Tam sim no thiab Kev Txhim Kho Qhov Teeb Meem Rau CLL

Zoo Siab

• Txheej txheem cej luam
• Kev kho mob rau qhov pheej hmoo tsis txaus siab CLL
• Cov kev kho mob rau nruab nrab- lossis siab pheej hmoo CLL
• Siv tshuaj khomob thiab siv tshuaj kho mob
• Cov hom phiaj kho
• Qhov txhab ntshav ntxiv
• Kev tawg
• Qia cell thiab pob txha hloov ntshav
• Kev kho mob tawg
• Tshuaj sib txuas ua ke
• Kev kho T-cell kho mob
• Lwm yam tshuaj nyob rau hauv kev tshawb nrhiav
• Cov nqa mus

Txheej txheem cej luam

Mob ntsws lymphocytic uas mob nqaij hlav ntev (CLL) yog ib yam mob cancer uas tiv thaiv kabmob qeeb mentshis. Vim tias nws tau qeeb qeeb, ntau tus neeg nrog CLL tsis tas yuav pib kho ntau xyoo tom qab lawv kuaj pom.

Thaum tus kabmob pib loj hlob, muaj ntau yam kev kho mob tuaj yeem pab tau tib neeg ua tiav kev zam txim. Qhov no txhais tau tias tib neeg tuaj yeem ntsib sijhawm ntev mus thaum tsis muaj tus cim qhia tias lawv muaj mob cancer hauv lawv lub cev.

Qhov kev xaiv tseeb uas koj yuav tau txais nyob ntawm ntau yam. Qhov no suav nrog lossis tsis koj qhov CLL yog tus mob, cov theem ntawm CLL raws li kev kuaj ntshav thiab kuaj lub cev, thiab koj lub hnub nyoog thiab kev noj qab haus huv tag nrho.

Thaum tsis muaj tshuaj kho tau rau CLL tseem, kev sib tawg hauv lub tiaj yog nyob rau lub qab ntug.

Kev kho mob rau qhov pheej hmoo tsis txaus siab CLL

Cov kws kho mob feem ntau siv sijhawm CLL siv qhov system hu ua Rai system. CLL uas tsis tshua muaj kev phom sij piav qhia txog cov neeg uas poob rau “theem 0” nyob rau hauv Rai system.

Hauv theem 0, lub qog ua kua, hnoos qeev, thiab lub siab tsis nthuav dav. Kev kuaj ntshav liab thiab ntshav liab yog tseem nyob ze qhov qub.

Yog tias koj muaj mob CLL tsawg, koj tus kws kho mob (feem ntau yog hematologist lossis oncologist) yuav qhia koj "tos thiab saib" rau cov tsos mob. Cov hau kev no tseem hu ua ua keb soj ntsuam.

Qee tus neeg uas muaj qhov muaj feem tsawg CLL yuav tsis xav tau kev kho ntxiv rau ntau xyoo. Qee tus neeg yuav tsis tas mus kho. Koj tseem yuav tsum tau mus ntsib kws kho mob txhawm rau mus soj ntsuam thiab kuaj ntshav kuaj ib ce.

Cov kev kho mob rau nruab nrab- lossis siab pheej hmoo CLL

Cov teeb meem nyuaj-nruab nrab ntawm CLL piav qhia txog cov neeg muaj theem 1 txog theem 2 CLL, raws li tus qauv Rai. Cov neeg muaj theem 1 lossis 2 CLL tau nthuav dav cov qog ntshav thiab ua rau tus po thiab lub siab loj tuaj, tab sis ze rau cov kab mob ntshav liab thiab platelet ntau.

Kev pheej hmoo siab CLL piav qhia txog cov neeg mob qog nqaij hlav 3 lossis theem 4. Qhov no txhais tau tias koj yuav muaj tus po loj, nplooj siab, lossis mob qog. Cov ntshav liab tsawg hauv lub cev kuj tseem muaj ntau. Hauv theem siab tshaj plaws, platelet suav yuav tsawg tsawg thiab.

Yog tias koj nyob nruab nrab - lossis pheej hmoo CLL, koj tus kws kho mob yuav pom zoo kom koj pib kho tam sim ntawd.

Siv tshuaj khomob thiab siv tshuaj kho mob

Yav dhau los, kev kho mob rau cov qauv ntawm CLL suav nrog kev sib xyaw ntawm kev siv tshuaj kho mob thiab tshuaj tua kab mob, xws li:

• fludarabine thiab cyclophosphamide (FC)
• FC ntxiv rau kev tiv thaiv tshuaj tiv thaiv kab mob hu ua rituximab (Rituxan) rau cov neeg muaj hnub nyoog qis dua 65 xyoo
• bendamustine (Treanda) ntxiv rau rituximab rau cov neeg laus dua 65 xyoo
• Kev siv tshuaj kho mob sib xyaw nrog lwm cov tshuaj tiv thaiv kab mob, xws li alemtuzumab (Campath), obinutuzumab (Gazyva), thiab ofatumumab (Arzerra). Cov kev xaiv no yuav siv tau yog tias thawj zaug kev kho mob tsis ua haujlwm.

Cov hom phiaj kho

Ob peb xyoos dhau los, kev nkag siab zoo dua ntawm cov tsiaj txhu ntawm CLL tau ua rau ntau cov hom phiaj kho ntxiv. Cov tshuaj no hu ua kev kho mob vim tias lawv tau qhia txog cov protein tshwj xeeb uas pab CLL hlav loj hlob.

Piv txwv ntawm cov hom phiaj tshuaj rau CLL suav nrog:

• ibrutinib (Imbruvica): tsom mus rau lub enzyme hu ua Bruton's tyrosine kinase, lossis BTK, uas yog qhov tseem ceeb rau CLL cell muaj sia nyob
• venetoclax (Venclexta): hom phiaj BCL2 protein, cov protein uas pom hauv CLL
• idelalisib (Zydelig): nplov kinase protein hu ua PI3K thiab yog siv rau kev rov qab CLL
• duvelisib (Copiktra): tseem tsom rau PI3K, tab sis feem ntau tsuas yog siv tom qab lwm txoj kev kho tsis tiav
• acalabrutinib (Calquence): lwm BTK inhibitor pom zoo nyob rau xyoo 2019 lig rau CLL
• venetoclax (Venclexta) nrog obinutuzumab (Gazyva)

Qhov txhab ntshav ntxiv

Tej zaum koj yuav tsum tau txhaj cov ntshav mus ntxiv ntshav kom ntau ntxiv rau cov ntshav.

Kev tawg

Kev siv hluav taws xob los siv hluav taws xob ntau los yog cua ntsawj txhawm rau pab tua cov qog noj ntshav thiab ua kom cov qog ntshav qis tuaj. Kev siv hluav taws xob ntau tsawg yog siv kho CLL.

Qia cell thiab pob txha hloov ntshav

Koj tus kws kho mob yuav hais kom hloov qia cell yog tias koj mob cancer tsis teb rau lwm yam kev kho mob. Lub qog cell hloov tso cai rau koj kom tau txais cov qib siab ntau dua ntawm cov kws kho mob txhawm rau tua cov qe ntshav ntau dua.

Kev siv tshuaj ntau dua tuaj yeem tsim kev puas tsuaj rau koj cov pob txha pob txha. Txhawm rau hloov cov hlwb no, koj yuav tsum tau txais cov qia hlwb pob txha los yog hlwb pob txha los ntawm tus neeg pub kev noj qab haus huv.

Kev kho mob tawg

Coob tus ntawm cov le caag nyob hauv kev tshawb nrhiav los kho neeg nrog CLL. Qee tus tau raug pom zoo tsis ntev los no yog Lub Chaw Tswj Xyuas Khoom Noj thiab Tshuaj (FDA).

Tshuaj sib txuas ua ke

Thaum lub Tsib Hlis 2019, FDA tau pom zoo venetoclax (Venclexta) ua ke nrog obinutuzumab (Gazyva) txhawm rau kho cov neeg uas tsis tau txais kev kho mob yav dhau los CLL raws li kev kho mob-tsis muaj tshuaj lom.

Lub Yim Hli 2019, cov kws tshawb fawb tau tshaj tawm cov txiaj ntsig ntawm Theem III kev soj ntsuam sim qhia pom tias kev sib xyaw ntawm rituximab thiab ibrutinib (Imbruvica) ua rau tib neeg tsis muaj kab mob mus ntev dua li kev kho mob tam sim no.

Cov kev sib txuas no ua rau nws ua rau tib neeg coob tuaj yeem ua yam tsis muaj kev kho mob hauv lub cev yav tom ntej. Kev kho tshuaj tsis siv tshuaj yog qhov tseem ceeb rau cov neeg uas tsis tuaj yeem tiv taus cov kev siv tshuaj lom neeg uas muaj feem cuam tshuam nrog kev phiv.

Kev kho T-cell kho mob

Ib qho ntawm feem kev cia siab rau yav tom ntej kev kho mob rau CLL yog CAR T-cell kev kho. CAR T, uas sawv cev rau cov chim chim antigen receptor T-cell kho, siv tus neeg lub cev tiv thaiv kab mob mus tua mob qog noj ntshav.

Cov txheej txheem cuam tshuam nrog kev rho tawm thiab hloov kho cov neeg lub cev tiv thaiv kab mob kom paub zoo dua thiab rhuav tshem cov qog nqaij hlav cancer. Cov qog ntshav no muab tso rau hauv lub cev kom hlav ntau thiab tua tus kabmob.

Kev kho mob T-cell yog cog lus, tab sis lawv muaj kev pheej hmoo. Ib qho kev pheej hmoo yog qhov mob hu ua cytokine release syndrome. Qhov no yog qhov mob teb los ntawm infused CAR T-hlwb. Qee tus neeg tuaj yeem ntsib kev mob hnyav uas yuav ua rau tuag taus yog tias tsis kho sai.

Lwm yam tshuaj nyob rau hauv kev tshawb nrhiav

Qee lwm cov hom phiaj tshuaj tam sim no tau raug ntsuas hauv kev soj ntsuam kuaj mob rau CLL suav nrog:

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

Thaum kuaj mob tas, qee cov tshuaj no tuaj yeem pom zoo rau kho CLL. Tham nrog koj tus kws kho mob txog kev koom nrog kev sim kho mob, tshwj xeeb yog cov kev kho tam sim no tsis ua hauj lwm zoo rau koj.

Kev kuaj mob ntsuas qhov ua tau zoo ntawm cov tshuaj tshiab nrog rau kev sib txuas ntawm cov tshuaj uas twb pom zoo lawm. Cov kev kho mob tshiab no tuaj yeem ua haujlwm zoo dua rau koj dua li cov kev tau txais tam sim no. Tam sim no muaj ntau pua txoj kev soj ntsuam kuaj mob txuas ntxiv rau CLL.

Cov nqa mus

Coob tus neeg uas tau kuaj mob nrog tus mob CLL yuav tsis tas pib kho kiag tamsis ntawd. Thaum tus kab mob no pib vam meej, koj muaj ntau txoj kev kho mob. Kuj tseem muaj ntau qhov kev sim kho mob los xaiv los ntawm qhov kev tshawb nrhiav cov kev kho tshiab thiab kev sib txuas ua ke.