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Idecabtagene vicleucel mushonga wekenza unotyisa unoshandisa maseru ako ekudzivirira chirwere kurwisa multiple myeloma. Mushonga uyu mutsva, unozivikanwawo se ide-cel kana nezita rayo rekuti Abecma, inomiririra kufambira mberi kukuru mukuchengetwa kwekenza kwemunhu.
Funga nezvazvo sekupa immune system yako simba guru. T-cells yako (masoja e immune system yako) anounganidzwa, achichinjwa majini murabhoritari kuti azive zviri nani uye kurwisa maseru ekenza, obva aendeswa zvakare mumuviri wako kuti arwise chirwere chiri mukati.
Idecabtagene vicleucel imhando yeCAR-T cell therapy yakagadzirirwa multiple myeloma. CAR-T inomirira
Multiple myeloma i kenza rinobata maseru eplasma mumwengo wako wemapfupa. Aya ndiwo maseru ane basa rekugadzira maantibodies ekurwisa zvirwere. Kana akava nekenza, anowanda zvisingadzoreki uye anobvisa maseru eropa ane hutano.
Chiremba wako angakurudzira kurapwa uku kana wakatotora misanganiswa yakati wandei yekurapa multiple myeloma yakajairika. Izvi zvinowanzo sanganisira zvinodhaka zvakaita se lenalidomide, pomalidomide, bortezomib, carfilzomib, daratumumab, kana kutamiswa kwemasero emuti, uye kenza yako yakadzoka kana kuti haina kupindura zvakakwana.
Idecabtagene vicleucel inoshanda nekushandura immune system yako kuita simba rinoshanda rekutarisana nekenza. Kurapa uku kunoonekwa sekwakasimba kwazvo munyika yekurapa kenza, ichimiririra imwe yenzira dzakanyanya kufambira mberi dzatinadzo.
Maitiro acho anotanga kana maT-cells ako aunganidzwa uye akagadzirwa genetically kuti agadzire ma receptors akakosha anogona kuziva protein inonzi BCMA. Mazhinji maseru e multiple myeloma ane BCMA yakawanda pamusoro pawo, zvichiita kuti ave akakodzera zvakakwana kune aya maseru ekudzivirira akachinjwa.
Kana yangodzoswa mumuviri wako, aya maT-cells akawedzerwa anowanda uye anova mauto evarwi vekenza. Vanofamba mumuviri wako nemumwengo wemapfupa, vachitsvaga nekuparadza maseru e myeloma. Runako rweiyi nzira nderekuti inoshandisa nzira yako yekudzivirira yechisikigo, ingori ine kugona kuri nani kwekutarisisa.
Chinoita kuti kurapwa uku kuve kwakasimba ndiko kugona kwayo kupa dziviriro inogara kwenguva refu. Mamwe emaT-cells akachinjwa aya anogona kuramba ari mumuviri wako kwemwedzi kana kunyange makore, achienderera mberi nekutarisa chero maseru ekenza ari kudzoka.
Idecabtagene vicleucel haisi chinhu chaunotora kumba semupiritsi kana jekiseni. Iyi inzira yakaoma, ine matanho akawanda inoda kurongeka kwakanyatsoitwa pakati pako nechikwata chako chekurapa panzvimbo yakakosha yekenza.
Rwendo rwacho runotanga ne leukapheresis, nzira iyo maT-cell ako anounganidzwa kuburikidza nemaitiro akafanana nekupa maplatelet. Iwe uchabatana nemuchina unoparadzanisa maT-cell ako kubva muropa rako, uchidzosa zvimwe zvezvikamu zveropa rako kwauri. Izvi zvinowanzo tora maawa 3-6 uye zvinowanzotsungirirwa zvakanaka.
Nepo maseru ako achigadzirwa murabhoritari (iyo inotora anenge masvondo mana), iwe uchagamuchira zvinonzi lymphodepleting chemotherapy. Izvi zvinowanzo sanganisira kugamuchira fludarabine uye cyclophosphamide kuburikidza neIV kwemazuva matatu. Nhanho iyi inobatsira kuchenesa nzvimbo mumuviri wako wekudzivirira chirwere kuti maseru matsva eCAR-T ashande nemazvo.
Pazuva rekuisa, iwe uchagamuchira maseru ako eCAR-T akagadzirirwa iwe kuburikidza neIV, zvakafanana nekugamuchira kuwedzerwa kweropa. Kuisa chaiko kunokurumidza zvinoshamisa, kazhinji kunotora isingasviki awa. Zvisinei, iwe uchada kugara pedyo nenzvimbo yekurapa kwemavhiki mana mushure meizvozvo kuti uongororwe zvakanyanya.
Idecabtagene vicleucel inowanzo kupiwa seimwe chete kurapwa, kwete kurapwa kuri kuenderera mberi senge chemotherapy yechinyakare. Kana maT-cell ako akachinjwa aiswa, akagadzirirwa kuramba achishanda mumuviri wako kwenguva yakareba.
Nzira yekurapa yekutanga inotora anenge mavhiki 6-8 kubva pakutanga kusvika kumagumo. Izvi zvinosanganisira nguva yekuunganidza maseru, kugadzira, chemotherapy yekugadzirira, uye kuisa pachayo. Zvisinei, mhedzisiro yekurapa inogona kugara kwenguva refu.
Masero ako eT-cells akachinjwa anogona kuramba achishanda mumuviri wako kwemwedzi kana kunyange makore mushure mekuiswa. Vamwe varwere vanoramba vachibatsirwa kubva kurapwa kumwe chete uku kwenguva yakareba, kunyangwe mhinduro dzemunhu dzichisiyana zvakanyanya. Chikwata chako chekurapa chichakutarisa zvakanyanya nemiedzo yeropa yenguva dzose uye zvidzidzo zvekuongorora kuti uone kuti kurapwa kuri kushanda sei.
Kana kurapwa kukamira kushanda zvakanaka nekufamba kwenguva, chiremba wako angangokurukura dzimwe sarudzo, asi kudzokorora CAR-T cell therapy kazhinji hakusi tsika yakajairika nemaitiro aripo.
Kufanana nemamwe marapirwo ekenza ane simba, idecabtagene vicleucel inogona kukonzera mhedzisiro, dzimwe dzacho dzinogona kuva dzakakomba. Zvisinei, chikwata chako chekurapa chine ruzivo rwakanyanya mukugadzirisa mhedzisiro iyi uye chichakutarisa zvakanyanya mukati mekurapwa kwako.
Kunzwisisa zvekutarisira kunogona kukubatsira kuti unzwe wakagadzirira uye usina hanya nezve maitiro acho. Ngatifambe nemhedzisiro inogona kuitika, tichitanga neiyo yakajairika uye tobva takurukura zvisingawanzoitiki asi zvinogona kuitika zvakanyanya.
Mhedzisiro Yakajairika
Vazhinji varwere vanowana imwe dhigirii yekuneta uye kusimba mumavhiki mushure mekurapwa. Unogonawo kuona zviratidzo zvakafanana nechirwere chakaita sefuruwenza, kusanganisira fivha, kutonhora, uye kurwadziwa kwemuviri. Izvi zvinowanika nekuti immune system yako iri kushanda nesimba kurwisa kenza.
Zviratidzo izvi zvinowanzoitika nekutarisirwa kunotsigira uye zvinowanzoita nani sezvo muviri wako uchigadzirisa kurapwa. Chikwata chako chekurapa chichapa mishonga uye nzira dzekukubatsira kuti unzwe wakasununguka.
Mhedzisiro Yakakomba
Kune mhedzisiro miviri inogona kukonzera matambudziko inoda kutariswa kwechimbichimbi kwechiremba: cytokine release syndrome (CRS) uye neurologic toxicities. Kunyangwe izvi zvichityisa, chikwata chako chekurapa chakagadzirira kuzviziva nekuzvibata nekukurumidza.
Cytokine release syndrome inoitika kana maT-cells ako akabatidzwa achiburitsa huwandu hukuru hwezvinhu zvinopisa zvinonzi cytokines. Funga nezvazvo sekuti immune system yako iri kufara zvakanyanya nezvekurwisa kenza. Zviratidzo zvinogona kusanganisira fivha yakanyanya, kudzikira kweropa, kuoma kufema, uye kunzwa kusagadzikana zvakanyanya.
Mhedzisiro yeNeurologic inogona kusanganisira kuvhiringidzika, kuoma kutaura, kutetereka, kana kubatwa. Izvi zvinoitika nekuti maseru eimmune akabatidzwa dzimwe nguva anogona kukanganisa tsinga. Zvizhinji zvezviratidzo zve neurological zvenguva pfupi uye zvinogadziriswa nekubata kwakakodzera.
Mhedzisiro isingawanzoitiki asi yakakosha
Vamwe varwere vanogona kukudziridza kuverenga ropa kwakaderera kwenguva yakareba, izvo zvinogona kuwedzera njodzi yekutapukirwa, kubuda ropa, kana anemia. Muzviitiko zvisingawanzoitiki, varwere vanogona kukudziridza kenza yechipiri makore mushure mekurapa, kunyangwe njodzi iyi ichiita seyediki.
Kune zvakare mukana mudiki wekukudziridza zvinonzi tumor lysis syndrome, uko maseru ekenza anoputsika nekukurumidza zvekuti anoburitsa zvirimo muropa nekukurumidza kupfuura itsvo dzako dzinogona kuzvigadzirisa. Ichi chokwadi chiratidzo chekuti kurapwa kuri kushanda, asi kunoda kunyatso tarisa uye kurapwa.
Chikwata chako chekurapa chichakurukura zvese zvinogoneka izvi newe zvakadzama uye chichave nechokwadi chekuti unonzwisisa zviratidzo zvekuyambira zvekuona. Rangarira, mhedzisiro yakakomba inogoneka kana yabata nekukurumidza, ndosaka kunyatso tarisa kwakakosha.
Havana munhu wese ane multiple myeloma anokodzera idecabtagene vicleucel. Chikwata chako chekurapa chichanyatsoongorora hutano hwako hwese nenhoroondo yako yekurapa kuti uone kana kurapwa uku kwakakukodzera.
Kurapa uku hakukurudzirwi kana uine zvirwere zvakawanda zviri kushanda, kunyanya zvirwere zvakakomba zvevhairasi zvakaita seHIV, hepatitis B, kana hepatitis C zvisina kutarisirwa zvakanaka. Muromo wako wekudzivirira muviri unofanirwa kuve wakasimba zvakakwana kuti ugone kubata maitiro ekurapa, uye zvirwere zvinoshanda zvinogona kuomesa kupora.
Vanhu vane mamwe mamiriro emoyo, zvirwere zvemapapu, kana matambudziko eitsvo vangave vasiri vakakodzera, sezvo nhengo idzi dzinofanirwa kushanda zvakanaka kuti dzibate kushushikana kwekurapa. Chiremba wako achaita bvunzo dzakazara, kusanganisira bvunzo dzemabasa emoyo uye zvidzidzo zvebasa remapapu, kuti ave nechokwadi chekuti une hutano hwakakwana hwekuti uite maitiro acho.
Kana uine nhoroondo yezvirwere zvakakomba zveautoimmune, kurapwa uku hakungakukodzera. Sezvo CAR-T therapy ichiwedzera muviri wako wekudzivirira muviri, zvinogona kuwedzera mamiriro eautoimmune uko muviri wako wekudzivirira muviri wakatowedzera.
Vakadzi vane pamuviri kana vanoyamwisa havafanirwe kugamuchira kurapwa uku, sezvo mhedzisiro pavacheche vari kukura isingazivikanwe. Uye zvakare, varume nevakadzi vanofanirwa kushandisa nzira yekudzivirira kubata pamuviri panguva yekurapa uye kwenguva yakati gare gare.
Idecabtagene vicleucel inotengeswa pasi pezita rebrand Abecma. Zita rebrand iri ndiro raunozoona pamapepa echipatara uye magwaro einishuwarenzi, kunyangwe chikwata chako chekurapa chingareva nezvazvo nemazita akati wandei.
Unogonawo kunzwa ichinzi "ide-cel" mumakakatanwa ekurapa, iyo iri shanduro pfupi yezita re generic. Vamwe vanachiremba nevakashandi vekuchengetwa kwevanhu vanogona kungoreva nezvazvo se "CAR-T therapy" pavanenge vachikurukura sarudzo dzako dzekurapa, kunyangwe iyi iri chikamu chakakura chinosanganisira mamwe marapirwo akafanana.
Abecma inogadzirwa neBristol Myers Squibb vachishanda pamwe chete nebluebird bio. Zvakakosha kuziva kuti iyi ndiyo kurapwa kwakanyanya kuita uye kunowanikwa chete pazvipatara zvakaziviswa zvine hunyanzvi hweCAR-T cell therapy.
Kana idecabtagene vicleucel isingakukodzere, kana uri kutsvaga zvese zvaungaita, pane dzimwe nzira dzekurapa multiple myeloma yakadzoka. Chiremba wako achakubatsira kunzwisisa kuti ndeipi ingave yakakodzera mamiriro ako chaiwo.
Ciltacabtagene autoleucel (Carvykti) imwezve CAR-T cell therapy inotarisa iyo BCMA protein imwechete asi inoshandisa nzira yakasiyana zvishoma. Inobvumidzwawo kune varwere vane multiple myeloma vakaedza kurapwa kwakawanda kare, uye dzimwe ongororo dzinoratidza kuti inogona kushanda kunyangwe muvarwere vakambogamuchira mamwe maCAR-T therapies.
Bispecific T-cell engagers inomiririra imwe nzira itsva. Izvi zvinosanganisira mishonga yakaita se teclistamab (Tecvayli) uye elranatamab (Elrexfio), iyo inobatsira kubatanidza maT-cells ako zvakananga kumasero ekenza pasina kukumbira genetic modification. Kurapwa uku kunopiwa semajekiseni uye kunogona kupihwa munzvimbo dzekunze.
Traditional combination therapies dzinoramba dziri nzira dzakakosha zvakare. Izvi zvinogona kusanganisira mhando itsva dzemishonga yeimmunomodulatory, proteasome inhibitors, uye monoclonal antibodies dzaisave chikamu chekurapwa kwako kwekare.
Kune vamwe varwere, stem cell transplant yechipiri inogona kufungwa, kunyanya kana wakaita mhinduro yakanaka kune transplant yako yekutanga uye zvave makore akati wandei kubva pakurapwa ikoko. Clinical trials dzichiongorora nzira itsva zvachose dziripo nguva dzose uye dzinogona kupa mukana wekurapwa kwemazuva ano.
Zvese zviri zviviri idecabtagene vicleucel (Abecma) uye ciltacabtagene autoleucel (Carvykti) ndizvo zvakanaka CAR-T cell therapies ye multiple myeloma, asi vane misiyano inogona kuita kuti imwe yakakodzera mamiriro ako kupfuura imwe.
Ciltacabtagene autoleucel inoshandisa dhizaini yakasiyana yeCAR inotarisa zvikamu zviviri zveBCMA protein panzvimbo peimwe, zvichigona kuita kuti ive inoshanda pakuziva nekurwisa maseru ekenza. Dzimwe nzira dzekuedza dzinoratidza kuti inogona kuburitsa mhinduro dzakadzama uye dzinogara kwenguva refu mune vamwe varwere.
Zvisinei, idecabtagene vicleucel yanga iripo kwenguva refu uye ine ruzivo rwakawanda rwechokwadi shure kwayo. Izvi zvinoreva kuti vanachiremba vane ruzivo rwakawanda nezve mhedzisiro yenguva refu uye vane ruzivo rwakawanda mukugadzirisa matambudziko ayo. Maitiro ekugadzira ide-cel akagadzirwa zvakanaka, izvo dzimwe nguva zvinogona kureva nguva pfupi yekumirira.
Mhedzisiro yematambudziko yakafanana pakati pekurapa uku, kunyangwe dzimwe nzira dzekudzidza dzichiratidza misiyano midiki mumitengo yezvimwe zvinetso. Chikwata chako chekurapa chichafunga nezvezvinhu zvakaita sekurapa kwako kwapfuura, mamiriro ako ehutano azvino, uye nekukurumidza kwaunoda kutanga kurapa paunenge uchikubatsira kusarudza pakati pavo.
Pane kuti imwe ive yakanaka zvachose, sarudzo inowanzouya pasi kune zvinhu zvakaita sekuti inowanikwa pakati pako pekurapa, nguva dzekugadzira, uye ruzivo rwechiremba wako nekurapa kwega kwega. Zvese zvinomiririra kufambira mberi kukuru mukurapa multiple myeloma.
Vanhu vane chirwere chemoyo dzimwe nguva vanogona kugamuchira idecabtagene vicleucel, asi zvinoda kuongororwa nekuchenjerera kwakanyanya uye kuongororwa. Kurapa kunogona kuisa kumwe kushushikana pamoyo wako, kunyanya panguva iyo matambudziko akadai se cytokine release syndrome angaitika.
Chiremba wako wemoyo uye oncologist vachashanda pamwechete kuti vaongorore kushanda kwemoyo wako usati wapiwa mushonga. Izvi zvinowanzo sangana neechocardiogram kana MUGA scan kuyera kuti moyo wako unokwanisa sei kupomba ropa. Kana kushanda kwemoyo wako kwakakanganiswa zvakanyanya, timu yako yezvokurapa inogona kukurudzira kuvandudza hutano hwemoyo wako kutanga kana kufunga nezve mamwe marapirwo.
Panguva yekurapa, uchagamuchira imwe monitoring yematambudziko ane chekuita nemoyo. Mashoko akanaka ndewekuti mativi mazhinji ane chekuita nemoyo kubva kuCAR-T therapy ndeechinguvana uye anogoneka kana akabatwa nekukurumidza. Timu yako yezvokurapa ine ruzivo rwakawanda rwekutarisira varwere vane mamiriro akasiyana emoyo vanogamuchira kurapwa uku.
Mamiriro ezvinhu aya haangaitiki zvachose nekuti idecabtagene vicleucel inongopiwa muzvipatara zvakakosha nevashandi vakadzidziswa. Mushonga unoverengwa zvakanyatsoenderana nehuremu hwemuviri wako uye huwandu hwemaCAR-T masero akagadzirwa zvakananga iwe.
Kusiyana nemishonga yaungatora kumba, kurapwa uku kunopiwa kuburikidza nekuisa ropa kunotungamirirwa zvakanyatso. Kune akawanda ekuchengetedza aripo kuti uve nechokwadi chekuti unogamuchira huwandu chaihwo. Timu yako yezvokurapa inosimbisa kuzivikanwa kwako uye mushonga chaiwo kakawanda usati wapiwa uye panguva yekuiswa.
Kana iwe uine chero hanya nezvekurapwa kwako kana uine zviratidzo zvisingatarisirwi mushure mekuwana CAR-T therapy, taura nechikwata chako chekurapa nekukurumidza. Vanowanikwa 24/7 kuti vatarise chero mibvunzo kana zvinokunetsa zvaungave nazvo panguva yekurapwa kwako nekupora.
Idecabtagene vicleucel inowanzo piwa seimwe chete infusion, saka kukanganwa mushonga mupfungwa dzechinyakare hakushande. Zvisinei, kune zvikamu zvekurapa apo nguva yakakosha, zvakadai sepreparatory chemotherapy kana zuva rakarongeka rekuiswa.
Kana usingakwanisi kugamuchira chemotherapy yako yekugadzirira sezvakatarwa, chikwata chako chekurapa chichashanda newe kuti chichirongedzerezve zvakakodzera. Nguva iri pakati pechemotherapy yekugadzirira uye kupinza kweCAR-T cell yakarongwa zvakanyatsonaka kuti iwedzere kushanda kwemushonga.
Kana uchida kunonotsa kupinza kwako kweCAR-T cell nechikonzero chipi nechipi, izvi zvinogoneka. Masero ako akagadziridzwa anogona kuchengetwa zvakachengeteka kwenguva yakati uchigadzirisa chero nyaya dzehutano kana dzimwe nyaya dzinogona kunge dzamuka. Chikwata chako chekurapa chichabatana nenguva itsva kuti chive nechokwadi chekuwana mhedzisiro yakanaka.
Sezvo idecabtagene vicleucel ichipiwa semushonga mumwe chete panzvimbo yeimwe kurapa kuri kuenderera mberi, hapana nzvimbo yekusarudza kwaunoti "kumira kutora" mupfungwa yechinyakare. MaT-cells akagadziridzwa anoenderera mberi achishanda mumuviri wako kwemwedzi kana makore mushure mekuiswa.
Zvisinei, chikwata chako chekurapa chichakutarisa zvakanyanya nemiedzo yeropa yenguva dzose, zvidzidzo zvekuongorora, uye kuongorora kwemuviri kuti uone kuti mushonga uri kushanda sei. Kana mushonga ukamira kushanda nekufamba kwenguva, uchakurukura dzimwe sarudzo dzekurapa nachiremba wako.
MaCAR-T cells mumuviri wako achaderera zvakasikwa nekufamba kwenguva, kunyangwe mamwe angaramba achishanda kwemakore. Sisitimu yako yekudzivirira muviri ichadzokera zvishoma nezvishoma kune imwe nzvimbo yakajairika, kunyangwe iwe uchagara uine mamwe maT-cells akagadziridzwa anogona kupa dziviriro inoramba ichienderera mberi kubva pakudzoka kwekenza.
Parizvino, idecabtagene vicleucel inowanzo piwa semushonga mumwe chete, uye kudzokorora CAR-T cell therapy hachisi chiitiko chakajairika. Zvisinei, tsvakurudzo iri kuenderera mberi kuti inzwisise kuti kurapwa kunodzokororwa kungabatsira rini uye sei kune vamwe varwere.
Kana gomarara rako re multiple myeloma rikadzoka mushure mekutanga kupindura kurapwa kwe CAR-T, chikwata chako chekurapa chichaongorora zvinhu zvakawanda kuti chizive matanho akanakisa anotevera. Izvi zvinogona kusanganisira mamwe marapirwo e CAR-T, miviri inopesana nemuviri, misanganiswa yechinyakare yekemotherapu, kana kuyedzwa kwekiriniki kuchiongorora nzira itsva.
Vamwe varwere vane chirwere chavo chinodzoka mushure mekurapwa kwe CAR-T vangave vakakodzera kune rumwe rudzi rwekurapwa kwe CAR-T, senge ciltacabtagene autoleucel, kunyanya kana vakapindura zvakanaka pakutanga. Chikwata chako chekurapa chichafunga nezvehutano hwako hwese, kuti kurapwa kwekutanga kwakashanda kwenguva yakadii, uye kuti dzimwe sarudzo dzipi dziripo pakuronga matanho ako anotevera.