Ho kenyelletsa masapo a masapo

Ho kenyelletsa 'moko oa masapo ke mokhoa oa ho nka sebaka sa masapo a senyehileng kapa a senyehileng ka lisele tsa' mele tsa masapo tse phetseng hantle.

Moko oa masapo ke lisele tse bonolo tse mafura tse ka har'a masapo a hao. Moko o hlahisa lisele tsa mali. Lisele tsa stem ke lisele tse sa butsoang masong a masapo tse hlahisang lisele tsohle tsa mali tse fapaneng.

Pele ho kenyelletsoa, ​​chemotherapy, radiation, kapa ka bobeli li ka fanoa. Sena se ka etsoa ka mekhoa e 'meli:

• Phekolo ea Ablative (myeloablative) - Chemotherapy e phahameng, radiation, kapa ka bobeli li fanoa ho bolaea lisele tsa mofets'e. Sena se boetse se bolaea masapo ohle a phetseng hantle a setseng, mme se lumella lisele tse ncha tsa stem ho hola mokong oa masapo.
• Kalafo e fokotsehileng ea matla, e bitsoang hape ho kenyelletsa mini - Tekanyetso e tlase ea chemotherapy le radiation li fanoa pele ho kenngwa. Sena se lumella batho ba baholo, le ba nang le mathata a mang a bophelo hore ba kenngoe.

Ho na le mefuta e meraro ea ho fetisoa ha moko oa masapo:

• Autologous bone bone marrow - Lentsoe auto le bolela ho intša. Lisele tsa stem lia tlosoa ho uena pele o fumana kalafo ea chemotherapy e phahameng kapa kalafo ea radiation. Lisele tsa stem li bolokiloe ka lehare. Kamora chemotherapy e phahameng kapa kalafo ea radiation, lisele tsa hau tsa stems li khutlisetsoa 'meleng oa hau ho etsa lisele tse tloaelehileng tsa mali. Sena se bitsoa phallo ea pholoso.
• Ho kenyelletsa 'mele oa allogeneic Lentsoe allo le bolela tse ling. Lisele tsa stem lia tlosoa ho motho e mong, ea bitsoang mofani. Hangata, liphatsa tsa lefutso tsa mofani li lokela hore bonyane li tsamaisane le liphatsa tsa hau tsa lefutso. Ho etsoa liteko tse khethehileng ho bona hore na mofani o tšoana hantle le uena. Moena kapa khaitseli ho ka etsahala hore e be papali e ntle. Ka linako tse ling batsoali, bana le beng ka bona ba bang ba bapala hantle. Bafani ba sa amanang le uena, leha ho le joalo ba ntse ba tšoana, ba ka fumanoa ka lingoliso tsa naha tsa moko oa masapo.
• Phetisetso ea mali ea umbilical cord - Ena ke mofuta oa ho kenyelletsa li-allogeneic. Lisele tsa 'mele li ntšoa ka mokokotlong oa lesea le sa tsoa tsoaloa hang ka mor'a hore le hlahe. Lisele tsa bakoang li hoamisitsoe ebe li bolokoa ho fihlela li hlokahala bakeng sa ho kenyelletsa. Lisele tsa mali tsa umbilical cord li holile haholo ka hona ha ho na tlhoko e nyane ea ho lekana hantle. Ka lebaka la palo e nyane ea lisele tsa bakoang, lipalo tsa mali li nka nako e telele ho fola.

Ho kenyelletsa sele ea stem hangata ho etsoa kamora chemotherapy le radiation e phethehile. Lisele tsa bakoang li fetisetsoa maling a hau, hangata ka har'a tube e bitsoang catheter e bohareng ea venous. Mokhoa ona o ts'oana le ho tšeloa mali. Lisele tsa bakoang li feta maling ho ea mokong. Ka makhetlo a mangata, ha ho hlokahale opereishene.

Lisele tsa mofani tsa mofani li ka bokelloa ka mekhoa e 'meli:

• Kotulo ea moko oa masapo - Ts'ebetso ena e nyane e etsoa tlasa anesthesia e akaretsang. Sena se bolela hore mofani o tla be a robetse ebile a sa utloe bohloko nakong ea ts'ebetso. Moko oa masapo o tlosoa mokokotlong oa masapo a mabeli a letheka. Palo ea mokoallo e tlositsoeng e latela boima ba motho ea e amohelang.
• Leukapheresis - Taba ea mantlha, mofani o fuoa matsatsi a mangata ho thusa lisele tsa methapo ho tloha mosong oa masapo ho ea maling. Nakong ea leukapheresis, mali a ntšoa ho mofani ka mohala oa IV. Karolo ea lisele tse tšoeu tsa mali tse nang le li-stem li aroloa ka mochineng ebe lia tlosoa ebe li fuoa moamoheli hamorao. Lisele tse khubelu tsa mali li khutlisetsoa ho mofani.

Phetisetso ea moko oa masapo e nkela sebaka sa moko oa masapo o sa sebetseng hantle kapa o sentsoe (ablated) ke chemotherapy kapa radiation. Lingaka li lumela hore bakeng sa mofetše o mongata, lisele tse tšoeu tsa mofani tsa mali li ka hlasela lisele tsa mofets'e tse setseng, tse ts'oanang le ha lisele tse tšoeu li hlasela baktheria kapa livaerase ha li loantša tšoaetso.

Mofani oa hao oa tlhokomelo ea bophelo a ka khothaletsa ho kenyelletsa 'moko oa masapo haeba u na le:

• Mefuta e meng ea mofetše, e kang leukemia, lymphoma, myelodysplasia, kapa myeloma e mengata.
• Lefu le amang tlhahiso ea lisele tsa moko oa masapo, joalo ka aplastic anemia, congenital neutropenia, mafu a matla a sesole sa 'mele, sickle cell anemia, kapa thalassemia.

Ho kenyelletsa 'mele oa masapo ho ka baka matšoao a latelang:

• Bohloko ba sefuba
• Lahlela khatello ea mali
• Feberu, ho bata, ho tsuba
• Tatso e monate molomong
• Ho opeloa ke hlooho
• Hives
• Ho nyekeloa
• Bohloko
• Phefumoloho e khutšoanyane

Mathata a ka bang teng a ho kenyelletsa 'moko oa masapo a ipapisitse le lintho tse ngata, ho kenyelletsa:

• Lilemo tsa hau
• Bophelo ba hau ka kakaretso
• Mofani oa hau o ne a le motle hakaakang papaling
• Mofuta oa phetisetso ea moko oa masapo oo uo fumaneng (mali a autologous, allogeneic, kapa umbilical cord)

Mathata a ka kenyelletsa:

• Khaello ea mali
• Ho tsoa mali ka matšoafong, mala, bokong le libakeng tse ling tsa 'mele
• Likotsi
• Ho koala methapong e menyenyane ea sebete
• Tšenyo ea liphio, sebete, matšoafo le pelo
• Khōlo e liehang ho bana ba amohelang 'moko oa masapo
• Ho khaotsa ho ilela khoeli
• Ho hloleha ha Graft, ho bolelang hore lisele tse ncha ha li lule 'meleng ebe li qala ho hlahisa lisele tsa bakoang
• Graft-versus-host host (GVHD), boemo boo lisele tsa bafani li hlaselang 'mele oa hau
• Ts'oaetso, e ka bang mpe haholo
• Ho ruruha le ho opeloa molomong, 'metso,' metso le mala, tse bitsoang mucositis
• Bohloko
• Mathata a mala, ho kenyelletsa letšollo, ho nyekeloa ke pelo le ho hlatsa

Mofani oa hau o tla botsa ka nalane ea hau ea bongaka mme a etse tlhahlobo ea 'mele. U tla ba le liteko tse ngata pele kalafo e qala.

Pele o kenteloa, o tla ba le li-tubes tse 1 kapa tse peli, tse bitsoang li-catheters tse mahareng tsa venous, tse kentsoeng ka har'a sejana sa mali molaleng kapa matsohong. Phala ena e u lumella ho fumana kalafo, maro, 'me ka linako tse ling phepo e nepahetseng. E boetse e sebelisoa ho hula mali.

Mofani oa hau o tla bua ka khatello ea maikutlo ea ho ba le 'moko oa masapo. U kanna ua batla ho kopana le moeletsi. Ho bohlokoa ho bua le ba lelapa la hau le bana ho ba thusa ho utloisisa seo ba ka se lebellang.

U tla hloka ho etsa meralo ea ho u thusa ho itokisetsa ts'ebetso le ho sebetsana le mesebetsi kamora ho kenyelletsa.

• Tlatsa taelo ea tlhokomelo ea pele
• Lokisetsa matsatsi a phomolo a bongaka mosebetsing
• Hlokomela libanka kapa litlaleho tsa lichelete
• Lokisetsa tlhokomelo ea liphoofolo tse ruuoang lapeng
• Lokisetsa hore motho e mong a thuse ka mesebetsi ea lapeng
• Netefatsa litaba tsa inshorense ea bophelo bo botle
• Lefa likoloto
• Lokisetsa ho hlokomela bana ba hao
• Fumana ntlo ea hau kapa ea lelapa la hau haufi le sepetlele, ha ho hlokahala

Ho kenyelletsa 'mele oa masapo hangata ho etsoa sepetlele kapa setsing sa bongaka se sebetsanang le kalafo e joalo. Boholo ba nako, o lula setsing se ikhethileng sa ho kenya 'moko oa masapo bohareng. Sena ke ho fokotsa menyetla ea hau ea ho fumana tšoaetso.

Ho ipapisitse le kalafo le moo e etsoang teng, ho kenya kapa ho kenya setho sa allogeneic hohle kapa karolo ea sona ho ka etsoa joalo ka mokuli ea kantle. Sena se bolela hore ha ua tlameha ho robala sepetlele bosiu bo le bong.

Ho lula sepetlele nako e telele ho latela:

• Hore na o bile le mathata afe kapa afe a amanang le ho kenyelletsa
• Mofuta oa ho kenya
• Mekhoa ea setsi sa hau sa bongaka

Ha u ntse u le sepetlele:

• Sehlopha sa tlhokomelo ea bophelo se tla lekola palo ea mali a hau le matšoao a bohlokoa.
• O tla fumana meriana ho thibela GVHD le ho thibela kapa ho alafa mafu, ho kenyeletsoa lithibela-mafu, li-antifungal le meriana e thibelang likokoana-hloko.
• Mohlomong u tla hloka litšelo tse ngata tsa mali.
• U tla feptjoa ka methapo (IV) ho fihlela u ka ja ka molomo, 'me litla-morao tsa mala le liso tsa molomo li felile.

Ha u tsoa sepetlele, etsa bonnete ba hore u latela litaelo tsa hore na u ka itlhokomela joang lapeng.

Hore na o etsa hantle hakae kamora ho kenya semela ho latela:

• Mofuta oa phetisetso ea moko oa masapo
• Lisele tsa mofani li tšoana hantle hakae le tsa hau
• U na le mofetše kapa bokuli ba mofuta o fe
• Lilemo tsa hau le bophelo bo botle ka kakaretso
• Mofuta le tekanyetso ea chemotherapy kapa kalafo ea radiation eo u neng u e-na le eona pele u kenya
• Mathata afe kapa afe ao u ka bang le ona

Ho kenyelletsa 'mele oa masapo ho ka folisa bokuli ba hau ka botlalo kapa ka mokhoa o itseng. Haeba ho kenyelletsa ho atleha, o ka khutlela mesebetsing ea hau e tloaelehileng hang ha o se o phetse hantle. Hangata ho nka selemo se le seng hore motho a fole ka botlalo, ho latela hore na ho hlaha mathata afe.

Mathata kapa ho hloleha ha ho fetisoa ha moko oa masapo ho ka lebisa lefung.

Ho kenyelletsa - moko oa masapo; Ho kenyelletsa seleng ea stem; Ho kenyelletsa hematopoietic stem cell; Ho fokotsa matla a ho kenyelletsa nonmyeloablative; Ho kenyelletsa mini; Ho kenyelletsa 'mele oa masapo a Allogenic; Phetoho ea 'mele ea masapo ea Autologous; Phetisetso ea mali ea mohala oa umbilical; Phokolo ea mali ea aplastic - ho kenyelletsa 'moko oa masapo; Kankere ea mali - ho kenyelletsa masapo a masapo; Lymphoma - ho kenyelletsa 'moko oa masapo; Ho kenyelletsa mefuta e mengata ea myeloma

• Ho tsoa mali nakong ea kalafo ea mofets'e
• Ho kenyelletsa 'mele oa masapo - ho tsoa
• Catheter e bohareng ea venous - phetoho ea ho apara
• Catheter ea maqhubu a bohareng - ho ruruha
• Ho noa metsi ka polokeho nakong ea kalafo ea mofets'e
• Molomo o omileng nakong ea kalafo ea mofets'e
• Ho ja likhalori tse eketsehileng ha u kula - batho ba baholo
• Ho ja likhalori tse eketsehileng ha u kula - bana
• Molomo oa mucositis - ho itlhokomela
• Pathese e kentsoeng kahare e kenang ka hare - ho phalla
• Ho ja ka mokhoa o bolokehileng nakong ea kalafo ea mofets'e

• Takatso ea moko oa masapo
• Likarolo tse entsoeng tsa mali
• Mongo oa masapo ho tloha lethekeng
• Ho kenyelletsa masapo a masapo - letoto la lihlooho tse

Mokhatlo oa Amerika oa Clinical Oncology webosaete. Ho kenyelletsa 'moko oa masapo ke eng? www.cancer.net/navigating-cancer-care/how-cancer-treated/bone-marrowstem-cell-transplantation/what-bone-marrow-transplant-stem-cell-transplant. E ntlafalitsoe ka Phato 2018. E fihlile ka la 13 Hlakola 2020.

Heslop HE. Kakaretso le khetho ea mofani oa phetisetso ea hematopoietic stem cell. Ka: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Melao-motheo le Tloaelo ea Motheo. La 7th. Philadelphia, PA: Elsevier; 2018: khaolo ea 103.

Ke A, ​​Pavletic SZ. Phetisetso ea hematopoietic stem cell. Ka: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, bahlophisi. Abeloff's Clinical Oncology. La 6th. Philadelphia, PA: Elsevier; 2020: khaolo ea 28.