Daawooyinka cusub ayaa ka soo baxaya heer aad u deg-deg ah oo loogu talagalay bukaanada qaba kansarka dhiigga , ama xinjirrada dhiigmarka, sida leukemia , lymfoma, iyo miyeloma badan .
Horumarka daaweynta ee hoos ku xusan waxaa loo arki karaa tallaabooyin yaryar, halkii ay ka sii gudbi lahaayeen wareegyo waaweyn; Si kastaba ha noqotee, daaweyntan ayaa laga yaabaa inay bixiyaan faa'iido nololeed oo si aad ah u macno leh kuwa ay saameeyeen.
Xaaladaha qaarkood, daawooyinka soo socda ayaa laga yaabaa inay xitaa ku hayaan ololka rajada gubanaya - daaweynta daaweynta sida laf-dhabarka laf-dhabarka ayaa ugu dambeyntii la sii wadi karaa- halka horay loo soo sheegay, tani maaha mid ikhtiyaar ah.
Horumarka noolaanshaha waa in la tixgeliyaa iyada oo lala socdo saameynaha iyo sunta; Xaaladahaas, bukaanku caadi ahaan waxay rabaan inay ku noolaadaan labadaba iyo sidoo kale (tayada nolosha), iyo ilaa inta ay awoodaan (badbaado).
Dhakhtarrada dhawaan la ansixiyay
Daroogada | Cudurada la baranayo | Faa'iido iskeelka ah |
Inotuzumab ozogamicin (Besponsa) | Iskuday ama jaban B-cell ALL |
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Lenalidomide (Revlimid) | Meelo cusub oo la baaray |
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Daunorubicin iyo liposome cytarabine ee cirbadeynta (Vyxeos) | AML (t-AML) oo la xidhiidha daaweynta cusub ee la ogaaday AML leh isbeddellada la xiriirta myelodysplasia (AML-MRC) |
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1. Inotuzumab Ozogamicin (Besponsa) ee Lymphocytic Leukemia
Qiyaastii 5,970 kiisaska cusub ee ' lymphocytic leukemia' (ALL) ayaa la filayay inay ka dhacaan Maraykanka sannadka 2017, iyada oo ku dhawaad 1,440 dhimasho isla sannadkaas, sida laga soo xigtay qiyaasaha Cancer Society. Inkasta oo horumarinta tobanaankii sano ee la soo dhaafay lagu daaweeyo kansarrada dhiigga ee kala duwan, saadaalinta bukaankan qaba ALL waa mid liita.
Qalabka unugyada unugyada qanjidhka (allogeneic stem-cell transplantation) (ka-qaadashada laf-dhabarka ee deeq-bixiye) waxay bixisaa ballanqaad, oo suurta gal ah, daaweynta dadka waawayn ee DHAMMAAN. Si kastaba ha noqotee, waxaa jira dhibaatooyin ah in laga adkaado: heerarka hooseeya ee dhameystirida buuxda ee daaweynta kemotherabi ee hadda. Qalitaanka unugyada unugyada qanjirada 'stem cell transplantation' waxay caadi ahaan u baahan tahay in qofku ku guuleysto dhamaystirid cudurku, iyo nasiib darro, taasi oo macnaheedu yahay in dadka qaangaarka ah ee soo noqnoqda ama dib u soo ceshaday B-cell ALL (cudur soo laabtay, inkastoo daaweyn) ay heli karaan isqabad.
Sidaas daraadeed, daroogooyinka daroogada ayaa raadinayay qalab cusub oo lagu beegsanayo unugyada kansarka. Iskudarida unugyada leh calaamade la yiraahdo CD22 waxay noqon karaan hal qalab sida xaaladaha saxda ah. CD22 waa maadi ah oo ay sameeyaan unugyo gaar ah oo jirka ka mid ah oo ay ku xiran yihiin unugyadahaan, waxay u dhowdahay sida tags, dibadda qolka, gudaha gudaha xuubka unugyada. Bukaannada qaba B-cell ALL, unugyada kansarku waxay leeyihiin CD22 molecule tan boqolkiiba 90 kiisaska - waana kuwa aad u fiican ee ganacsiga daaweynta kansarka.
Inotuzumab ozogamicin (Besponsa) waa antibio-anti-monoclonal anti-monoclonal antibiotics oo ku xiran calicheamicin, wakiil oo dila unugyada la beegsaday.
Inotuzumab ozogamicin waxaa loogu yeeraa conjugate sababta oo ah waa unugyo ku xiran, ama isku xiran, wakiil oo dila unugyada. Qaybta difaaca jirka waxay raadisaa unugyada leh CD22 calaamadeeye, qaybta isku-xirnaanta waxay burburisaa unugyada bartilmaameedka.
FDA waxay ogolaatay inotuzumab ozogamicin oo ku salaysan caddayn ka timid tijaabo caafimaad oo cilmi-baarayaashu ay baari jireen amniga iyo waxtarka daroogada marka la barbar dhigo habka kiimikada kale. Baadhitaankan ayaa waxaa ku jiray 326 bukaan oo dib-u-soo-celin ama B-cell ALL-ka ah oo dib-u-soo-kabasho ah oo qaatay hal ama laba daaweyn oo hore.
Marka la eego FDA, oo ah 218 bukaanno la qiimeeyey, boqolkiiba 35.8 oo qaata inotuzumab ozogamicin ayaa soo martay jawaab buuxda, 8,0 bilood; ee bukaannada qaata kiimiko daaweyn kale, kaliya boqolkiiba 17.4 waxay soo mareen jawaab buuxda, mid dhexdhexaad ah 4.9 bilood.
Sidaas darteed, inotuzumab ozogamicin waa doorasho daaweyn oo cusub oo loogu talagalay dib-u-noqoshada ama dib-u-nooleynta B-cell B ALL.
Waxyeellooyinka caamka ah ee ka yimaada isotuzumab ozogamicin waxaa ka mid ah heerarka hoose ee taramadaha (trombocytopenia), heerarka hooseeya ee unugyada dhiigga cad (nutropenia, leukopenia), infekshin, heerarka hoose ee unugyada dhiigga cas (dhiig-yaraan), daal, dhiig-baxa (dhiig baxa), xummad qandho, madax-xanuun, heerar hoose oo unugyada dhiigga cad oo qaba qandho (febrile nutropenia), dhaawaca beerka (transaminases iyo / ama gamma-glutamyltransferase), xanuunka caloosha, iyo heerarka sare ee bilirubin ee dhiigga (hyperbilirubinemia). Wixii macluumaad dheeraad ah ee badbaadada, fiiri dhamaystirka macluumaadka qorista.
2. Lenalidomide (Revlimid) Ka Dib Qalitaanka Qanjirka Meelo badan
Daaweynta dayactirka ee lenalidomide ka dib marka la beddelo xubin cusbada unugyada unugyada dhiig-mareenka ee unugyada dhiig-mareenka.
McCarthy iyo asxaabtiisu waxay falanqeeyay xogta bukaanka laga bilaabo saddex tijaabo oo tijaabo ah oo laga helay Maraykanka, Faransiiska iyo Talyaaniga. Daraasadu waxay ka koobnayd bukaanno badan oo la aqoonsan yahay oo loo yaqaan 'myeloma multiple transplant transplant oo ka dibna 1,208 ka mid ah ayaa lagu daweeyay lenalidomide ka dib, halka 603 bukaan ah ay heleen placebo ama la arkay ama la kormeeray.
Bukaan-jiifka lagu daaweeyo lenalidomide waxay leeyihiin wanaajinta badbaadada, iyadoon la socodsiin cudurkooda, marka la barbardhigo kuwa helay placebo ama kormeer (52.8 bilood iyo 23.5 bilood). Wadar ahaan 490 bukaan ayaa u dhintay. Lacagta badbaadada ugu weyn ayaa lagu arkay kooxda lenalidomide.
Qayb badan oo ka mid ah bukaanada ka tirsan kooxda lenalidomide waxay la kulmeen kaneecada labaad ee dhiigbaxa koowaad iyo buro culus oo ah kaneecada hoose ee labaad; Si kastaba ha ahaatee, heerarka horumarka, dhimashada sababtoo ah dhammaan sababaha, ama dhimashada maaddada myeloma ee dhammaantood waxay ku badan yihiin kooxda xeeldheer / kooxda.
3. Kiimiko-isku-dhafan oo loo yaqaan 'Chemotherapy' oo loogu talagalay cudurka "Leukemia Myeloid Leukemia"
AML waa kansar degdeg ah oo horayba u socda oo ka billowda lafta lafta isla markaana si dhakhso ah u keeno tirada unugyada dhiigga cad ee dhiigga. Qiyaastii 21,380 qof ayaa lagu ogaan doonaa AML sannadkan, qiyaastii 10,590 bukaan oo qaba AML ayaa u dhiman doona cudurka.
Vyxeos waa mid isku-dhafan ee daawooyinka kemotherabi ee daunorubicin iyo cytarabine kuwaas oo caawin kara bukaannada qaarkood in ay ka dheeraadaan haddii ay tahay inay si gooni ah u helaan labada daaweyn. FDA waxay ogolaatay Vyxeos si loogu daaweeyo dadka qaangaarka ah ee leh laba nooc oo ah 'myeloid leukemia bacterial leukemia' (AML):
- AML (t-AML) oo daaweyn ah oo cusub oo la aqoonsan yahay, iyo
- AML leh isbeddellada la xiriirta myelodysplasia (AML-MRC).
T-AML waxay u dhacdaa sida dhibaatada kiimikada ama shucaaca qiyaastii 8 ilaa 10 boqolkiiba dhammaan bukaanada loo daweeyo kansarka. Celcelis ahaan, waxay dhacdaa shan sano gudahood daaweynta ka dib. AML-MRC waa nooca AML oo la xidhiidha taariikhda cudurada qaarkood ee dhiigga iyo isbeddellada muhiimka ah ee unugyada leukemia. Labada bukaan ee leh t-AML iyo kuwa leh AML-MRC waxay leeyihiin nolol aad u yar.
309 bukaan oo qaba cudurka cusub ee AM-AML ama AML-MRC oo loo aqoonsaday inay yihiin kuwa loo yaqaan Vyxeos ama daaweynta si gooni ah loo daweeyo ee daunorubicin iyo cytarabine, bukaanada helay Vyxeos waxay ku noolyihiin bukaanno badan oo daaweyn kala duwan oo ah daawada daunorubicin iyo klamabiin guud ahaan badbaadada 9.56 bilood iyo 5.95 bilood).
Dhibaatooyinka caadiga ah waxaa ka mid ah dhacdooyinka dhiiga (dhiigbaxa), qandho ay ku jirto tirada unugyada dhiiga unugyada dhiigga (febrile nutropenia), finan, barar ah unugyada (bararka), lallabbo, caabuqa xuubka xuubka (mucositis), iyo waxyeelo kale oo ay ka mid yihiin dhibaatooyinka caloosha , cudurada halista ah iyo garaaca wadnaha oo aan caadiga ahayn (arrhytmia).
> Ilo:
> Faahfaahinta Warbaahinta ee FDA. FDA waxay ansixisay daaweyn cusub oo loogu talagalay dadka qaangaarka ah ee laf-dhabarka ku soo noqda ama dib-u-ceshad lymphoblastic. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm572131.htm.
> Faahfaahinta Warbaahinta ee FDA. FDA waxay ogolaataa daaweynta ugu horeysa ee noocyada qaar ka mid ah kuwa saboolka ah ee aan caadiga ahayn ee laf-dhabarka. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm569883.htm.
> FDA waxay ogolaatay isticmaalka cusub ee Lenalidomide ee Meelo badan. https://www.cancer.gov/news-events/cancer-currents-blog/2017/fda-lenalidomide-myeloma-maintenance.