Yini i-Azacitidine: Ukusetshenziswa, Umthamo, Imiphumela Eceleni nokuningi

I-Azacitidine iyimithi yomdlavuza esiza ukwelapha imidlavuza ethile yegazi ngokusebenza ezingeni lezakhi zofuzo ukuze kubuyiselwe ukusebenza okujwayelekile kwamaseli. Yilokho odokotela abakubiza ngokuthi “i-hypomethylating agent,” okusho ukuthi isiza ukuvula kabusha izakhi zofuzo ezivaliwe amaseli omdlavuza, okuvumela umzimba wakho ukuthi ulwe nesifo ngempumelelo.

Le mithi ilethe ithemba ezigulini eziningi ezinomdlavuza wegazi ebezinenani elilinganiselwe lezindlela zokwelapha ngaphambili. Ngenkathi idinga ukuqashwa ngokucophelela futhi iza nemiphumela emibi, i-azacitidine isize ukwelula nokuthuthukisa izinga lempilo lezinkulungwane zabantu emhlabeni jikelele.

Yini i-Azacitidine?

I-Azacitidine iyinguqulo yokwenziwa yebhulokhi yemvelo yokwakha i-DNA ebizwa ngokuthi i-cytidine. Isebenza ngokungena ku-DNA yakho ne-RNA, bese ivimba i-enzyme ebizwa ngokuthi i-DNA methyltransferase esetshenziswa amaseli omdlavuza ukuvala izakhi zofuzo ezibalulekile.

Cabanga ngayo njengokhiye wamaselula ovula izakhi zofuzo umzimba wakho ozidingayo ukulwa nomdlavuza. Lapho amaseli omdlavuza eziphindaphinda, avame “ukuvala” izakhi zofuzo ezingavimbela ukukhula kwawo noma zibangele ukufa kwamaseli. I-Azacitidine isiza ukuvula kabusha lezi zakhi zofuzo ezivikelayo, inikeze amasosha akho omzimba ithuba elingcono lokubona nokuhlasela amaseli omdlavuza.

Le mithi ingeyodwa ekilasini elibizwa ngokuthi ama-antimetabolites, okusho ukuthi iphazamisa imetabolism yamaseli omdlavuza nokukhiqizwa kwe-DNA. Ngokungafani nemithi ye-chemotherapy eqondile enobuthi emaseleni omdlavuza, i-azacitidine isebenza ngobuciko ngokuthi iprogram kabusha ukuthi amaseli omdlavuza aziphatha kanjani.

Isetshenziselwani i-Azacitidine?

I-Azacitidine isetshenziswa ikakhulukazi ukwelapha ama-myelodysplastic syndromes (MDS), iqembu lemidlavuza yegazi lapho umnkantsha wakho wamathambo ungakhiqizi amaseli egazi anempilo ngendlela efanele. Iphinde yamukelwe ngezinhlobo ezithile ze-acute myeloid leukemia (AML) ezigulini ezingekho ngaphansi kokwelashwa okukhulu kwe-chemotherapy.

Udktela wakho angase ancome i-azacitidine uma unezinhlobo ezingaphansi ze-MDS ezihlanganisa i-anemia engamelani, i-anemia engamelani ene-ringed sideroblasts, noma i-anemia engamelani enama-blasts amaningi. Lezi zimo zenza ukuthi umnkantsha wakho wamathambo ukhiqize amaseli egazi angajwayelekile angasebenzi kahle, okuholela ku-anemia, ingozi eyengeziwe yokutheleleka, nezinkinga zokuphuma igazi.

Umuthi ngezinye izikhathi usetshenziselwa i-chronic myelomonocytic leukemia (CMML), omunye umdlavuza wegazi othinta amaseli amhlophe egazi. Kwezinye izimo, odokotela bangase bawucabangele eminye imidlavuza yegazi lapho ukwelashwa okujwayelekile kungafaneleki noma kungasebenzanga.

Ngokuvamile, i-azacitidine ingase isetshenziswe ngaphandle kwelebula yezinye izimila eziqinile lapho okunye ukwelashwa kuhlulekile, nakuba lokhu kudinga ukucatshangelwa ngokucophelela yithimba lakho le-oncology.

Isebenza Kanjani I-Azacitidine?

I-Azacitidine isebenza ngokugxambukela ku-DNA methylation, inqubo amaseli omdlavuza ayisebenzisela ukuthulisa ama-gene ngokuvamile angavimbela ukukhula kwesimila. Uma uthola umjovo, umuthi uhamba ngegazi lakho futhi ufakwa ku-DNA yamaseli ahlukanisa ngokushesha, okuhlanganisa amaseli omdlavuza.

Uma isingaphakathi kwe-DNA, i-azacitidine ibamba futhi inciphise i-enzyme DNA methyltransferase, okuyilapho amaseli omdlavuza ancika khona ukuze agcine ama-gene okucindezela isimila evalekile. Lokhu kuvumela ama-gene abalulekile njenge-p16 ne-p15 ukuthi asebenze futhi, asize ukubuyisela ukulawulwa okujwayelekile komjikelezo weseli futhi kuqale ukufa kweseli lomdlavuza.

Umuthi futhi uthinta i-RNA, uphazamisa ukukhiqizwa kwamaprotheni kumaseli omdlavuza. Lesi senzo esiphindwe kabili ku-DNA ne-RNA senza i-azacitidine isebenze ikakhulukazi emidlavuzeni yegazi esingamelani nokunye ukwelashwa.

I-Azacitidine ithathwa njengomuthi oqinile womdlavuza. Ayinamandla njengama-regimen e-chemotherapy e-high-dose, kodwa inamandla kune-hormone therapies noma i-targeted therapies. Iziguli eziningi ziyayibekezelela kangcono kune-chemotherapy yendabuko ngenkathi zisaqaphela imiphumela enengqondo.

Kufanele Ngiyithathe Kanjani I-Azacitidine?

I-Azacitidine inikezwa njengomjovo ngaphansi kwesikhumba sakho (i-subcutaneous) noma emthanjeni (i-intravenous), ngokuvamile ehhovisi likadokotela noma esikhungweni somdlavuza esingaphandle. Awukwazi ukuthatha lo muthi ngomlomo, njengoba udinga ukunikezwa ochwepheshe bezempilo abaqeqeshiwe.

Uhlelo olujwayelekile luhlanganisa ukuthola imijovo izinsuku eziyisikhombisa zilandelana, kulandelwe isikhathi sokuphumula samasonto amathathu. Lo mjikelezo wezinsuku ezingama-28 uyaphindwa, nakuba udokotela wakho angashintsha isikhathi ngokusekelwe endleleni umzimba wakho osabela ngayo kanye nokubalwa kwegazi lakho.

Ngaphambi komjovo ngamunye, ithimba lakho lezempilo lizohlola ukubalwa kwegazi lakho kanye nesimo sempilo yakho esiphelele. Akudingeki ukuthi uzile ukudla ngaphambi kokwelashwa, kodwa ukudla ukudla okulula ngaphambi kwesikhathi kungasiza ekuvikeleni isicanucanu. Ukuphuza amanzi amaningi ngazo zonke izinsuku zokwelashwa kusiza izinso zakho ukuthi zisebenze ngempumelelo imithi.

Izindawo zakho zomjovo zizoshintshwa ukuvimbela ukucasuka, ngokuvamile zishintshana phakathi kwamathanga akho, isisu, kanye nezingalo ezingenhla. Umjovo ngokwawo uthatha imizuzu embalwa nje, nakuba kungase kudingeke uhlale ukuze uqashwe, ikakhulukazi ngesikhathi sokwelashwa kwakho kokuqala.

Kufanele Ngiyithathe Isikhathi Esingakanani I-Azacitidine?

Iziguli eziningi ziqhubeka nokuthatha i-azacitidine okungenani imijikelezo emine kuya kweyisithupha (cishe izinyanga ezi-4-6) ngaphambi kokuba odokotela bakwazi ukuhlola ngokugcwele ukuthi iyasebenza yini. Abantu abaningi abasabela kahle emuthini baqhubeka nokwelashwa isikhathi eside, ngezinye izikhathi iminyaka, uma nje bekwazi ukuyibekezelela kahle futhi ilawula umdlavuza wabo.

Udokotela wakho uzoqapha ukubalwa kwegazi lakho kanye nempilo yakho yonke njalo emavikini ambalwa ukuze anqume ukuthi imithi iyasiza yini. Ezinye iziguli zibona ngcono ngaphakathi kwemijikelezo yokuqala embalwa, kanti ezinye zingase zidinge isikhathi eside ukuze zibonise izinzuzo. Umgomo uwukuthola ibhalansi efanele phakathi kokulawula umdlavuza wakho nokugcina izinga lempilo yakho.

Uma uhlangabezana nemiphumela emibi kakhulu noma umdlavuza wakho uqhubeka ngaphandle kokwelashwa, udokotela wakho angase alungise umthamo wakho, ashintshe isimiso, noma ashintshele emuthini ohlukile. Isinqumo sokuqhubeka noma ukuyeka i-azacitidine sincike ekuphenduleni kwakho komuntu ngamunye nokuthi ulawula kahle kangakanani noma yimiphi imiphumela emibi.

Ngokungafani nokwelashwa komdlavuza okuthile okunikezwa isikhathi esinqunyiwe, i-azacitidine ivame ukuqhubeka uma nje inikeza inzuzo ngaphandle kokubangela imiphumela emibi engamukeleki. Ithimba lakho le-oncology lizosebenza nawe ukunquma indlela engcono kakhulu yesimo sakho esithile.

Yini Imiphumela Emibi ye-Azacitidine?

I-Azacitidine ingabangela imiphumela emibi ngoba ithinta zombili amaseli omdlavuza namanye amaseli anempilo ahlukanisa ngokushesha. Imiphumela eminingi emibi ilawuleka ngokuqapha okufanele nokunakekelwa okusekelayo, futhi iziguli eziningi zithola ukuthi zingagcina izinga elihle lempilo ngenkathi zithola ukwelashwa.

Imiphumela emibi evame kakhulu ongase uyithole ihlanganisa ukukhathala, isicanucanu, nokusabela endaweni yokujova njengobubomvu noma ukuvuvukala. Lokhu kuvamile ukwenzeka ezinsukwini ezimbalwa zokuqala zomjikelezo ngamunye futhi kuvame ukuthuthuka njengoba umzimba wakho ujwayela umuthi.

Nansi imiphumela emibi ongase uhlangabezane nayo, ihlelwe kusukela kokuvamile kuya kokungavamile:

• Ukukhathala nobuthakathaka, okuthinta cishe u-80% weziguli
• Isicanucanu nokuhlanza, ngokuvamile kulula kuya kokulingene
• Ukusabela endaweni yokujova njengobubomvu, ukuvuvukala, noma ukulimala
• Ukubalwa kwegazi okuphansi (i-anemia, amaseli amhlophe egazi aphansi, ama-platelet aphansi)
• Ukuqunjelwa noma ukuqunjelwa
• Ukuncipha kwesifiso sokudla
• Umkhuhlane, ikakhulukazi ngesikhathi semijikelezo yokuqala
• Ubuhlungu bemisipha noma amalunga
• Isiyezi noma ikhanda
• Ukuphefumula

Iqembu lakho lezempilo lizokuqapha ngokucophelela ukuze libone le miphumela futhi linganikeza imithi noma amasu okusiza ukuphatha lezi zimpawu. Iziguli eziningi zithola ukuthi imiphumela emibi ibonakala kakhulu ngesikhathi semijikelezo yokuqala embalwa futhi ngokuvamile iba lula ukuyiphatha ngokuhamba kwesikhathi.

Imiphumela emibi ebucayi kodwa engavamile idinga ukunakekelwa kwezempilo ngokushesha. Lokhu kufaka izimpawu zokutheleleka okukhulu (umkhuhlane omkhulu, amaqhwa, ukukhathala okukhulu), ukopha okungavamile noma ukulimala, isicanucanu esikhulu esikuvimbela ukuthi ungagcini uketshezi, noma ubunzima bokuphefumula.

Ngokuvamile, ezinye iziguli zingase zibe nezinkinga ezinzima njenge-pneumonia, ukusabela kwesikhumba okukhulu, noma izinkinga zezinso. Udokotela wakho uzoxoxa ngalezi zinto nawe futhi achaze izimpawu zokuxwayisa okufanele uziqaphele phakathi kokwelashwa.

Ubani Ongafanele Athathe i-Azacitidine?

I-Azacitidine ayifanele wonke umuntu, futhi udokotela wakho uzohlola ngokucophelela ukuthi iphephile yini kuwe ngokusekelwe empilweni yakho yonke nomlando wezokwelapha. Umuthi udinga ukuthi umzimba wakho ube nokwanele ukubekezela imiphumela yawo ekukhiqizweni kwamaseli egazi.

Akufanele uthole i-azacitidine uma unokungezwani nayo noma i-mannitol (ingxenye esetshenziswa emjovweni). Udokotela wakho uzophinda aqaphele kakhulu uma unezifo zesibindi ezinzima, njengoba lokhu kungathinta indlela umzimba wakho oqhubula ngayo umuthi.

Izimo ezithile zidinga ukuqapha okwengeziwe nokuqapha okuseduze, nakuba zingakukhiphi ngokuzenzakalelayo ekwelashweni:

• Isifo sezinso esinzima noma ukuncika ku-dialysis
• Ukutheleleka okusebenzayo, okungalawulwa
• Isifo senhliziyo esinzima noma ukuhlaselwa yinhliziyo kwakamuva
• Ukubala kwegazi okuphansi kakhulu okungathuthuki ngokunakekelwa okusekelayo
• Ukukhulelwa noma ukuncelisa ibele
• Ukuhlinzwa okukhulu kwakamuva noma ukulimala okuphilisayo
• Eminye imidlalo yomdlavuza esebenzayo edinga ukwelashwa

Udktora wakho uzohlola lezi zinto ngokumelene nezinzuzo ezingaba khona zokwelashwa. Kwezinye izimo, ukubhekana nalezi zinkinga kuqala noma ukuhlinzeka ngokunakekelwa okwengeziwe okusekelayo kungenza i-azacitidine ibe yindlela efanelekile.

Uma uhlela ukukhulelwa noma ukuthola ingane, xoxa ngalokhu nodokotela wakho ngaphambi kokuqala ukwelashwa. I-Azacitidine ingalimaza izingane ezisakhula, futhi kokubili amadoda nabesifazane kufanele basebenzise izindlela zokuvimbela inzalo ezisebenzayo ngesikhathi sokwelashwa kanye nasezinyangeni ezimbalwa ngemva kwalokho.

Amagama Omkhiqizo we-Azacitidine

I-Azacitidine itholakala ngaphansi kwegama lomkhiqizo elithi Vidaza, okuyindlela evame kakhulu yokwelashwa ngalo mithi. I-Vidaza iza njengempushana exutshwe namanzi ahlanzekile ngaphambi kokujova, futhi itholakala kokubili ngamafomula angaphansi kwesikhumba kanye nangaphakathi kwemithambo.

Ifomu elisha lomlomo elibizwa nge-Onureg (amaphilisi e-azacitidine) nalo liyatholakala ezigulini ezithile ezifanele ukwelashwa kokugcinwa ngemva kokwelashwa kokuqala. Leli fomu lepilisi livumela ezinye iziguli ukuthi ziqhubeke nokwelashwa ekhaya kunokuza emtholampilo ukuze zithole imijovo.

Izinhlobo ezivamile ze-azacitidine ejovwayo nazo ziyatholakala, ezingase zibe ngentengo ephansi ngenkathi zinikeza izinzuzo ezifanayo zokwelapha. Umshwalense wakho kanye nekhemisi kungase kuthinte ukuthi yiluphi uhlobo oluthile noma inguqulo ejwayelekile oyitholayo.

Noma ngabe yiluphi uhlobo olutholayo, isithako esisebenzayo nokusebenza kahle kuhlala kufana. Ithimba lakho lokunakekelwa kwezempilo lizoqinisekisa ukuthi uthola ifomula efanele yohlelo lwakho oluthile lokwelashwa.

Ezinye izindlela ze-Azacitidine

Eminye imithi eminingi ingelapha iminyango yegazi efanayo, nakuba ukukhetha kuncike ekuxilongweni kwakho okuthile, impilo yonke, kanye nokwelashwa kwangaphambilini. Udokotela wakho uzocabangela lezi ezinye izindlela uma i-azacitidine ingafaneleki noma iyeka ukusebenza kuwe.

I-Decitabine (Dacogen) ingenye i-ejenti ye-hypomethylating esebenza ngendlela efana ne-azacitidine. Ezinye iziguli ezingasabeli komunye zingazuza komunye, yize zihlanganyela imiphumela eminingi efanayo kanye nezindlela zokusebenza.

Ezinye izinketho zokwelashwa udokotela wakho angazicabangela zihlanganisa:

• I-Venetoclax, evame ukuhlanganiswa ne-azacitidine ngezinhlobo ezithile ze-AML
• I-Lenalidomide (Revlimid) yezinhlobo ezithile ze-MDS
• Izindlela zokwelashwa ngamakhemikhali ezinamandla ezigulini ezincane, ezinempilo
• Ukunakekelwa okusekelayo ngokumpontshelwa igazi kanye nezici zokukhula
• Izivivinyo zomtholampilo eziphenya ngemithi emisha yokwelapha
• Ukufakelwa komnkantsha wamathambo ezigulini ezifanelekayo

Enye indlela engcono kakhulu incike ezintweni ezifana nobudala bakho, impilo yonke, izimpawu zofuzo emangqamuzaneni akho omdlavuza, kanye nezintandokazi zakho. Ithimba lakho le-oncology lizoxoxa ngalezi zinketho nawe uma i-azacitidine ingeyona inketho efanele noma iyeka ukusebenza.

Ezinye iziguli zingathola ukwelashwa okuhlanganisiwe okuhlanganisa i-azacitidine kanye neminye imithi, okungase ngezinye izikhathi kusebenze ngempumelelo kunanoma iyiphi imithi eyodwa.

Ingabe i-Azacitidine Ingcono Kune-Decitabine?

Kokubili i-azacitidine ne-decitabine bangama-ejenti e-hypomethylating asebenza ngendlela efanayo, kodwa banezinto ezithile ezingenza enye ifaneleke kakhulu kuwe kunenye. Akukho noyedwa othi ngokuqinisekile “ungcono” – ukukhetha kuncike esimweni sakho esithile nokuthi umzimba wakho usabela kanjani.

I-Azacitidine inikezwa ngemijovo izinsuku eziyisikhombisa zilandelana umjikelezo ngamunye, kuyilapho i-decitabine ngokuvamile inikezwa ngemithambo izinsuku ezintathu kuya kwezinhlanu. Ezinye iziguli zikhetha isimiso se-azacitidine ngoba imijovo engaphansi kwesikhumba inganikezwa ngokushesha endaweni engaphandle.

Ucwaningo luphakamisa ukuthi i-azacitidine ingase isebenze kangcono kancane ezinhlotsheni ezithile ze-MDS, ikakhulukazi isifo esingozini enkulu. Kodwa-ke, i-decitabine ingase ithandwe ezigulini ezinobunzima bokuphendula endaweni yokujova noma ezikhetha ukuphathwa ngemithambo.

Amaphrofayili emiphumela emibi afana phakathi kwemithi emibili, nakuba ezinye iziguli zikubekezelela kangcono kunenye. Udokotela wakho uzocabangela uhlobo lomdlavuza wakho, ukwelashwa kwangaphambilini, nezintandokazi zomuntu siqu lapho ekhetha phakathi kwazo.

Imibuzo Evame Ukubuzwa Mayelana ne-Azacitidine

Ingabe i-Azacitidine iphephile ezigulini ezinokuwohloka kwezinso?

I-Azacitidine ingasetshenziswa ezigulini ezinokuwohloka kwezinso okuncane kuya kokulingene, kodwa idinga ukuqapha ngokucophelela futhi mhlawumbe ukulungiswa komthamo. Udokotela wakho uzohlola ukusebenza kwezinso zakho njalo ngemivivinyo yegazi futhi angase anciphise umthamo wakho uma izinso zakho zingasebenzi kahle njengoba kufanele.

Uma unezifo ezinzima zezinso noma use-dialysis, udokotela wakho uzokala izinzuzo nezingozi ngokucophelela kakhulu. Umuthi ungasuswa nge-dialysis, ngakho-ke isikhathi sokwelashwa kungase kudingeke ukuthi sihlelwe neshejuli yakho ye-dialysis.

Ngingenzani uma ngisebenzisa i-Azacitidine eningi ngengozi?

Njengoba i-azacitidine inikezwa ochwepheshe bezempilo ezindaweni ezilawulwayo, ukweqisa ngengozi akuvamile kakhulu. Kodwa-ke, uma usola ukuthi uthole umuthi omningi kakhulu noma uhlangabezana nemiphumela emibi kakhulu, xhumana nethimba lakho lezempilo ngokushesha noma uye egumbini eliphuthumayo eliseduze.

Izimpawu zokweqisa okungenzeka zihlanganisa isicanucanu esibi nokuhlanza, ukukhathala okukhulu, umkhuhlane, ukuphuma kwegazi okungavamile, noma ubunzima bokuphefumula. Akukho umuthi oqondile we-azacitidine, ngakho ukwelashwa kugxila ekuphatheni izimpawu nasekusekeleni ukululama komzimba wakho.

Ngingenzani uma ngiphuthelwa umthamo we-Azacitidine?

Uma uphuthelwa umjovo we-azacitidine ohleliwe, xhumana nethimba lakho lezempilo ngokushesha ukuze lihlehlise. Ungazami ukwenza izidakamizwa ezingeziwe ngokuthatha imithi eyengeziwe - lokhu kungaba yingozi futhi ngeke kuthuthukise imiphumela yakho yokwelashwa.

Udaktela wakho angase alungise uhlelo lwakho lokwelashwa noma ashintshe umjikelezo wakho ngokuya ngokuthi zingaki izidakamizwa oziphuthelwe. Ukuqina kubalulekile ekusebenzeni, ngakho zama ukugcina zonke izikhathi zakho ezihleliwe futhi uxhumane nganoma yiziphi izingxabano zokuhlela kusengaphambili.

Ngingayeka nini Ukuthatha i-Azacitidine?

Kufanele uyeke i-azacitidine kuphela ngaphansi kokuqondisa kukadokotela wakho. Ngokungafani neminye imithi ethathwa isikhathi esinqunyiwe, i-azacitidine ivame ukuqhubeka uma nje isiza ukulawula umdlavuza wakho futhi uyayibekezelela kahle.

Udaktela wakho uzohlola njalo ukuthi imithi isasebenza yini ngokusebenzisa ukuhlolwa kwegazi, ama-biopsies omkholoni, kanye nokuqapha izimpawu zakho. Uma umdlavuza wakho uqhubeka noma imiphumela emibi iba nzima ukuyilawula, udokotela wakho uzoxoxa ngezindlela zokwelashwa ezingezinye noma izinketho zokunakekelwa okusekelayo.

Ngingakwazi Ukuthola Imithi Yokugoma Ngenkathi Ngithatha i-Azacitidine?

Kufanele ugweme imithi yokugoma ephilayo ngenkathi uthatha i-azacitidine ngoba imithi ingase ibuthakathise amasosha akho omzimba. Lokhu kufaka phakathi imithi yokugoma efana nomuthi wokugoma umkhuhlane ophilayo (i-nasal spray), i-MMR, kanye nemithi yokugoma i-varicella (izinkukhu).

Nokho, imithi yokugoma engasebenzi njengomuthi wokugoma umkhuhlane, umuthi wokugoma umkhuhlane wamaphaphu, kanye nemithi yokugoma i-COVID-19 ngokuvamile iphephile futhi iyatuswa. Udokotela wakho uzokweluleka ukuthi yimiphi imithi yokugoma okufanele uyithole nokuthi uyithole nini ukuze uthole ukuvikeleka okungcono kakhulu ngenkathi unciphisa izingozi.