Vatsvakurudzi vanoti stem cell transplantation, kunyanya kubva kunhengo dzemhuri imwe chete, yakashandura marapirwo eleukemia, chirwere chinotambudza vanhu vanosvika hafu yemiriyoni vekuAmerica. Uye kunyangwe kurapwa kuchibudirira kune vakawanda, hafu yeavo vanoitwa maitiro vanosangana neimwe mhando yegraft-versus-host disease (GvHD). Izvi zvinoitika kana maseru edziviriro achangobva kuisirwa aona muviri weanotambira se "wekune dzimwe nyika" obva ananga kukurwisa, sekunge angangoita hutachiona hunopinda.
Zvirwere zvizhinji zveGvHD zvinorapika, asi zvinofungidzirwa kuti imwe chete pagumi inogona kuisa upenyu panjodzi. Nokuda kwechikonzero ichi, vatsvakurudzi vanoti, mishonga yekudzivirira zvirwere inoshandiswa kudzivirira GvHD nemasero anopiwa, uye varwere, avo vakawanda vasina hukama, vanofananidzwa pese pazvinogoneka nevanopa kare kuti vave nechokwadi chokuti maitiro avo ekudzivirira zvirwere akafanana sezvinobvira.
Ichitungamirwa nevatsvagiri veNYU Langone Health uye neLaura naIsaac Perlmutter Cancer Center, chidzidzo chitsva uye chirikuenderera mberi chakaratidza kuti chirongwa chitsva chemishonga inodzivirira muviri, cyclophosphamide, abatacept, uye tacrolimus, yakagadzirisa zviri nani dambudziko reGvHD muvanhu vari kurapwa. kenza yeropa.
"Migumisiro yedu yekutanga inoratidza kuti kushandisa abatacept pamwe chete nemimwe mishonga inodzivirira zvirwere zvose zvakachengeteka uye inzira inobatsira yekudzivirira GvHD mushure mekutaridzirwa kwe stem cell yekenza yeropa," anodaro muongorori anotungamira uye hematologist Samer Al-Homsi, MD, MBA. "Zviratidzo zveGvHD zvine abatacept zvaive zvishoma uye zvakanyanya kurapwa. Hapana aityisidzira hupenyu, "anodaro Al-Homsi, purofesa wekiriniki muDhipatimendi reMishonga paNYU Grossman Chikoro cheMishonga uye Perlmutter Cancer Center.
Al-Homsi, uyo anoshandawo semutungamiri wepurogiramu yeropa uye marrow transplant paNYU Langone uye Perlmutter Cancer Center, ari kuratidza zvakawanikwa neboka paIndaneti Dec. 13 pamusangano wegore negore weAmerican Society of Hematology muAtlanta.
Ongororo yacho yakaratidza kuti pakati pevarwere vekutanga makumi maviri nevatatu vane kenza yeropa ine hasha yakapihwa posttransplant mushonga regimen mukati memwedzi mitatu, ina chete yakaratidza zviratidzo zvekutanga zveGvHD, zvinosanganisira kuputika kweganda, kusvotwa, kurutsa, uye manyoka. Zvimwe zviviri zvakatanga kuitika mavhiki gare gare, kunyanya mapundu eganda. Vose vakabudirira kurapwa nemimwe mishonga yezviratidzo zvavo. Hapana akava nezviratidzo zvakakomba, kusanganisira kukuvara kwechiropa kana kutadza kufema. Zvisinei, mumwe murwere, uyo kuisirwa kwakakundikana, akafa neleukemia inodzokororwa. Vamwe vose (varume nevakadzi makumi maviri nevaviri, kana kuti 23 muzana) vanoramba vasina kenza kupfuura mwedzi mishanu mushure mekutamiswa, nemasero anopiwa anoratidza zviratidzo zvekugadzira masero eropa matsva, ane utano, uye asina kenza.
Pamwe chete nekuwedzera sarudzo dzevanopa kune vese varwere, zviwanikwa zvechidzidzo zvine mukana wekugadzirisa kusaenzana kwemarudzi mu stem cell transplantation. Tichifunga nezvemhando yedziva revanopa kusvika parizvino, Vatema, vekuAsia America, uye Hispanics vari pasi pechikamu chimwe muzvitatu sezvingangoita sevanhu veCaucasians kuti vawane anonyatsoenderana stem cell donor, zvichisiya nhengo dzemhuri semupi anovimbika. Vamwe 12,000 vekuAmerica parizvino vakanyorwa uye vakamirira paNational bone marrow program registry, Al-Homsi manotsi.
Chidzidzo chemazuva ano chaisanganisira stem cell transplantation kubva kune vane hukama hwepedyo (hafu-inofananidzwa) vanopa nevarwere, kusanganisira vabereki, vana, uye vanin'ina, asi vane genetic make-up yakanga isina kufanana, pamwe nemusanganiswa wezvinodhaka uchiwedzera mukana wekubudirira kuisirwa.
Iyo itsva regimen inotsiva mushonga wagara uchishandiswa mycophenolate mofetil neabatacept. Al-Homsi anoti abatacept "inotariswa zvakanyanya" kupfuura mycophenolate mofetil uye inodzivirira immune T masero kubva pakuva "activated," danho rinodiwa musati masero ekudzivirira aya asati arwisa mamwe masero. Abatacept yatove yakatenderwa zvakanyanya kurapa zvimwe zvirwere zvekudzivirira muviri, senge arthritis, uye yakaedzwa zvakabudirira mukudzivirira GvHD nevaya vanonyatsoenderana, vasina hukama. Kusvika parizvino, vanopa vakanyatsoenderana vakaratidza mhedzisiro iri nani mukudzivirira chirwere chegraft-versus-host pane hafu-inofananidzwa mhuri, kana inonzi inonzi haploidentical, vanopa.
Zvakare, sechikamu chemushonga wakadzokororwa, vaongorori vakapfupisa nguva yekurapa tacrolimus kusvika kumwedzi mitatu, kubva pahwindo rekutanga rekurapa remwedzi mitanhatu kusvika mipfumbamwe. Izvi zvakakonzerwa nemushonga unogona kuita chepfu paitsvo.
