Graft versus host disease (GvHD), mhedzisiro inogona kuitika mushure meiyo allogeneic transplant.
Chii chinonzi graft versus host disease (GvHD)?
Chirwere cheGraft versus host (GvHD) idambudziko rakajairika reiyo allogeneic stem cell transplant. Izvo zvinoitika kana T-masero eiyo immune system nyowani, anoona maseru eanogamuchira sekunze, uye oarwisa. Izvi zvinokonzera hondo pakati pe 'graft' ne 'host'.
Inonzi graft versus host, nekuti 'graft' ndiyo inopihwa immune system, uye 'host' ndiye murwere anogamuchira maseru akapihwa.
GvHD idambudziko rinogona kuitika chete mukati allogeneic transplants. Allogenic transplant inosanganisira stem masero anopiwa kuti murwere agamuchire.
Kana munhu aine kuchinjirwa kwaanogashira ega masero, aya anonzi an autologous kuisirwa. GvHD haisi dambudziko rinogona kuitika muvanhu vari kugamuchira kudzoreredzwa kwemasero avo.
Chiremba anoongorora varwere veGvHD nguva nenguva sechikamu chekutevera rubatsiro mushure mekurapa allogeneic transplants. Pachikamu chega chega chemuviri chakabatwa neGvHD chisingaperi, zvibodzwa zviri pakati pe0 (hapana zvazvinoita) ne3 (zvakanyanya kukanganisa) zvinopihwa. Chibodzwa chinoenderana nemabatiro anoita zviratidzo pahupenyu hwezuva nezuva uye izvi zvinobatsira vanachiremba kuti vasarudze kurapwa kwakanyanya kumurwere.
Mhando dzegraft versus host disease (GvHD)
GvHD inonzi 'acute' kana 'chronic' zvichienderana nekuti murwere anoiwana riini uye zviratidzo nezviratidzo zveGvHD.
Acute graft versus host hosha
- Inotanga mukati memazuva zana ekutanga mushure mekutapurirana
- Vanopfuura 50% yevarwere vane allogenic transplant, vanoona izvi
- Kazhinji inowanzoitika mavhiki maviri kusvika matatu mushure mekusimwa. Iyi 2 - 3 vhiki chiratidzo ndipo apo masero matsva anotanga kutora basa rekudzivirira kwemuviri uye kugadzira masero matsva eropa.
- Acute GvHD inogona kuitika kunze kwemazuva 100, izvi zvinowanzoitika muvarwere vakave neyakaderedzwa-yakanyanya mamiriro ekugadzirisa asati aisirwa.
- Mune acute GvHD, iyo graft iri kuramba iyo yainotambira, kwete muenzi ari kuramba kubatanidzwa. Nepo musimboti uyu wakafanana mune acute uye asingaperi GvHD, maficha eacute GvHD akasiyana neaya asingaperi.
Kuomarara kweacute GvHD kunoiswa giredhi kubva pachinhanho chekutanga (chakanyanya kupfava) kusvika pachinhanho IV (chakanyanya), iyi giredhi system inobatsira vanachiremba kusarudza nezvekurapa. Nzvimbo dzinonyanya kuzivikanwa dzeacute GvHD ndeidzi:
Gastrointestinal tract: kukonzeresa manyoka anogona kuita zvese nemvura kana kubuda ropa. Nausea uye kurutsa pamwe chete nekurwadziwa kwemudumbu, kuonda uye kuderera kwechido.
Ganda: Kunoita kuti pave nepundu rinorwadza uye rinokwenya. Kazhinji inotangira mumaoko, tsoka, nzeve nechipfuva asi inogona kupararira nemuviri wose.
Chiropa: Chiropa chinokonzera jaundice inova muunganidzwa we'bilirubin' (chinhu chinowanikwa mukushanda kwechiropa chakajairika) chinoshandura kuchena kwemaziso uye ganda reyero.
Boka rinorapa rinofanirwa kuongorora murwere kuti GvHD nguva nenguva sechikamu chekutarisirwa kwekutevera.
Chronic graft inopesana nehosha yehosha
- Chronic GvHD inoitika mazuva anopfuura 100 mushure mekuisirwa.
- Kunyange zvazvo inogona kuitika chero ipi zvayo post-transplant, inowanzoonekwa mukati megore rokutanga.
- Varwere vanga vaine acute GvHD vari panjodzi huru yekuva nechirwere cheGvHD.
- Vanosvika 50% yevarwere vanowana acute GvHD vanozosangana nechirwere cheGvHD chisingaperi.
- Inogona kukanganisa chero munhu kutumira stem cell transplant.
Chronic GvHD inowanzobata:
- Muromo: inokonzera muromo wakaoma uye unorwadza
- Ganda: kuputika kweganda, ganda rinoita manyemwe uye rinokwenya, kuomesa ganda uye kuchinja kune ruvara rwayo uye inzwi.
- Matumbu: kuzvimba, manyoka, kuda kurutsa, kurutsa uye kuonda kusingatsananguriki.
- Chiropa: chinowanzoratidza zviratidzo zvakafanana nehutachiona hwehepatitis
Chronic GvHD inogonawo kukanganisa dzimwe nzvimbo, semeso, majoini, mapapu uye nhengo dzakavandika.
Zviratidzo nezviratidzo zvegraft versus host disease (GvHD)
- Rash, kusanganisira kupisa uye kutsvuka kweganda. Ichi chipundu chinowanzo ratidza pazvanza zveruoko uye pasi petsoka. Inogona kusanganisira trunk nemamwe magumo.
- Kusvotwa, kurutsa, manyoka, kugwamba mudumbu uye kurasikirwa nechido kunogona kuva nziyo dzeGvHD yemudumbu.
- Yero yeganda nemaziso (iyi inonzi jaundice) inogona kuva chiratidzo cheGvHD yechiropa. Kusashanda zvakanaka kwechiropa kunogona kuonekwawo pane kumwe kuongororwa ropa.
- Mouth:
- Dry mouth
- Kuwedzera kunzwisiswa kwemuromo (zvinopisa, kutonhora, fizz, chikafu chinonhuwira nezvimwewo)
- Kunetseka kudya
- Chirwere chemazino uye kuora kwemazino
- Ganda:
- Mapundu
- Dry, tight, itchy ganda
- Kukora uye kuomesa kweganda izvo zvinogona kukonzera kurambidzwa kufamba
- Ruvara rweganda rwakashanduka
- Kusashivirira kune shanduko yekushisa, nekuda kweakakuvadzwa sweat gland
- Nail:
- Kuchinja kwembambo yezvipikiri
- Zvipikiri zvakaoma, zvinoputika
- Kurasikirwa kwembambo
- Gastrointestinal tract:
- Kufirwa kwechido
- Unexplained kuora kurasikirwa
- Kudzora
- Diarrhea
- Abdominal cramping
- Mapapu:
- Kupfupika kwemhepo
- Kukosora kusingapere
- Wheezing
- Chiropa:
- Kuzvimba dumbu
- Yellow disclouration yeganda/maziso (jaundice)
- Kusashanda zvakanaka kwechiropa
- Tsandanyama nemajoini:
- Tsandanyama kupera simba uye cramping
- Kuoma kwakabatana, kuoma uye kuoma kuwedzera
- Genitalia:
- Mukadzi:
- Vagina kuoma, kuvava uye kurwadziwa
- Vaginal maronda uye mavanga
- Kudimburira mukadzi
- Kusvirana kwakaoma/kurwadza
- Murume:
- Kupfupika uye mavanga eurethra
- Kukwenya nemavanga pascrotum nenhengo yesikarudzi
- Kusvirwa nemboro
- Mukadzi:
Kurapa kwegraft versus host disease (GvHD)
- Kuwedzera immunosuppression
- Kutungamirirwa kwecorticosteroids yakadai sePrednisolone uye Dexamethasone
- Kune imwe yakaderera giredhi ganda GvHD, topical steroid cream inogona kushandiswa
Nekurapwa kweGvHD iyo isingapindure kune corticosteroids:
- Ibrutinib
- Ruxolitinib
- Mycophenolate mofetil
- Sirolimus
- Tacrolimus uye Cyclosporin
- Monoclonal antibodies
- Antithymocyte Globulin (ATG)
