiza odokotela ukuba banqume ngokwelashwa okungcono kakhulu kwesiguli.
Izinhlobo ze-graft versus host disease (GvHD)
I-GvHD ithathwa ngokuthi 'acute' noma 'ehlala njalo' kuye ngokuthi isiguli siyizwa nini kanye nezimpawu nezimpawu ze-GvHD.
I-graft enzima ngokumelene ne-host host
- Iqala phakathi kwezinsuku eziyi-100 zokuqala emva kokufakelwa
- Ngaphezu kwe-50% yeziguli ezinokufakelwa kwe-allogenic, zithola lokhu
- Ngokuvamile kwenzeka emavikini angu-2 kuya kwangu-3 ngemva kokufakelwa. Lesi sibonakaliso samasonto angu-2 - 3 yilapho ama-stem cells amasha eqala ukuthatha umsebenzi wamasosha omzimba futhi enze amangqamuzana egazi amasha.
- I-Acute GvHD ingenzeka ngaphandle kwezinsuku eziyi-100, lokhu ngokuvamile kwenzeka ezigulini eziye zaba nohlelo oluncishisiwe lwesimo ngaphambi kokufakelwa.
- Ku-acute GvHD, igraft yenqaba umsingathi wayo, hhayi umsingathi owenqaba ukuxhunyelelwa. Nakuba lesi simiso siyafana kukho kokubili i-acute kanye ne-GvHD engapheli, izici ze-acute GvHD zihlukile kulezo ezingelapheki.
Ubunzima be-acute GvHD buhlelwa kusuka esigabeni I (esithambile kakhulu) kuya esigabeni IV (esinzima), lolu hlelo lokugreda lusiza odokotela ukuthi banqume ngokwelashwa. Izindawo ezivame kakhulu ze-acute GvHD yilezi:
Umgudu wamathumbu: ukubangela isifo sohudo esingase sibe namanzi noma sibe negazi. Isicanucanu nokuhlanza okuhambisana nobuhlungu besisu, ukuncipha kwesisindo nokuncipha kwesifiso sokudla.
Isikhumba: okubangela ukuqubuka okubuhlungu nokulumayo. Ngokuvamile iqala ezandleni, ezinyaweni, ezindlebeni nasesifubeni kodwa ingasakazeka kuwo wonke umzimba.
Isibindi: ukubangela i-jaundice okuwukunqwabelana kwe-'bilirubin' (into ebandakanyeka ekusebenzeni okuvamile kwesibindi) eshintsha umhlophe wamehlo ube phuzi kanye nesikhumba sibe phuzi.
Ithimba elelaphayo kufanele lihlole isiguli i-GvHD njalo njengengxenye yokunakekelwa kokulandelela.
Ukuxhunyelelwa okungapheli ngokumelene nesifo sokusingatha
- I-Chronic GvHD yenzeka ngaphezu kwezinsuku eziyi-100 ngemva kokufakelwa.
- Nakuba kungenzeka kunoma iyiphi indawo ngemva kokufakelwa, ngokuvamile kubonakala phakathi nonyaka wokuqala.
- Iziguli ezike zaba ne-Acute GvHD zisengozini enkulu yokuba ne-GvHD engapheli.
- Cishe u-50% weziguli ezithola i-Acute GvHD zizoqhubeka nokuba ne-GvHD engapheli.
- Kungaba nomthelela kunoma ubani othumela ukufakelwa kwe-stem cell.
I-Chronic GvHD ivame ukuba nomthelela:
- Umlomo: kubangela umlomo owomile futhi obuhlungu
- Isikhumba: ukuqubuka kwesikhumba, isikhumba siyaxega futhi silume, siqina futhi sishintshe umbala nephimbo.
- Amathumbu: ukuqunjelwa, isifo sohudo, isicanucanu, ukuhlanza nokuncipha kwesisindo ngendlela engachazeki.
- Isibindi: ngokuvamile siveza izimpawu ezifana ne-viral hepatitis
I-Chronic GvHD ingathinta nezinye izindawo, njengamehlo, amalunga, amaphaphu nezitho zangasese.
Izimpawu nezimpawu ze-graft versus host disease (GvHD)
- Ukuqubuka, okuhlanganisa ukushiswa nokubabomvu kwesikhumba. Lokhu kuqubuka kuvame ukuvela ezintendeni zesandla nasematheni ezinyawo. Ingabandakanya isiqu kanye namanye amaphethelo.
- Isicanucanu, ukuhlanza, isifo sohudo, ukuqunjelwa kwesisu kanye nokungathandi ukudla kungaba yizingoma ze-GvHD yamathumbu.
- Ukuba phuzi kwesikhumba namehlo (lokhu kubizwa ngokuthi i-jaundice) kungaba uphawu lwe-GvHD yesibindi. Ukungasebenzi kahle kwesibindi kungabonakala nakwezinye izivivinyo zegazi.
- Umlomo:
- Umlomo omile
- Ukwanda kokuzwela ngomlomo (okushisayo, okubandayo, i-fizz, ukudla okubabayo njll.)
- Ubunzima bokudla
- Isifo sezinsini nokubola kwamazinyo
- Isikhumba:
- Rash
- Isikhumba esomile, esiqinile, esilumayo
- Ukuqina nokuqina kwesikhumba okungase kubangele imikhawulo yokunyakaza
- Umbala wesikhumba ushintshile
- Ukungabekezelelani ukushintsha kwezinga lokushisa, ngenxa yezindlala zokujuluka ezilimele
- Izipikili:
- Izinguquko ekuthungeni kwezinzipho
- Izinzipho eziqinile, eziphukayo
- Ukulahlekelwa izinzipho
- Umgudu wamathumbu:
- Ukulahlekelwa kwesifiso
- Ukulahlekelwa kwesisindo esingachaziwe
- Ukuvota
- Uhudo
- Ukwehla kwesisu
- Amaphaphu:
- Ukuphelelwa umoya
- Ukukhwehlela lokho akupheli
- Ukushisa
- Isibindi:
- Ukuvuvukala kwesisu
- Ukushintsha umbala ophuzi kwesikhumba/amehlo (i-jaundice)
- Ukungajwayelekile kokusebenza kwesibindi
- Imisipha namalunga:
- Ubuthakathaka bemisipha kanye nama-cramping
- Ukuqina kwamalunga, ukuqina kanye nobunzima bokwelula
- Izitho zangasese:
- Owesifazane:
- Ukoma, ukulunywa kanye nobuhlungu
- Izilonda zesitho sangasese sowesifazane kanye nezibazi
- Ukuncipha kwesitho sowesifazane sangasese
- Ucansi olunzima/ olubuhlungu
- Owesilisa:
- Ukuncipha kanye nezibazi ze-urethra
- Ukuluma kanye nezibazi ku-scrotum nomthondo
- Ukucasuka komthondo
- Owesifazane:
Ukwelashwa kwe-graft versus host disease (GvHD)
- Ukwandisa i-immunosuppression
- Ukuphathwa kwe-corticosteroids njenge-Prednisolone ne-Dexamethasone
- Kwesinye i-GvHD yesikhumba esiphansi, ukhilimu we-topical steroid ungasetshenziswa
Ngokwelashwa kwe-GvHD engaphenduli kuma-corticosteroids:
- Ibrutinib
- I-Ruxolitinib
- I-Mycophenolate mofetil
- I-Sirolimus
- I-Tacrolimus ne-Cyclosporin
- Amasosha omzimba angama-monoclonal
- I-Antithymocyte Globulin (ATG)
