Abacwaningi bathi ukufakelwa kwama-stem cell, ikakhulukazi amalungu omndeni owodwa, kuye kwashintsha indlela yokwelapha i-leukemia, isifo esiphatha cishe isigamu sesigidi saseMelika. Futhi nakuba ukwelashwa kuphumelela kwabaningi, ingxenye yalabo abenza inqubo iba nohlobo oluthile lwe-graft-versus-host disease (GvHD). Lokhu kwenzeka lapho amangqamuzana amasosha omzimba asanda kufakwa ebona umzimba womsingathi wawo “njengowangaphandle” bese ewuqondisa ukuze awuhlasele, njengoba nje ebengenza igciwane elihlaselayo.
Izigameko eziningi ze-GvHD ziyelapheka, kodwa isilinganiso esisodwa kweziyi-10 singabeka impilo engozini. Ngenxa yalesi sizathu, abacwaningi bathi, izidakamizwa ezicindezela amasosha omzimba zisetshenziselwa ukuvimbela i-GvHD ngamangqamuzana anikelwe, futhi iziguli, ikakhulukazi ezingahlobene, zifaniswa noma nini lapho kungenzeka khona nabanikelayo kusengaphambili ukuze kuqinisekiswe ukuthi amasosha abo omzimba afana ngangokunokwenzeka.
Iholwa abacwaningi e-NYU Langone Health kanye ne-Laura kanye ne-Isaac Perlmutter Cancer Centre, ucwaningo olusha noluqhubekayo lubonise ukuthi uhlobo olusha lwezidakamizwa ezicindezela umzimba, i-cyclophosphamide, i-abatacept, ne-tacrolimus, yabhekana kangcono nenkinga ye-GvHD kubantu abelashwayo. umdlavuza wegazi.
"Imiphumela yethu yokuqala ibonisa ukuthi ukusebenzisa i-abatacept ngokuhlanganiswa nezinye izidakamizwa ezicindezela amasosha omzimba kokubili kuphephile futhi kuyindlela ephumelelayo yokuvimbela i-GvHD ngemva kokufakelwa kwe-stem cell ngomdlavuza wegazi," kusho umphenyi oholayo wocwaningo kanye nesazi segazi uSamer Al-Homsi, MD, MBA. “Izimpawu ze-GvHD ezine-abatacept bezincane futhi ziyelapheka kakhulu. Abekho abebebeka impilo yabo engcupheni,” kusho u-Al-Homsi, uprofesa wezokwelapha eMnyangweni Wezokwelapha e-NYU Grossman School of Medicine nasePerlmutter Cancer Center.
U-Al-Homsi, ophinde asebenze njengomqondisi wohlelo lokufakelwa igazi nomnkantsha e-NYU Langone nase-Perlmutter Cancer Center, wethula okutholwe yiqembu ku-inthanethi ngoDis. 13 emhlanganweni waminyaka yonke we-American Society of Hematology e-Atlanta.
Uphenyo lwabonisa ukuthi phakathi kweziguli zokuqala ezingu-23 zabantu abadala ezinomdlavuza wegazi oyingozi ezinikezwe uhlobo lwesidakamizwa ngemva kokufakelwa kabusha esikhathini esiyizinyanga ezintathu, ezine kuphela zabonisa izimpawu zakuqala ze-GvHD, okuhlanganisa ukuqubuka kwesikhumba, isicanucanu, ukuhlanza, nesifo sohudo. Okunye ukusabela okubili kwavela ngemva kwamasonto amabili, ikakhulukazi ukuqubuka kwesikhumba. Bonke belashwe ngempumelelo ngeminye imithi yezimpawu zabo. Azikho ezaba nezimpawu ezinzima kakhulu, okuhlanganisa ukulimala kwesibindi noma ukuphefumula kanzima. Nokho, esinye isiguli, ukufakelwa kwaso akuphumelelanga, sabulawa i-leukemia eqhubekayo. Abanye (abesilisa nabesifazane abangu-22, noma amaphesenti angu-95) bahlala bengenawo umdlavuza ngaphezu kwezinyanga ezinhlanu ngemva kokufakelwa, namangqamuzana anikelwe abonisa izimpawu zokukhiqiza amangqamuzana egazi amasha, anempilo, nangenawo umdlavuza.
Kanye nokwanda kwezinketho zabanikelayo kuzo zonke iziguli, imiphumela yocwaningo inamandla okubhekana nokuhlukana kwezinhlanga ekufakweni kwe-stem cell. Uma kubhekwa imvelo yechibi labanikeli kuze kube manje, AbaNsundu, ama-Asian Americans, kanye nama-Hispanics bangaphansi kwengxenye eyodwa kwezintathu njengaseCaucasia ukuze bathole umnikezeli wamaseli we-stem ofana ngokuphelele, okushiya amalungu omndeni njengomthombo othembeke kakhulu wokunikela. Abantu baseMelika abangaba ngu-12,000 njengamanje abasohlwini futhi abalindile kurejista yohlelo lwethambo lomnkantsha, amanothi e-Al-Homsi.
Ucwaningo lwamanje lwaluhilela ukufakelwa kwe-stem cell kusuka kubanikeli abasondelene (isigamu esifaniswe) neziguli, okuhlanganisa abazali, izingane, nezingane zakubo, kodwa ufuzo lwazo lwalungafani, nenhlanganisela yezidakamizwa ikhulisa amathuba okuthi ukufakelwa kabusha okuphumelelayo.
Uhlelo olusha lungena esikhundleni somuthi osetshenziswa ngokwesiko i-mycophenolate mofetil nge-abatacept. U-Al-Homsi uthi i-abatacept "iqondiswe kakhulu" kune-mycophenolate mofetil futhi ivimbela ama-immune T cells ukuthi "asebenze," isinyathelo esidingekayo ngaphambi kokuba lawa maseli omzimba akwazi ukuhlasela amanye amangqamuzana. I-Abatacept isivele yagunyazwa kabanzi ukwelapha okunye ukuphazamiseka kwamasosha omzimba, okufana nesifo samathambo, futhi ihlolwe ngempumelelo ekuvimbeleni i-GvHD ngabanikeli abafaniswe eduze, abangahlobene. Kuze kube manje, abanikeli abafaniswe ngokugcwele babonise imiphumela engcono ekuvimbeleni isifo sokuxhunyelelwa ngokumelene nosokhaya kunomkhaya ofaniswa nengxenye, noma lokho okubizwa ngokuthi abanikeli be-haploidentical.
Futhi, njengengxenye yokwelashwa okubuyekeziwe, abacwaningi banciphisa isikhathi sokwelashwa kwe-tacrolimus saba yizinyanga ezintathu, kusukela ewindini lokwelapha lokuqala lezinyanga eziyisithupha kuya kweziyisishiyagalolunye. Lokhu kwakungenxa yemiphumela emibi engase ibe nobuthi yomuthi ezinso.
