Izinselele Ekwelapheni Ukutheleleka Kwesifo Sesikhunta Esihlaselayo Ezigulini Ezinomdlavuza Wegazi: Ukuqonda okuvela ku-ASH 2024
Emhlanganweni Waminyaka Yonke Wama-66 we-American Society of Hematology (ASH) ngo-2024, uSolwazi Sun Yuqian wasePeking University People's Hospital wethule ucwaningo olubalulekile ngesifo sefungal esihlaselayo (bIFD) ezigulini ezifakelwa i-allogeneic hematopoietic stem cell transplantation (allo-HSCT) eShayina. Ucwaningo, olwenziwe ezibhedlela ezingu-12, lushicilelwe kumagazini osemthethweni we- Izifo Ezithelelanayo Inhlangano yaseMelika,Izifo Ezithelelanayo Zomtholampilo (I-CID).
Ucwaningo, olwaziwa ngokuthi ucwaningo lwe-CAESAR 2.0, lugxile kubantu abadala abangu-2,015 abathola i-HSCT kusukela ngoJanuwari kuya kuDisemba 2021. Luveze ukuthi u-76.08% weziguli uthole ukwelashwa kwe-antifungal, ikakhulukazi i-voriconazole (44.37%) kanye ne-posaconazole (31.71%). Naphezu kokusetshenziswa kabanzi kwale mithi ye-antifungal, ucwaningo luthole ukuthi ukwanda kwaminyaka yonke kwesifo se-invasive fungal disease (IFD) kungu-6.3%, kanti izinga lokufa eliphakeme lingu-48.28%. I-Candida, i-Aspergillus, nezinye isikhunta zikhonjwe njengezifo eziyinhloko ezibangela ukutheleleka.
USolwazi Sun uphinde wabhekana nezinselele zezokwelapha ezihambisana nokuxilonga nokwelapha i-bIFD ezigulini ezine-hematologic money. Ukuphumelela kwe-IFD kwenzeka ngesikhathi sokuvimbela i-antifungal, okwenza kube nzima ukuxilongwa kanye nokwelashwa. Ngenxa yokungabikho kwencazelo ejwayelekile, amazinga okusabalala kwe-bIFD ahluka kakhulu, kusukela ku-1% kuya ku-42%. Lokhu kungafani kwenza kube nzima ukusungula izindlela zokuxilonga ezihambisanayo kanye nezinqubo zokwelapha.
Enye yezinselelo ezinkulu eziqokonyiswe nguSolwazi Sun ubunzima bezinto eziyingozi ze-bIFD, okuhlanganisa i-neutropenia ende, ukusetshenziswa kwama-steroid, kanye nokusetshenziswa isikhathi eside kwama-antibiotic amaningi. Ngaphezu kwalokho, imithi yokukhunta esetshenziselwa ukuvimbela ingase ingambozi njalo ububanzi obuphelele bamagciwane angaba khona, futhi izinhlobo zesikhunta ezisafufusa zingase zigweme ukutholakala ngenxa yokuzwela okuncishisiwe ekuhlolweni kokuxilonga njengokuhlolwa kwe-PCR kanye ne-GM.
USolwazi Sun ugcizelele ukubaluleka kokwelashwa kwe-antifungal kusenesikhathi, ikakhulukazi ezigulini ezisengozini enkulu ezibonisa izimpawu zokutheleleka. Uncome ukuthi ukwelashwa kwe-antifungal okusekelwe ebufakazini kufanele kuqalwe ngokushesha ezigulini ezigula kakhulu ezisolwa nge-bIFD, ngisho nangaphambi kokuba kutholakale imiphumela yelabhorethri. Uphinde weluleka ukusetshenziswa kwemithi ye-antifungal ehlukile ohlelweni lokuvimbela ukuze kwandiswe ukusebenza kahle kokwelashwa.
Okutholakele kocwaningo lwe-CAESAR 2.0 kugcizelela isidingo samasu athuthukisiwe okuphatha ingozi ye-IFD ezigulini ezine-HSCT kanye nesidingo esiphuthumayo sokuxilongwa nokungenelela kusenesikhathi. Njengoba uSolwazi Sun ephetha, ngenkathi ama-antifungal agents akhona eqhubeka nokudlala indima ebalulekile, ukuthuthukiswa kwezindlela zokwelapha ezintsha namathuluzi okuxilonga kubalulekile ekuthuthukiseni imiphumela yeziguli. Ukwelashwa okusha, njenge Ukwelashwa nge-immunotherapy kanye nemithi emisha yokulwa namagciwane, kungase kunikeze ithemba elisha ezigulini ezilwa nalezi zifo ezisongela ukuphila.
Lolu cwaningo oluqavile nge-bIFD luqokomisa izinselele eziqhubekayo odokotela ababhekene nazo ekuphatheni ukutheleleka kwesikhunta ezigulini ezine-hematologic money futhi lukhomba isidingo esibalulekile sokuthuthuka okuqhubekayo kokubili emasu okuvimbela kanye nokwelapha.