Te Whakawhitinga Iwi Iwi Ma Nga Tamariki

Te Whakawhitinga Iwi Iwi Ma Nga Tamariki

Ko te whakawhitinga wheua wheua (BMT) he tikanga hei whakakapi i te wheua wheua mate o te tamaiti ki te wheua wheua hauora mā te whakawhiti i ngā pūtau take hematopoietic. I roto i ngā tamariki, ka whakamahia te whakawhitinga wheua wheua hei rongoā i ngā mate kino me ngā mate kore kino.

He aha te koiwi wheua?

He kiko ngohengohe te hinu wheua kei roto i ngā āputa o ngā wheua nunui. He rite ki tētahi wheketere e hanga ana i ngā pūtau take (ngā pūtau mātua, ngā pūtau hanga toto rānei). Ka tīmata ēnei pūtau take te wehewehe me te pakeke tae noa ki te tino whanake, ka hanga i ngā momo pūtau toto katoa: ngā pūtau mā, ngā pereti toto me ngā pūtau toto whero. Ko ngā pūtau take kei roto i ngā āputa hinu wheua o ngā wheua nunui. Ko te huarahi māmā ki te tiki pūtau take ko te tiki mai i ngā wheua hope.

Haunga te hinu wheua, kei roto i te toto pito me te toto ā-taha ngā pūtau take.

He aha nga momo whakawhitinga wheua wheua?

Ka taea te kohi i ngā pūtau take mai i te tinana o te tūroro, ka taea rānei te tango mai i tētahi atu tangata. E mōhiotia ana tēnei tangata ko te kaituku.

Whakawhiti Autologous

Ka tangohia ngā pūtau take mai i te toto o te tūroro mā te apheresis mā te whakamahi i ngā mīhini motuhake (peripheral) kātahi ka whakahokia ki te tūroro i muri i te maimoatanga whakangāwari.

Whakawhiti Allogeneic

He whanaunga, he whanaunga rānei te kaituku, engari he rite te momo Human Leukocyte Antigen (HLA). Mā ngā whakamātautau toto, mā te huware rānei e whakataurite te HLA o te kaituku me te tūroro.

He tikanga haumaru te tuku pūtau take. He tikanga noa te tīmata mā te whakamātautau i ngā tuākana me ngā tuāhine, nā te mea ko rātou pea te hunga e pai ana ki a rātou.

Kia pai te hauora o te kaituku. Ka tukuna ia ki te tirotiro hauora kia mohio ai kaore he raruraru ki tona ake hauora mai i te tukanga.

He aha mena karekau nga teina e tino rite ki te hunga koha?

• Ngā Kaituku Haploidentical: 50% o ngā tuākana/teina ōrite, tetahi rānei o ngā mātua, ka taea te whakaaro hei kaituku rerekē ina he kino te hua o te whakamātautau paturopi motuhake ki te kaituku i te tūroro.
• Ngā Kaituku Kore-Hononga: Ka tīpakohia ngā kaituku mai i ngā rēhita pūtau take (Mā te mahi tahi me te whakaae)

He aha te wa e tika ai te whakawhitinga wheua wheua?

Ka tīmata ngā pūtau toto hei pūtau kāore anō kia pakari. Ka puta atu i te hinu wheua ka tomo ki te toto i muri i te pakeketanga. Ina pakaru te hinu wheua, ka iti ake ngā pūtau toto e puta mai ana, ka iti ake hoki ngā pūtau ārai mate. Koia te take, hei whakakapi i te hinu wheua kua pakaru, kua mate rānei, me whakatō hinu wheua.

Nga tohu mo te whakawhitinga wheua wheua:

• Te mate pukupuku toto mā (te mate pukupuku toto mā) te mate pukupuku toto kua hoki anō rānei
• Ngā pukupuku totoka pērā i ngā neuroblastoma mōrearea nui, ngā lymphoma, me ngā pukupuku roro
• Te anemia aplastic (he āhuatanga e mutu ai te hanga toto hou e te tinana)
• Te mate pūtau toto whero (he mate e pā ana ki te āhua o ngā toto toto whero, ā, ka pā kino ki te haemoglobin)
• Te Thalassemia (he āhuatanga e pā ana ki te kaha o te tinana ki te whakaputa i te hemoglobin noa)
• Ngā mate pāwera tuku iho (ngā āhuatanga ira e pā ana ki te pāwera o te tinana)
• Ngā mate ārai mate – Te mate tuatahi o te ngoikore o te ārai mate, te mate maha-mate.

He aha te tikanga o te whakawhitinga wheua wheua?

Aromātai i mua i te whakawhitinga

He maha ngā whakamātautau me ngā tikanga hei aromatawai i te hauora me te āhua whānui o tāu tamaiti, me te whakarite hoki kua tino rite te tamaiti mō te whakawhitinga toto. Tērā pea ka roa pea ngā whakamātautau mō ētahi rā, neke atu rānei, tae atu ki ngā whakamātautau toto taiwhanga, ngā whakamātautau whakaahua, ngā whakamātautau hei tirotiro i te whakarongo, te tirohanga, te mahi a ngā pukahukahu, te tirotiro hinengaro me te whanaketanga, me te mahi a te ngākau.

Kohikohi pūtau kakau mo te whakawhiti

Mena e tumanakohia ana he whakawhitinga pūtau-ā-roto, ka whakahaerehia e koe he tikanga e kiia nei ko te apheresis hei kohi i ngā pūtau take. Ka hiahia koe ki tētahi kaituku mēnā kei te whakahaerehia e koe he whakawhitinga pūtau-ā-roto mā te whakamahi i ngā pūtau take mai i te kaituku. Kia tautuhia he kaituku, ka tangohia ngā pūtau take mai i taua tangata hei whakarite mō te whakawhitinga. Ko ngā pūtake o ngā pūtau take ko:

• Ngā pūtau take hematopoietic toto ā-taha:

Ka whiwhihia ma te apheresis, ma te whakamahi i tetahi miihini motuhake. I te nuinga o te waa, ka whakamahia he momo IV (catheter) motuhake hei whakahaere i te rere o te toto i roto i te miihini hei kohi i nga pūtau kakau. Heoi, ki te kore e rahi nga uaua o to tamaiti kia pai ai te rere o te toto, ka hiahia pea ia ki te whakatakoto i tetahi catheter mo te wa poto mo te kohi. I tenei wa ko tenei te huarahi pai ki te kohikohi i nga pūtau kakau.

• He kowhatu otaota

Ka kohia nga pūtau kakau mai i te iliac crest he wahanga o te koiwi hope o te kaituku i raro i te rewharewha.

• Toto taura umbilical

Ka tangohia ngā pūtau take mai i te pito i muri tonu i te whānautanga o te pēpi. Ka whakamatautauria ngā pūtau take, ka patohia, ka tatauhia, ā, ka whakatiohia kia tae rā anō ki te wā e rite ai mō te whakatō.

Te tukanga whakawhiti hinu wheua:

Kāore he pokanga e whakamahia ana i roto i te Whakatōnga Toto mō te tūroro. He tikanga haumaru te tuku pūtau take mō ngā kaituku i raro i ngā tautuhinga whakahaere. Kāore he mea e ngaro tūturu i roto i te tinana, pērā i te Whakatōnga Whatukuhu. Ka ora anō ngā pūtau take i roto i ētahi rā torutoru. Ka werohia ngā pūtau take ki roto i te tinana o te tūroro pērā i te Whakatōnga Toto noa iho.

E toru ngā taahiraa matua o te tukanga whakawhitinga wheua.

Hipanga 1: Te kohi i te hinu wheua, i ngā pūtau take rānei (te hauhake) mai i te kaituku.

Hipanga 2: Te whakangaro katoa i te hinu wheua o nāianei, kia āwhina ai i te tūroro ki te whiwhi i ngā pūtau take hou.

Hipanga 3: Te werohanga i te hinu wheua, i ngā pūtau take rānei mā te ara uaua, pērā i te whakawhiti toto. Tērā pea kāore he tohu o te tipu o te hinu wheua hou mō ngā wiki e rua ki te toru, ā, i ētahi wā ka roa ake pea te wā i mua i te whakaputa tika o ngā wāhanga katoa o te toto e te hinu wheua hou.

Ko tehea momo whakawhitinga he pai ake?

Mā te tākuta e rongoā ana i tāu tamaiti e tohutohu te momo whakawhitinga pūtau take pai rawa atu, ahakoa he autologous, he allogeneic rānei, me te pūtake pūtau tino pai. Ka pāngia tēnei kōwhiringa e ngā āhuatanga maha, tae atu ki:

• te momo mate o to tamaiti
• te hauora katoa o to tamaiti

He aha nga paanga o te whakawhitinga wheua wheua?

Ka puta pea ngā pānga taha o te hinu wheua. He motuhake ēnei ki te katoa. Ka rerekē i runga i te momo whakawhitinga wheua, te hauora whānui o tāu tamaiti, me ētahi atu mea anō hoki.

Ko ngā pānga taha tonu ka uru atu ki te mate pāwera, te mate graft-versus-host (GVHD) – he āhuatanga ka tauhohe te hinu wheua kua whakatōkia e te kaituku ki ngā kiko o te kaiwhiwhi (mēnā he whakatō Allogenic), te whakapairuaki, te ruaki, te mate waha, te ngenge, te iti o ngā pereti toto, te iti o ngā toto whero (e hua ai te anemia), me te mate korere.

Ina waea atu ki te taote?

Me toro atu ki te tākuta e rongoā ana mēnā ka kite koe i ngā tohu e whai ake nei i roto i te tamaiti:

• Fever
• Te mamae e whakararuraru ana i te kai, te tākaro, te hikoi, te neke rānei
• Te marea pumau
• Nga raruraru kite
• Nga raruraru Urinary
• Rahera
• Ngenge ngenge
• Nga huringa i roto i te tauira kumete
• Nga huringa nui i roto i te mahi, i te whanonga ranei

He aha te pānga o te whakawhitinga wheua ki te oranga o taku tamaiti? Ka taea e taku tamaiti te haere ki te kura me te mahi i ngā mahi o ia rā?

Ko te wa o to tamaiti ki te hoki mai ki te kura e whakawhirinaki ana ki te momo whakawhitinga wheua wheua i mahia e ia. I te nuinga o te wa, ka hoki mai te tamaiti ki te kura i roto i te ono marama ki te 6 tau i muri i te whakawhitinga. He mea tika kia karohia te mano tini me te mahi wehe hapori mo te iti rawa mo te ono marama hei aukati i te mate. Ka whakamohio atu to taakuta ki a koe i te wa e pai ana mo te tamaiti kia haere ano nga mahi i ia wa.

Ngā Whakaurunga nā Tākuta Vipin Khandelwal , Kaitohutohu, Tākuta Haemto-oncology me te Whakatō Huango Wheua, Apollo Cancer Centres Navi Mumbai