Ukuqhubela phambili kuNyango lokuQala kwi-B-ALL yabantu abadala: Uphononongo olupheleleyo oluvela kwi-Lancet Haematology
Kuphononongo oluphambili olupapashwe kwi I-Lancet Haematology, iingcali zichaze inkqubela phambili yakutshanje kunyango lokuqala lwe-B-cell Acute Lymphoblastic Leukemia (B-ALL) yabantu abadala, zigxininisa ukubaluleka kweendlela zonyango ezenzelwe umntu ngamnye kunye nokuhlanganiswa kweendlela ezintsha zokuzikhusela komzimba. Kwiminyaka elishumi edlulileyo, unyango lwe-B-ALL yabantu abadala olusandula ukuxilongwa luye lwenza inkqubela ebalulekileyo ngenxa yokuqonda okunzulu ibhayoloji yesifo, uphuhliso lweendlela zokulinganisa izifo ezincinci ezisele (MRD), kunye nokubandakanywa kweendlela eziphefumlelwe ngabantwana (PIR) ukuze kubekho iziphumo ezingcono.
Olu phononongo lugxininisa ukuba nangona izigulane ze-B-ALL zabantu abadala ziqhubeka nokujongana nemingeni yokungaphumeleli kunyango kunye namazinga aphezulu okufa xa kuthelekiswa nabantwana, amaqhinga aliqela aphambili aphucula ukuqikelela kwangaphambili. Kwizigulane ezincinci, ukusetyenziswa kweendlela eziphefumlelwe ngabantwana kuye kwabonakala kusebenza ngakumbi kunezonyango zesintu zabantu abadala, kunye namazinga okusinda ixesha elide afikelela kwi-78%. Nangona inzuzo yale ndlela yonyango iyancipha ngokukhula, le ndlela isabonelela ngophuculo olubalulekileyo, ngakumbi xa idityaniswe nezonyango zanamhlanje ezijoliswe kuzo ezifana ne-tyrosine kinase inhibitors (TKI) yePhiladelphia chromosome-positive (Ph+) B-ALL.
Ukongeza, ukufakwa kwe-immunotherapys ezifana ne-anti-CD20 monoclonal antibodies (umz., i-Belantamab Mafodotin kunye ne-Inotuzumab Ozogamicin) kwiiprotokholi zonyango lomgca wokuqala kubonise ithemba ekunciphiseni ubuthi obunxulumene ne-chemotherapy kunye nokuphucula amazinga okuphendula. Izifundo zibonise ukuba ezi arhente, xa zisetyenziswa kunye ne-chemotherapy eqhelekileyo, zinyusa kakhulu amazinga okukhululwa, ngakumbi kwiintlobo ze-B-ALL ezinomngcipheko ophezulu.
Kwizigulane ezindala (ezingaphezulu kweminyaka engama-60), kuye kwavela ixesha elitsha lonyango ngokusetyenziswa kweendlela ezisebenzisa amandla aphantsi kunye ne-immunotherapy. Ezi ndlela zijolise ekunciphiseni umthwalo we-chemotherapy, zibonelela ngokhetho olukhuselekileyo nolunokunyamezeleka ngakumbi kweli qela lisengozini. Izifundo zeklinikhi zihlola ngenkuthalo ukuhlanganiswa okufanelekileyo kwezi ndlela zonyango, kubandakanya ukusetyenziswa kwezonyango zeeseli ze-CAR-T kunye neearhente ezijoliswe kuzo, ukuphucula iziphumo ngakumbi.
Olu phononongo lugqiba kwelokuba nangona kwenziwe inkqubela phambili enkulu ekuphuculeni unyango lokuqala kubantu abadala i-B-ALL, uphando oluqhubekayo kunye novavanyo lweklinikhi lubalulekile ekusombululeni izikhewu kunyango, ngakumbi kwizigulane ezisengozini enkulu kunye nabantu abadala. Izicwangciso zonyango ezenzelwe wena ezisekelwe kwiprofayili yezakhi zofuzo kunye neyemolekyuli, kunye nophuhliso oluqhubekayo lwe-immunotherapy, zinika ithemba leziphumo ezingcono ngakumbi kwixesha elizayo.
Olu hlalutyo olupheleleyo lonyango lwe-B-ALL luphawula ixesha elibalulekileyo kumlo oqhubekayo nxamnye nalo mhlaza we-hematologic unzima, uzisa ithemba elitsha kwizigulana kwihlabathi liphela.