Ukufakelwa Kwamathambo Ezingane

Ukufakelwa Kwamathambo Ezingane

Ukufakelwa umnkantsha wethambo (i-BMT) inqubo yokufaka umnkantsha wethambo wengane onesifo ngomnkantsha wethambo onempilo ngokufaka amaseli okuqala egazi. Ezinganeni, ukufakelwa umnkantsha wethambo kusetshenziselwa ukwelapha izifo ezibulalayo kanye nezingezona ezibangela umdlavuza.

Uyini umnkantsha?

Umnkantsha wethambo uyizicubu ezithambile ezikhona ngaphakathi kwezikhala zamathambo amakhulu. Ufana nefektri eyenza amaseli okuqala (amangqamuzana abazali noma amaseli akha igazi). Lawa maseli okuqala aqala ukuhlukana futhi avuthwe aze akhule ngokugcwele, akha zonke izinhlobo ezahlukene zamaseli egazi: amaseli amhlophe, ama-platelet namaseli abomvu egazi. Amaseli okuqala avame ukutholakala ngaphakathi kwezikhala zomnkantsha wethambo zamathambo amakhulu. Indlela elula yokuthola amaseli okuqala ivela emathanjeni e-hip.

Ngaphandle komnkantsha, amaseli okuqala atholakala egazini le-umbilical cord kanye nasegazini elingaphandle.

Yiziphi izinhlobo zokufakelwa komnkantsha?

Amaseli okuqala angaqoqwa emzimbeni wesiguli noma angaqoqwa komunye umuntu. Lo omunye umuntu waziwa ngokuthi umnikeli.

Ukufakelwa kwe-Autologous

Amaseli e-stem athathwa egazini lesiguli nge-apheresis kusetshenziswa imishini ekhethekile (engaphandle) bese ebuyiselwa esigulini ngemva kokwelashwa kokulungisa isimo.

Ukufakelwa kwe-Allogeneic

Umnikeli uyisihlobo noma akahlobene kodwa une-Human Leukocyte Antigen (HLA) type efanayo. Ukulinganisa i-HLA yomnikeli nesiguli kwenziwa ngokuhlolwa kwegazi noma ngamathe.

Ukunikela ngamaseli e-stem kuyindlela ephephile. Kuvamile ukuqala ngokuhlola abafowethu nodadewethu, njengoba kungenzeka ukuthi banikeze okuhambisanayo okungcono kakhulu.

Onikelayo kufanele abe nempilo enhle. Uzohlolwa ngokucophelela ukuze aqinisekise ukuthi ngeke kube nengozi empilweni yakhe ngenxa yale nqubo.

Kuthiwani Uma Izelamani Zingafani Ngokugcwele Njengabanikeli?

• Abanikeli be-Haploidentical: Izelamani ezifanelana ezingama-50% noma umzali ngamunye angabhekwa njengomnikeli ohlukile uma ukuhlolwa kwe-antibody ethile yomnikeli kukhombisa ukuthi isiguli asinayo i-HIV.
• Abanikeli Abangahlobene: Abanikeli bakhethwa kurejista yamaseli okuqala (Kuzimele ngemva kokuhlolwa okuphelele kanye nemvume)

Kunini lapho ukufakelwa komnkantsha wethambo kuyadingeka?

Amaseli egazi aqala njengamaseli angavuthiwe. Aphuma emnkantsheni bese engena egazini ngemva kokuvuthwa. Uma umnkantshe wonakele, ukhiqiza amaseli egazi ambalwa kanye namaseli omzimba ambalwa. Yingakho, ukuze kuthathelwe indawo umnkantshe owonakele noma onesifo, kudingeka ukufakelwa umnkantsheni.

Izinkomba zokufakelwa komnkantsha:

• I-Leukemia eyingozi kakhulu (umdlavuza wamaseli amhlophe egazi) noma i-leukemia ephinde yabuya
• Izimila eziqinile njenge-High risk neuroblastomas, i-lymphomas, kanye nezimila zobuchopho
• I-anemia ye-Aplastic (isimo lapho umzimba uyeka ukukhiqiza amangqamuzana egazi amasha)
• Isifo se-sickle cell (isimo esithinta ukuma kwamaseli abomvu egazi esithinta i-hemoglobin)
• I-Thalassemia (isimo esithinta ikhono lomzimba lokukhiqiza i-hemoglobin evamile)
• Izinkinga ze-metabolic ezizuzwe njengefa (izimo zofuzo ezithinta i-metabolism)
• Izifo zokuzivikela komzimba - Isifo esiyinhloko sokuntuleka kwamasosha omzimba, i-Multiple sclerosis.

Ithini inqubo yokufakelwa komnkantsha?

Ukuhlolwa kwangaphambi kokufakelwa

Kuzoba nokuhlolwa okuhlukahlukene kanye nezinqubo zokuhlola impilo nesimo sengane yakho iyonke, kanye nokuqinisekisa ukuthi ingane ikulungele ngokuphelele ukufakelwa. Ukuhlolwa kungathatha izinsuku ezimbalwa noma ngaphezulu futhi kufaka phakathi ukuhlolwa kwegazi elebhu, ukuhlolwa kwezithombe, ukuhlolwa kokuhlola ukuzwa, umbono, ukusebenza kwamaphaphu, ukuhlolwa kwengqondo nokukhula, kanye nokusebenza kwenhliziyo.

Ukuqoqa ama-stem cells ukuze atshalwe kabusha

Uma kulindeleke ukuthi kufakwe i-autologous transplant, uzokwenza inqubo ebizwa ngokuthi i-apheresis ukuze uqoqe ama-stem cell. Uzodinga umnikeli uma wenza i-allogeneic transplant usebenzisa ama-stem cell avela kumnikeli. Uma umnikeli esetholakele, ama-stem cell ayasuswa kulowo muntu ukuze kulungiselelwe ukufakelwa. Imithombo yama-stem cell ihlanganisa:

• Amaseli e-hematopoietic stem egazi elingaphandle:

Zitholakala nge-apheresis, kusetshenziswa umshini okhethekile. Ngokuvamile, uhlobo olukhethekile lwe-IV (catheter) lusetshenziselwa ukwenza lula ukugeleza kwegazi ngomshini ukuze kuqoqwe ama-stem cells. Kodwa-ke, uma imithambo yengane yakho ingemikhulu ngokwanele ukuze ithole ukugeleza kwegazi okwanele, ingase idinge ukuthi ifakwe ikhethetha yesikhashana ekhethekile ukuze kuqoqwe inqubo. Manje-a-izinsuku lena indlela ekhethwayo yokuqoqa ama-stem cells.

• Umkantsha

Amaseli e-stem aqoqwa ku-iliac crest eyingxenye yethambo le-hip of the donor ngaphansi kwe-anesthesia.

• Umbilical Cord Blood

Amaseli e-stem athathwa entanjeni yesisu ngokushesha ngemva kokubeletha usana. Amaseli e-stem ayahlolwa, athayishwe, abalwe futhi aqandiswe kuze kube yilapho eselungele ukutshalwa.

Inqubo yokufakelwa komnkantsha wethambo:

Akukho ukuhlinzwa okuhilelekile ekufakweni kwesiguli. Ukunikela ngamaseli e-stem kuyindlela ephephile yabanikeli ngaphansi kwezilungiselelo ezilawulwayo. Akukho lutho olulahleka unomphela emzimbeni isib. njengasekufakweni kwezinso. Amaseli e-stem aphinde avuseleleke ezinsukwini ezimbalwa. Amaseli e-stem afakwa emzimbeni wesiguli njengokufakwa kwegazi okulula.

Kunezinyathelo ezintathu eziyinhloko enqubweni yokufakelwa umnkantsha wamathambo.

Isinyathelo 1: Ukuqoqa amaseli e-bone morrow noma ama-stem (isivuno) kumnikeli.

Isinyathelo sesi-2: Ukubhubhisa ngokuphelele umongo wamathambo okhona ngaleyo ndlela kusize isiguli ukuthi sithole amaseli amasha e-stem.

Isinyathelo 3: Ukufaka umongo wamathambo noma amaseli okuqala ngomzila womthambo, njengokumpontshelwa igazi. Kungase kungabi khona zimpawu zokukhula komngongo omusha amasonto amabili kuya kwamathathu, futhi ngezinye izikhathi kungathatha isikhathi eside ngaphambi kokuba umongo omusha ukhiqize zonke izingxenye zegazi ngokwanele.

Iluphi uhlobo lokufakelwa olungcono kakhulu?

Udokotela wengane yakho ozokweluleka ngohlobo olungcono kakhulu lokufakelwa i-stem cell, kungaba yi-autologous noma i-allogeneic, kanye nomthombo ophelele wamaseli. Lokhu kukhethwa kuthonywa izici ezahlukahlukene, okuhlanganisa:

• uhlobo lokuphazamiseka kwengane yakho
• impilo yengane yakho iyonke

Ingabe ikhona imiphumela emibi yokufakelwa komnkantsha wethambo?

Imiphumela emibi yomnkantsha ingavela. Lokhu kuhlukile kuwo wonke umuntu. Kuhlukahluka kuye ngohlobo lokufakelwa, impilo yengane yakho iyonke, kanye nezinye izinto eziguquguqukayo.

Imiphumela emibi esheshayo ingafaka ukutheleleka, isifo se-graft-versus-host (GVHD) – isimo lapho umongo wethambo otshalwe ngumnikeli usabela khona ezicutshini zomuntu otholayo (uma kwenzeka ukufakelwa i-Allogenic), isicanucanu, ukuhlanza, izilonda emlonyeni, ukukhathala, amazinga aphansi ama-platelet, amazinga aphansi amaseli abomvu egazi (okubangela i-anemia), kanye nesifo sohudo.

Umbiza nini udokotela?

Xhumana nodokotela olaphayo ngokushesha uma ubona izimpawu ezilandelayo enganeni:

• Fever
• Ubuhlungu obuphazamisa ukudla, ukudlala, ukuhamba, noma ukunyakaza
• Ukukhwehlela okuqhubekayo
• Izinkinga zembono
• Izinkinga zokuchama
• Ukuhlambalaza
• Ukukhathala okungavamile
• Izinguquko kuphethini yendle
• Izinguquko ezinkulu emsebenzini noma ekuziphatheni

Ukufakelwa isitho kuzoyithinta kanjani impilo yengane yami? Ingabe ingane yami ingaya esikoleni futhi yenze imisebenzi ejwayelekile?

Isikhathi somntwana wakho sokubuyela esikoleni sincike ohlotsheni lomnkantsha wamathambo ewenziwe ngalo. Ngokuvamile, ingane ingabuyela esikoleni ezinyangeni eziyisi-6 kuya onyakeni ongu-1 ngemva kokufakelwa. Kuyadingeka ukugwema izixuku futhi uzijwayeze ukuzihlukanisa nomphakathi okungenani izinyanga eziyi-6 ukuze uvimbele ukutheleleka. Udokotela wakho uzokwazisa uma sekulungile ukuthi ingane iphinde iqale ukwenza imisebenzi ejwayelekile.

Imibono kaDkt. Vipin Khandelwal , Umeluleki, i-Haemto-oncology kanye noDokotela Wokufakelwa Kwezitshalo Zomnkantsha Wamathambo, Izikhungo Zomdlavuza ze-Apollo eNavi Mumbai