Ngā Whakatairanga i roto i te Maimoatanga Tuatahi mō te Pakeke B-ALL: He Arotake Whānui mai i The Lancet Haematology
I roto i tētahi arotake whakahirahira i whakaputaina i roto i Te Rongoā Matepukupuku Lancet, kua whakamāramahia e ngā tohunga ngā whanaketanga hou o te maimoatanga tuatahi o te mate B-cell Acute Lymphoblastic Leukemia (B-ALL) pakeke, me te whakanui i te hiranga o ngā rautaki maimoatanga whaiaro me te whakaurunga o ngā rongoā ārai mate hou. I roto i te tekau tau kua pahure ake nei, kua nui ngā ahunga whakamua o te maimoatanga o te B-ALL pakeke kua kitea houtia nā te māramatanga hohonu ake ki te koiora o te mate, te whanaketanga o ngā tikanga ine i te mate toenga iti (MRD), me te whakaurunga o ngā tikanga rongoā tamariki (PIR) mō ngā putanga pai ake.
E whakaatu ana te arotake ahakoa kei te raru tonu ngā tūroro pakeke B-ALL i te kore angitu o te maimoatanga me te nui ake o ngā reiti mate i ngā tamariki, he maha ngā rautaki matua kei te whakapai ake i te matapae. Mō ngā tūroro taitamariki, kua kitea he whai hua ake te whakamahinga o ngā tikanga i ahu mai i ngā tamariki i ngā maimoatanga pakeke tuku iho, me te ekenga o ngā reiti oranga roa ki te 78%. Ahakoa ka heke te painga o ēnei maimoatanga i te pakeketanga, he nui tonu ngā whakapainga e tukuna ana e te huarahi, inā koa ka honoa ki ngā maimoatanga whai take hou pēnei i te tyrosine kinase inhibitors (TKI) mō te Philadelphia chromosome-positive (Ph+) B-ALL.
Hei tāpiritanga, ko te whakaurunga o ngā rongoā ārai mate pērā i ngā paturopi monoclonal anti-CD20 (hei tauira, Belantamab Mafodotin me Inotuzumab Ozogamicin) ki roto i ngā tikanga maimoatanga tuatahi kua whakaatu i te tumanako ki te whakaiti i te paitini e pā ana ki te chemotherapy me te whakarei ake i ngā reiti urupare. Kua whakaatuhia e ngā rangahau ko ēnei kaihoko, ina whakamahia tahi me te chemotherapy tikanga, ka whakanui ake i ngā reiti murunga, inā koa i roto i ngā momo ira morearea nui o te B-ALL.
Mō ngā tūroro kaumātua (>60 tau te pakeke), kua puta ake he wā hou mō te maimoatanga me te whakamahi i ngā tikanga iti ake te kaha me ngā rongoā ārai mate. Ko te whāinga o ēnei huarahi he whakaiti i te taumahatanga o te chemotherapy, me te tuku i tētahi kōwhiringa haumaru ake, e ngāwari ake ana hoki mō tēnei rōpū ngoikore. Kei te kaha te tūhura a ngā rangahau haumanu i te whakaurunga pai rawa atu o ēnei rongoā, tae atu ki te whakamahi i ngā rongoā pūtau CAR-T me ngā kaihoko kua tohua, hei whakapai ake i ngā putanga.
E ai ki te arotake, ahakoa kua nui ngā ahunga whakamua kua tutuki i roto i te arotau i ngā maimoatanga raina tuatahi mō te B-ALL pakeke, he mea nui ngā rangahau me ngā whakamātautau haumanu tonu hei whakatika i ngā āputa i roto i te maimoatanga, inā koa mō ngā tūroro mōrearea nui me ngā kaumātua. Ko ngā mahere maimoatanga whaiaro e ahu mai ana i te whakatauira ira me te irahiko, me te whanaketanga tonu o ngā rongoā ārai mate, e tuku ana i te tumanako mō ngā putanga pai ake i te heke mai.
Ko tēnei tātaritanga whānui o te maimoatanga B-ALL he tohu i tētahi wā tino nui i roto i te pakanga tonu ki tēnei mate pukupuku toto uaua, e kawe mai ana i te tumanako hou mō ngā tūroro puta noa i te ao.