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Understanding Leukaemias, Lymphomas and Myeloma

Am hiu Bnh bch cu, Bnh bch huyt v Bnh u ty

Mc Lc
HI BNH BCH CU ........................................................................1 BNH BCH CU BT NGUN T U? ...............................................2 NHIM V CA T BO MU L G? ....................................................3 GIA NH T BO MU .....................................................................4 BNH BCH CU L BNH G? ...........................................................5 N G U Y N N H N G Y R A N H N G B N H N Y L G ? ..............6 CCH CHN ON BNH? .................................................................6 CC DNG BNH BCH CU ..............................................................7 BNH BCH HUYT V BNH U TY .................................................. 11 TR LIU ....................................................................................... 13 I S N G B U N G T H M U V T Y X N G ............. 18 NI KHC C TH GIP C......................................................... 19

HI BNH BCH CU
Hi Bnh Bch Cu (The Leukaemia Foundation) l t chc v v li, hot ng ton quc, ch trng vo phng din chm sc v cha tr bnh nhn bnh bch cu, bnh bch huyt, bnh u ty, bnh thiu mu bt sn (aplastic anaemia) v cc chng ri lon lin quan n mu. Hi Bnh Bch Cu hon thnh mc tiu ny bng cch h tr v hng dn/c vn, cung cp ch , thuyt ging v bnh tt, chuyn ch v gip thit thc cho bnh nhn v gia nh.

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BNH BCH CU BT NGUN T U?

Nhiu ngi ngh rng bnh bch cu l bnh ung th mu. Tht ra, y l bnh ung th ty xng nh my trong xng, ni ch to t bo mu. Mun hiu r bnh trng ny hn, trc tin qu v cn phi hiu: mu l g sn sinh u, v hot ng nh th no.

Mu
Mu gm c t bo mu (blood cells) v huyt tng (plasma), huyt tng l phn cht lng ca mu. y l cht dch chuyn ch t bo mu, nhng mnh cc nh tri ni l lng trong huyt tng.

Ty xng
Loi m xp chim c phn li rng ca xng l ty xng. y l nh my t bo mu. Khi t bo mu trng thnh v khi c th cn thm mu v l do c bit, chng s ri khi ty xng nhp vo dng mu. Trong c th khe mnh, ty xng sn sinh phn ln ba loi t bo mu, nh: hng cu bch cu tiu cu.

C th cn thn kim sot s tng trng v pht trin ca t bo mu, hu sn sinh ng s lng mi loi t bo mu gi cho c th c khe mnh. Mi giy ng h, c th sn sinh ra hng triu hng cu v bch cu. Thng thng cc t bo ny nm trong ty xng cho n khi trng thnh lu chuyn trong mch mu v hon thnh c nhiu chc nng khc nhau. Tt c t bo mu s trng thnh, ri cht, nhng tui th ca mi t bo khc bit nhau ng k. Sau khi ri khi ty xng, hng cu sng c chng bn thng. Bch cu ch sng c mt vi ting. Tiu cu sng c mt vi ngy. V tui th ca bch cu v tiu cu ngn ngi, do , kh thay th bng phng php truyn mu.

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NHIM V CA T BO MU L G? Hng cu (Xe bn ch nhin liu)

C huyt cu t ch xy t phi i khp mi ni trong c th. Dc ng, hng cu tip thu cht thi v em tr li phi, ri c th thi ra ngoi di dng thn kh (ccbon dixt). Nu thiu hng cu, con ngi cm thy mt mi v yu sc. C ngi d b mt v ti xanh, v c th khng c lng xy cn thit. Tnh trng thiu hng cu gi l thiu mu.

Bch cu (Lnh nh vim nhim)

Chng vim nhim, tiu dit vi trng (khun) gy bnh v nhng t bo b tn thng trong c th. Bch huyt bo-T (T-lymphocytes) iu khin h min nhim, c th dit siu vi khun v t bo ung th. Bch huyt bo-B (B-lymphocytes) sn sinh khng th. Bch cu trung tnh (Neutrophils) chng vim nhim, tiu dit vi khun v x l m b tn thng. Bch cu n nhn to (Monocytes) kt hp vi bch huyt bo chng li vim nhim, cn thit cho vic sn sinh khng th. Tnh trng thiu bch cu lm cho con ngi thng hay b vim nhim v nu b vim nhim th b nng hn, c khi nguy him n tnh mng.

Tiu cu (T bo tu sa)
Lm mu ng hay ng cc cm mu. Nu mch mu b tn thng (th d nh b ct hay bm), cc tiu cu s dn n im ny v bm dnh vo nhau, to thnh nt chn vt h. Thiu tiu cu, c th lm cho con ngi thng hay b chy mu mi, khi b ct th chy mu lu dt, b bm bt bnh thng, hoc i cu, i tiu ra mu, da b chy mu. Trong trng hp trm trng, khi lng tiu cu xung qu thp, cc c quan ni tng v no b c th b xut huyt. Ton y khoa iu tr s bo qu v bit khi lng tiu cu ca qu v st gim.

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GIA NH T BO MU
Tt c t bo mu u c cng mt ngun gc t t bo mm (stem cell) hay t bo tin thn (precursor cell). Tuy nhin, trong thi k pht trin ban u, cc t bo ny chia thnh hai gia nh chnh - ty bo (myeloid) v bch huyt bo (lymphoid). Gia nh ty bo gm c: hng cu, tiu cu v cc bch cu nht nh. Bch cu trong gia nh ny gi l bch cu ht (granulocytes) hay bch cu n nhn to (monocytes), ty theo chc nng.

Gia nh bch huyt bo gm c: tt c cc bch cu cn li. Khi trng thnh, nhng t bo ny gi l bch huyt bo (lymphocytes).

Cch hai gia nh chng vim nhim

D bch cu thuc hai gia nh ny cng lm chin chng li k th gy vim nhim, nhng s dng phng php khc nhau. Bch hu thuc gia nh ty bo l hng ro phng th chng vim nihm u tin ca c th. Cc bch huyt bo phi mt nhiu thi gian hn mi huy ng c, nhng li c kh nng chng vi khun xm lc chuyn nghip hn. Bch huyt bo cn hin din trong cc m bch huyt khp ni trong c th. a s m bch huyt tp trung ti hch bch huyt, gan, l lch, dc theo ng rut v ng h hp. H bch huyt l h thng tip thu cht thi, lc v thot cht dch. Tuy nhin, tng t nh h tun hon vn chuyn mu, h bch huyt vn chuyn cht dch trong gi l mu trng. Cht dch ny gip vn chuyn bch huyt bo. Nh vy, bch huyt bo hin din c trong mu ln mu trng.

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BNH BCH CU L BNH G?

Bnh bch cu xy ra khi c th bt u tch t bch cu bt bnh thng. V vy, s lng v kh nng ca t bo mu trng thnh b gim bt. T bo tr thnh bt bnh thng v chng khng th trng thnh trn vn. Tnh trng khng th trng thnh trn vn ny l yu t chnh gy ra bnh bch cu. Nhng t bo em b, hay cn non, tch t trong c th v chng khng cht v khng b tiu hao dn. Khi pht bnh bch cu, cc t bo bnh bch cu tch t trong ty xng. Cui cng tt c bch cu, hng cu v tiu cu bnh thng ht ch tr ng hay khng i mi na. Ty xng khe mnh b thay th bng nhng t bo cn non, ri cui cng nhng t bo ny nhp vo dng mu v i khp ni trong c th. Do , khi s lng t bo cn non gia tng, th s lng hng cu, bch cu v tiu cu gim bt. V th, bnh nhn s c mt s triu chng hay du hiu thiu loi t bo mu no . Th d nh, thiu hng cu s lm cho bnh nhn b mt v xanh xao (thiu mu), thiu bch cu s lm cho bnh nhn b nhim trng i, nhim trng li, v thiu tiu cu s lm cho da bnh nhn b ni mn , bm nhiu ch, v chy mu mi. l nguyn do v sao chng thiu mu, chy mu v nhim trng thng xy ra.

Bnh bch huyt v bnh u ty l nhng bnh g?

Khi t bo thuc gia nh bch huyt bo bt u trng thnh, chng di chuyn n cc c quan khc trong c th, k c tuyn c, cc hch bch huyt v cc m khc. Nu cc t bo nhng ni ny khng trng thnh thm na, hay b lon chc nng, ngi ta b mc bnh (lin quan ti bnh bch cu) gi l u bch huyt c tnh (malignant lymphoma). Mt s bnh u bch huyt, khc vi bnh bch cu, c th ch quanh qun mt m nht nh. Bnh u bch huyt c th pht trin chm hay tht nhanh. Mt s u hch bch huyt gi l bnh Hodgkin (Hodgkin's disease), cn mt s u khc gi l u bch huyt khc Hodgkin (non-Hodgkins lymphoma). C mt loi u bch huyt c tnh c bit, lin h n t bo sn sinh khng th k cu, gi l tng bo. Bnh ny gi l a u ty (multiple myeloma).

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NGUYN NHN GY RA NHNG BNH NY L G?

n nay, chng ta cha bit r nguyn nhn no gy ra bnh bch cu, bnh bch huyt, bnh u ty v cc chng ri lon v mu. Tuy nhin, mt s yu t dng nh c nh hng ti s pht trin ca nhng bnh ny. Nhng yu t ri ro ny ch l mt phn ca nguyn nhn gy bnh trong trng hp c nhn v chim t l rt t ni chung cc trng hp bnh. Trong a s trng hp, th khng xc nh c nguyn nhn gy bnh. C mt hay nhiu yu t di y, khng nht thit l qu v s b nhng bnh ny. Nu lo ngi, qu v nn ni chuyn vi bc s. Yu t di truyn Bc x Ha cht Siu vi khun.

CCH CHN ON BNH?

Triu chng bnh bch cu v cc chng ri lon ty xng lin h cng ging nh nhiu bnh tt khc. Mt s bnh bch cu khng gy ra triu chng no cho n khi bnh kh pht trin ri v c khi chng c triu chng g. Tuy nhin, iu ny khng c ngha, nu chn on c khi mi chm bnh th s ngn chn bnh lan truyn, v khi pht tc, bnh bch cu lan rng trong ty xng. Bnh bch cu c chn on bng hai xt nghim - th mu v sinh thit ty xng (bone marrow biopsy). Khi ly mu lm xt nghim v xem xt bng king hin vi, chuyn vin xt nghim s m s lng bch cu v tiu cu. Nu s lng bch cu bt bnh thng, th c ngha l: s lng tiu cu thp; s lng hng cu thp, s lng bch cu trng thnh thp; hay s lng bch cu cn non hay sm nhp vo mu (gi l nguyn bo blasts) cao. Sau l lm sinh thit ty xng. Bc s s dng kim v ng chch trch mt t ty xng. Bc s s chch thuc t hay thuc gim au cho bnh nhn khi lm th thut ny. Cc loi thuc mi s lm bnh nhn b au khi lm sinh thit.

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Mu ty xng s c phn tch bng nhiu xt nghim, t vic xem xt bng king hin vi n cch cy ty xng xt nghim c bit. Ri bc s s chn bnh. Ngc vi nhng iu thng nghe ni, khng phi lc no t bo bnh bch cu cng pht trin nhanh hn t bo thng. Thc ra, theo cc th nghim trong phng th nghim nghin cu, mt s t bo bnh bch cu li pht trin chm hn t bo thng. S lng t bo mu cao l v t bo bnh bch cu tch t trong mch mu. T bo bnh bch cu cn non, tch t trong mch mu v c th khng s dng chng. Do , s lng t bo ny tng dn. Khi s lng t bo ny tng qu cao, cc mch mu c th b tt nghn v lm tn thng m trong c th. Mu tr nn rt c v dnh, khin mu kh lu chuyn. y l mt trong nhng tc hi ca bnh bch cu m bc s mun tr.

CC DNG BNH BCH CU

Bn dng bnh bch cu thng thng l: Bnh Bch Cu Nguyn Bo Cp Tnh (Acute Lymphoblastic Leukaemia - ALL) Bnh Bch Cu Bch Huyt Bo Mn tnh (Chronic Lymphocytic Leukaemia - CLL) Bnh Bch Cu Ty Bo Cp Tnh (Acute Myeloid Leukaemia - AML) Bnh Bch Cu Ty Bo Mn tnh (Chronic Myeloid Leukaemia- CML)

Bnh Bch Cu Cp Tnh (Acute Leukaemia) xy ra khi cc t bo trong thi k pht trin ban u b nh hng. Do , cc t bo ny cn khng trng thnh c v hon ton v dng. Do , bnh nhn b bnh bch cu dng cp tnh d b vim nhim, chy mu, v thiu mu, v hu nh phi c tr liu ngay. Bnh Bch Cu Mn tnh (Chronic Leukaemia) xy ra khi cc t bo kh pht trin hn b nh hng. Thng thng nhng t bo c phn ln chc nng bnh thng, v bnh nhn t b thiu mu, chy mu v vim nhim hn. Bnh nhn trong trng hp ny khng cn phi c tr liu ngay v mt s ngi chng cn phi c tr liu g c. Bnh bch cu chia thnh dng ty bo (myeloid) hay bch huyt bo (lymphoid).

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Khi bnh bch cu nh hng n nhng t bo m sau cng s bin thnh tiu cu, hng cu, bch cu ht v bch cu n nhn to, tnh trng ny gi l bnh bch cu ty bo (myeloid), ty xng (myelogenous), ht (granulocytic), hay ty bo (myelocytic). Khi bnh bch cu nh hng n nhng t bo m sau cng s bin thnh bch huyt bo, tnh trng ny gi l bnh bch cu nguyn bo (lymphoblastic), bch huyt (lymphoid), bch huyt bo (lymphocytic), hay bch huyt (lymphatic).

Bnh bch cu nguyn bo cp tnh

(Acute lymphoblastic Leukaemia ALL. Cn gi l acute lymphocytic hay acute lymphatic leukaemia) Bnh bch cu dng ny thng xy ra vi tr th, nhng cng xy ra vi ngi ln. T bo bt bnh thng ca bnh bch cu nguyn bo cp tnh, vit tt l ALL l bch huyt bo cn non - tc l bch cu thuc h bch huyt, do , gi l nguyn bo bch huyt bo (lymphoblasts). Bch huyt bo c nhim v bo v c th chng vim nhim. Khi ty xng b ALL nh hng, kh nng sn sinh t bo chng vim nhim b suy gim, khin ngi ta c th b vim nhim nng. Ngoi ra, bnh bch cu cn lm cho t bo sn sinh tiu cu v hng cu khng cn t hot ng. Tr liu Bnh bch cu dng ny thng c th tr liu hu hiu bng liu php ha hc. i vi tr em, ALL c th tng i d tr. C n 75% tr em b bnh bch cu dng ny, khi c tr liu, bnh thuyn gim hon ton v sau dt hn. ALL cn phi c tr liu c bit, gi l cch iu tr no b hay h thn kinh trung ng d phng (brain hay central nervous system prophylaxis). Nhiu ha cht dng tr ALL, b mng no cn li, nhng t bo bnh bch cu th i qua c. iu tr d phng l cch tr liu no v mng no trnh trng hp t bo bnh bch cu n np ti nhng ni ny trong lc iu tr bng ha cht, ri tip tc pht trin sau khi ngng iu tr. Cch tr liu ny l chch thuc vo ct sng, lng, hay c khi iu tr bng cch ri tia bc x vo no hay ct sng, nhng cch ny t c s dng hn. i vi bnh nhn, sau khi tr liu ln u, bnh ti pht, th c th tr bng phng php ghp t bo mm.

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Bnh bch cu bch huyt bo mn tnh

(Chronic lymphocytic leukaemia CLL. Cn gi l chronic lymphatic hay chronic lymphoid leukaemia) y l dng bnh bch cu mn tnh hay tin trin chm. Tng t nh ALL, bnh ny nh hng n bch huyt bo. Thng thng ngi ln tui d b mc bnh ny hn cha c trng hp tr em b mc bnh ny. V bnh tin trin chm, bch huyt bo v cc t bo khc khng b trn ngp nhanh nh trng hp bnh cp tnh. Nh vy, bnh nhn b CLL c th khng cm thy c triu chng g l, mi cho n khi bnh kh pht trin ri. Mt s ngi chng bao gi cn phi tr bnh. Cc triu chng bnh, nu c, l cm gic khng khe trong ngi, mt mi, yu sc, st, n khng ngon ming, hay st cn. Tr liu Nu bnh tim n th khng phi tr liu v bnh nhn c th sinh hot bnh thng nhiu nm. Khi bnh honh hnh, th c th tr bng liu php ha hc, dng mt hay nhiu ha cht kt hp v thnh thong tr bng bc x. Ni chung, khng th tr dt hn CLL, nhng bnh nhn thng vn sng khe mnh trong nhiu nm. C th bnh nhn cn phi s dng thuc chng, thuc tr sinh v sn phm ch to t mu.

Bnh bch cu ty bo cp tnh

(Acute myeloid leukaemia AML. Cn gi l acute myelocytic, acute granulocytic hay acute myelogenous leukaemiabnh) Bnh bch cu ty bo cp tnh nh hng n cc t bo thuc gia nh ty bo. Gia nh ty bo gm c bn loi t bo mu: bch cu ht bch cu n nhn to hng cu tiu cu.

Bch cu ht, l loi t bo ch yu b nh hng i vi bnh bch cu dng ny. Ty bo lu chuyn trong mu, vi nhim v truy tm k th xm lc truyn nhim trong mu v m ln cn. Bch cu ht phn ng nhanh chng i vi tt c k th xm lc, trong khi bch huyt bo

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Understanding Leukaemias, Lymphomas and Myeloma

phn ng chm hn nhng c kh nng chng k th xm lc chuyn nghip hn. Khi pht hin k th xm lc, bch cu n nhn to ca gia nh ty bo n hay nut v tiu dit chng. AML xy ra khi c th b thiu t bo ty bo trng thnh v ty bo cn non hay em b tch t. Khi ty bo cn non tch t trong mu qu nhiu, chng c th lm nghn mch mu. Bnh bch cu dng ny c th xy ra vi tr em v thanh thiu nin nhng thng thng th ngi ln d b bnh ny hn. Tr liu Khi tr liu, bnh AML ca mt s ngi thuyn gim hon ton (tc l khng b bnh di hn). Tuy nhin, nhng cch tr liu mi c th nng cao xc sut sng cn ca bnh nhn.

Bnh bch cu ty bo mn tnh

(Chronic myeloid leukaemia CML. Cn gi l chronic myelogenous, chronic granulocytic hay chronic myelocytic leukaemia) Ty bo bt bnh thng ca bnh bch cu dng ny, b ngoi thng c v trng thnh nhng chng khng hot ng bnh thng. Bnh bch cu ny i i vi nhng t bo ch im bt bnh thng gi l Nhim sc th Philadelphia (Philadelphia chromosome)' v nh hng n bnh nhn tr nhiu hn so vi CLL. Ngoi ra CML cn khc nhng dng bnh bch cu khc, v bnh ny c hai thi k. Trong thi k th nht, t bo bt bnh thng sn sinh chm, kinh nin (chronic multiplication). i khi, CML t nhin chuyn sang thi k cp tnh, trong trng hp ny, CML tr nn ging y nh bnh bch cu cp tnh. i vi hu ht bnh nhn trong trng hp ny, tr bnh l iu gay go. Ghp ty xng l liu php may ra c li. Tr liu CML c th pht trin thi k mn tnh ba nm hay lu hn, nh vy d tr liu v kim ch hu hiu, nhng khng th tr dt hn. Ghp t bo mm l cch iu tr y ha hn cho ngi b b CML. S dng thuc interferon liu lng mnh c th cng hiu. Gn y a s bnh nhn c th s dng loi thuc mi c pht minh gi l Glivec.

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Nu ch s dng liu php ha hc tr bnh CML trong thi k cp tnh, th bnh ny c th thuyn gim, nhng thng thng cng khng c lu di. Ngoi ra, tr dt bnh cho bnh nhn CML trong thi k cp tnh bng cch ghp ty xng, l iu kh thc hin hn.

BNH BCH HUYT V BNH U TY U bch huyt Hodgkin

y l loi u chnh ca hch bch huyt. Thng thng bnh ny pht trin chm, v cc hch bch huyt ln xut hin ngy cng nhiu hn, thng l c. Cch tr liu gm c gii phu, ri tia bc x hay liu php ha hc. Nhiu ngi b bnh Hodgkin c iu tr dt hn, d khi chn on c, th bnh lan trn. Bnh ny ch yu xy ra vi thanh nin.

U bch huyt c tnh (U bch huyt khc Hodgkin)

y l u c tnh ca cc bch huyt bo, sau khi di chuyn ra khi ty xng. U bch huyt xut hin hch bch huyt hay cc m mm trong c th. Thng thng bnh bch huyt xy ra vi thanh nin. U bch huyt c tnh c ba hng: 1. Hng thp (Low grade) Nu u bch huyt cha lan trn, th c th tr bng gii phu hay ri tia bc x cc b. Tuy nhin, thng thng th u bch huyt hng ny lan trn nhanh chng khi triu chng bnh xut hin. Bnh nhn u bch huyt hng thp c th khng cn phi tr liu nhiu nm, m vn sng th. Ngy nay, nh nhiu k thut mi nh khng th n tnh, th d nh MabThera, v ghp t bo mm, xc sut sng cn ca bnh nhn c chiu kh quan hn. 2. Hng trung (Intermediate grade) U bch huyt hng ny pht trin nhanh hn hng thp. Nu cha lan trn, th u bch huyt hng trung, c th tr dt bng bc x, tng t nh u bch huyt hng thp. Thm ch khi bnh lan trn, trong nhiu trng hp vn c th tr dt bnh bng liu php ha hc kt hp, i khi bng liu lng mnh v ghp t bo mm.

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3.

Hng cao (High grade) U bch huyt hng ny c c tnh ging nh bnh bch cu cp tnh v c tr liu tng t, bng liu php ha hc kt hp v cch iu tr no hay h thn kinh trung ng d phng (xin xem phn tr liu bnh bch cu nguyn bo cp tnh). Tin lng ca u bch huyt hng ny ty vo bnh pht trin mc no. Nu bnh cha pht trin nhanh khi pht hin, th c th tr c bng liu php ha hc. Nu bnh pht trin nhanh khi pht hin, th kh d tr c bng cch cng thm phng php ghp t bo mm (ly t bnh nhn hay b con tng thch) vo chng trnh iu tr.

a u ty
y l loi u, m cc bch huyt bo cn rt non, gi l tng bo, tch t trong c th, nht l cc xoang ca xng. U ty l trng hp cc t bo sn sinh khng th v nhng cht chng vim nhim khc, pht trin bt bnh thng. T bo u ty c th lm tiu hao lng canxi ca xng v lm xng b xp, dn n tnh trng au xng v gy xng, lng canxi trong mu cao, thiu mu v suy thn. Tr liu di hn bng cch kt hp bc x, gii phu v liu php ha hc, c kt qu tt i vi nhiu bnh nhn, v phng php ghp t bo mm c th ko di mng sng bnh nhn. Ngoi ra cn c mt s cht v hi vi t bo (noncytotoxic agents), c th dng lm cng xng v trnh b gy. Nhng cht khc, th d nh thalidomide (thalidomide) cho thy c kt qu ha hn khi dng tr bnh u ty.

Thiu mu bt sn (Aplastic anaemia)

Bnh thiu mu bt sn l trng hp ty xng ngng sn sinh ton b cc t bo mu. Bnh ny khc bnh bch cu ch, l cc t bo khng sinh sn thay v khng tng trng. Nh vy trong ty xng c rt nhiu t bo m thay v t bo sn sinh mu nh bnh thng. Bnh ny c th nh hng n ngi thuc mi la tui, nhng thng xy ra tui t 15 n 24, v trn 60 tui. Thot u bnh ny c v ging nh bnh bch cu. Cch tr liu gm c thuc c ch min dch, ghp t bo mm, yu t kch mu tng trng v kch thch t pht trin m (anabolic).

Hi chng lon sn ty (Myelodysplastic syndrome)

Lon sn ty i i vi mt s t bo pht trin qu thi k nguyn bo hay t bo mm, v c khi gi l tin thn-bnh bch cu hay bnh bch cu m . Cch tr liu c th l liu php nng hay dng thuc chng

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ung th, ty theo dng bnh hay ghp t bo mm d giao (allogenic stem cell transplant) i vi bnh nhn tr tui.

Nhng bnh ty xng lin h

C nhiu bnh c tnh khc, i i vi t bo ty bo v bch huyt bo, th d nh chng tng tiu cu thit yu (thrombocythaemia), huyt cu t-niu kch pht v m (paroxysmal nocturnal haemoglobinuria), tng hng cu v cn (polycythaemia rubra vera), x ha ty xng (myelofibrosis) v bnh bch cu t bo nhung mao (hairy cell bnh bch cu).

TR LIU
Bnh bch cu v nhng bnh lin h, khng nht thit phi tr liu, nht l trong trng hp ca ngi ln tui. Nhng ngi khc, c th iu tr, thnh thong bng gii phu, bc x, ha cht hay kt hp. Khi tr bnh bch cu mn tnh, thng thng ch cn lin tc ung thuc liu lng thp, ung thuc tng t, hay thnh thong chch thuc gi cho s lng bch cu khng tng cao. Thng thng, bnh nhn bnh bch cu c th khng cn phi iu tr mt thi gian di. Bnh bch cu cp tnh th hu nh lun lun phi tr liu bng cch kt hp thuc chng ung th gi liu php ha hc kt hp. Mc ch khi tr liu l tiu dit phn ln t bo bt bnh thng, t bo bnh thng sn sinh trong ty xng (gi l liu php cm ng [induction therapy]). Khi liu php ha hc lm cho mu v ty xng c v bnh thng v bnh nhn cm thy khe khon, tnh trng ny gi l thuyn gim hon ton. iu quan trng nn bit l thuyn gim hon ton khng c ngha l bnh bch cu b tn dit. Phn ln n lc nghin cu dn vo vic khai trin k thut d tm s lng t bo bnh bch cu cn st li trong ty xng. Liu php cng c (consolidation therapy) c s dng khi bnh trng khng cn hin nhin, sau khi tr bng liu php cm ng, nhng vn bit l bnh cha ht. Tr bng ha cht theo chu k vi liu lng thp, s lm gim thm s lng t bo bt bnh thng. Trong nhiu trng hp, d khng d tm c, nhng mt s t t bo bt bnh thng vn cn trong ty xng. Trong trng hp ny, bnh bch cu c th ti pht v gi l bnh ti pht hay b bnh tr li. Tr liu ln na c th t c tnh trng thuyn gim hon ton nhng cng c th khng.

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tr bnh tip, bc s c th cho bnh nhn dng liu lng thuc thp, gi l liu php duy tr (maintenance chemotherapy). Trong giai on tr liu ny, liu php cm ng v cng c lm gim ti a s t bo bt bnh thng v mc ch ca liu php duy tr nh k l kim ch cn bnh cho n khi, may ra, bnh t ht hay b h min dch tiu dit.

Liu php ha hc (Chemotherapy)

T ng liu php ha hc xut x t hai t ng Hy Lp liu php tc l tr liu, v ha hc tc l ha cht. Liu php ha hc l cch s dng thuc lin tc tiu dit hay kim ch t bo c tnh pht trin. Liu php ny dng mt loi thuc hay kt hp nhiu loi thuc. Ty theo bnh ca bnh nhn, bc s s nh cch tr liu. Khi c tr liu bng liu php ha hc, bnh nhn ung thuc vin hay thuc con nhng, hay chch thuc vo tht (di da), tim thuc vo tnh mch (trong tnh mch), hay qua ng dn c bit ni vi tnh mch. Tr liu bng thuc ung th khng b au n. Thng thng nhng hnh thc khc ca liu php ha hc cng khng gy ra au n, ngoi trng hp b au cht xu v kim chch. Thuc phi lu chuyn trong dng mu i n nhng t bo bt bnh thng. Thuc ca liu php ha hc lm gin on hay tiu dit tin trnh nhn i hay pht trin ca t bo bt bnh thng. Nhng phn ng cng pht c th xy ra Nhiu loi thuc dng trong liu php ha hc c th gy ra phn ng cng pht. B cng pht nng hay nh ty vo bnh nhn. Cc nghin cu hin vn c gng tm cch gii hn ti a cc phn ng cng pht ny v hin nay c nhiu loi thuc mi c bo ch ngn chn phn ng cng pht. Thuc ca liu php ha hc ngn chn t bo nhn i. Khi t bo ty xng bnh thng, nhn i nhanh chng duy tr sn lng mu, th chng cng b tc ng lin i. Tt c nhng phn ng bt li thng thy xy ra vi bnh nhn, d nh hay nng, u c tnh cch tm thi v bnh nhn s c thng xuyn th mu theo di tc ng ca thuc.

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Liu php ha hc nh hng n nhng t bo pht trin nhanh. Nhng t bo ny c th l t bo bnh thng cng nh t bo bnh bch cu, bnh bch huyt hay bnh u ty. Nhng t bo bnh thng c th b nh hng bao gm: ty xng h tiu ha (ming, bao t v rut) nang lng/tc.

Tuy nhin, t bo bnh thng c kh nng ti sinh. Tc ng i vi ty xng Ty xng l ni c th sn sinh t bo mu: bch cu chng vim nhim hng cu, trnh tnh trng thiu mu v vn chuyn xy n cc m tiu cu gip mu ng li v vt da t d lnh.

Do , sau khi iu tr bng liu php ha hc, t bo ty xng bnh thng c th tm thi ngng hot ng, khin cho bnh nhn b thiu mu v chy mu hay chy mu nhiu hn. Tc ng vi h tiu ha V t bo bnh thng ca h tiu ha (ming, bao t v rut) b thuc tiu dit, bnh nhn ca liu php ha hc c th b nhng iu di y: bun nn, i v n khng ngon ming trong ming b l v khi nut b au i cu thng xuyn v phn lng to bn v gic bin i.

Tc ng vi lng/tc Tm thi b rng tc (k c lng) l hin tng ph thng nhng khng phi thuc no cng vy. Hu ht trng hp, sau khi liu php ha hc chm dt, lng/tc s mc li. Tc ng vi sinh sn Liu php ha hc c th lm cho c nam ln n b tit sn. Tuy nhin c trng hp bnh nhn vn c th c con c, nhng phi tho lun vi bc s hay y t chuyn khoa nu mun c con.

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Kinh nguyt ca ph n cha tt kinh c th tri st hay ngng mt thi gian. Ph n ln tui hn c th b tt kinh sm. Ph n c th th thai, nhng v phng din y khoa th khng nn. Nn tho lun v phng php nga thai vi chuyn gia huyt hc. Tc ng chm Trong trng hp bnh nhn sng th, c khi h d b mc cc loi ung th khc, c l v c iu tr bng liu php ha hc v bc x. Ngoi ra, vic tr liu c th lm cho tr em km thng minh (gim thng s thng minh). Qu v nn tho lun nhng vn ny vi bc s lm sng.

Liu php bc x (Radiation therapy)

Liu php bc x l cch s dng tia-X c bit tiu dit t bo ung th. Ty liu lng v v tr ri bc x, iu tr bng cch ny c th gy ra tc ng ging nh liu php ha hc. i vi mt s dng bnh bch cu, liu php bc x c bit c th ri vo u. Nh vy, bnh nhn c th b chng mt v mt mi mt thi gian, nhng s t bt dn.

T bo mm hay ghp ty xng

T xa n nay, t ng ghp ty xng, vn dng m t tin trnh ghp t bo ty xng vo bnh nhn sau khi iu tr bng liu php ha hc v/hay bc x bng liu lng mnh. By gi, tin trnh ny oc gi l ghp t bo mm (stem cell transplantation). T bo mm sinh si ny n trong ty xng v chu trch nhim ch to hng cu, bch cu v tiu cu. Mt s t t bo mm cng lu chuyn trong mu. tr dt bnh cho bnh nhn, bc s s dng liu lng mnh. Nhng khi s dng liu lng mnh, thng thng nhng t bo mm bnh cng chu chung s phn nhng t bo bt bnh thng cn tn ti. vt qua tr ngi ny, trc khi xc tin tr liu, bc s s ly t bo mm ca bnh nhn ra v ghp vo bnh nhn sau khi tr xong bng liu lng mnh. Nhng t bo mm ny s pht trin trong xoang xng, v sn xut hng cu, bch cu v tiu cu. T bo mm l nhng t bo quan trng d c ly ra t mu, khi chng lu chuyn trong mch mu, hay t ty xng, ni chng ngh ngi v sinh si ny n. T bo mm c th c ly ra bng nhiu cch v t nhiu ngi hin tng khc nhau.

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Ngun t bo mm Ty xng: t bo mm c th ly t ty xng ca ngi hin tng. Ngi hin tng s c gy m, ri m nhiu mi kim vo ty xng hng chu rt t bo mm. Mu tun hon: trong mch mu c mt s rt t t bo mm. Sau khi iu tr bng liu php ha hc hay bng kch thch t ty xng, thng gi tt l G-CSF, t bo mm s ri khi ty xng, chy vo mu nhiu hn. Nhng t bo mm ny c th c ly ra bng k thut gn lc c bit, s dng my phn t bo. Mu giy nhau: Thng thng, sau khi sinh em b, mu giy nhau s b thi b. y l ngun t bo mm phong ph. Nhng t bo mm c th c rt ra t giy nhau ph thi, sau khi sinh em b, ct gi di hn v c th l dng lm ngun ty xng. Tin trnh ny khng gy nguy him cho b m hay em b. T bo mm ca ngi hin tng Bn thn (Autologous): t bo mm ca chnh bnh nhn. Nhng t bo mm ny c th rt ra khi bnh nhn trong thi k thuyn gim. (bn thn = chnh mnh) Anh ch em: t anh, ch hay em tng thch, hay trong trng hp him thy, t ngi thn khc trong gia nh. (Trc y, gi l di truyn d giao [allogeneic]). Ngi l: t bo mm c th c rt t ngi tnh nguyn, c tn trong s b hin tng ty xng hay mu giy nhau, hot ng khp th gii. Nh phng php i chiu in ton, nn c th tm ngi hin tng tng thch vi bnh nhn. Nhng phng thc ny c th khng ph hp vi mi ngi hay khng th s dng vi mi bnh nhn, v bc s, y t v gia nh phi mt nhiu cng sc v bnh nhn cng b d b nguy him. Tuy nhin, nu lm c, ghp t bo l c hi cha c bnh c bit n nhiu nht, i vi nhiu bnh tt.

Nhng cht iu chnh phn ng sinh hc

Ngy cng c nhiu quan tm v lnh vc bo ch s lng ln nhng cht thng c trong c th m c th s dng tr bnh bch cu, bnh bch huyt v bnh u ty. i cng, nhng cht ny gm c bn loi: cht c th c ch vic sn sinh t bo bt bnh thng (v d nh interferon i vi CML),

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cht c th kch thch ty xng bnh thng ti sinh (v d nh nhn t kch thch cm), cht c th kch thch t bo bnh bch cu trng thnh bnh thng mt thi gian (axt retinoic), v cht gip h min dch tiu dit t bo bt bnh thng (v d nh khng th n tnh).

C mt bnh tng i t ngi bit n, gi l bnh bch cu t bo nhung mao (hairy cell), tr bng interferon kh d dng, nhng nay c nhng thuc tt hn, th d nh cladribine. Cng cuc nghin cu v tm hiu vn tip din trn mi lnh vc.

I SNG B UNG TH MU V TY XNG

iu quan trng l ch trng vo vic sng mt cuc i ngi bnh nguy him n tnh mng, thay v ch cht. Thng thng mc ch ca vic tr liu l tr dt bnh, nhng d khng th t c iu ny i na, t ra cng c th c c nhng thng nm sng khe mnh v thuyn gim hon ton. Bnh nhn thng hay c xu hng nh gi tng lai mnh theo kt qu tt hay xu ca ngi khc. Tuy nhin, mi ngi chng ta khc nhau, v kt qu tr liu cng c tnh cch c nhn. Bnh nhn cn nn bit l nhn vin y khoa v iu dng c th cung cp thng tin cn thit v c hun luyn a ra quyt nh c lp v c trch nhim. Nh , bnh nhn c th sinh hot ht sc bnh thng.

Thng tin v tr gip

Khi c chn bnh ny, bnh nhn c cch i ph khc nhau. Thc ra, chng c cch i ph no ng hay sai, hay cch i ph mu mc no. Cng nn bit l s hiu bit c th gip xua tan bt phn no ni lo s v nhng iu m mt. i vi mt s ngi, khi bnh c chn on r rng, h c nhng phn ng khc nhau, t cm tng khng chp nhn n cm gic rng ri chn tay. Cng c nhiu ngi cm thy bt lc, tc gin v hoang mang. Con ngi ta thng s cht hay s ngi thn yu b cht. Mt khc, mt s ngi li phn vn khng bit h c tht s b bnh hay khng. Mt s ngi cm thy bi ri v bn thn hay ngi thn trong gia nh b bnh c tnh. Nhiu ngi lo lng v vin cnh phi cha tr tn nhiu tin.

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D nhin, c ngi mun c kin th nh v cch tr liu v phn ng cng pht, v liu php khc. Tt nht l bnh nhn v gia nh ni chuyn thng vi bc s, v bt c thc mc hay nghi ngi no v y khoa. Ngoi ra, ni chuyn vi chuyn vin y khoa khc, cc bnh nhn v ngi thn trong gia nh, am tng v tnh cht phc tp ca nhng xc cm v nhu cu di hn c bit ca ngi phi sng vi cn bnh ny, cng l iu c ch.

NI KHC C TH GIP C
Bnh nhn nn thng xuyn nu thc mc v y khoa vi bc s. Cn bnh, cch tr liu v tc ng i vi bnh nhn c trnh by trong tp ti liu ny. Tuy nhin, bnh nhn c th gp phi nhng vn khc, lm cho cho h bn tm khng km cn bnh, th d: p lc tinh thn i vi bnh nhn v/hay gia nh ch hay vic i li ti chnh hc hnh vic lm.

C nhng t chc chuyn gip bnh nhn v gia nh vt qua hay gim thiu ti a nhng vn v x hi. Gia nh phi mnh dn tho lun nhng vn ny vi nhn vin y khoa v iu dng. Ngoi ra, iu phi vin dch v tr gip ca Hi Bnh Bch Cu cng c th gip. Kh nng i ph c vi nhng vn tnh cm ca mt c nhn thay i khng ngng. Chia s vn bng cch tho lun ci m, s c li v cng, khng ring i vi bnh nhn, m cn i vi ngi hu thun. Thng thng bnh nhn s chia s nhng vn tnh cm vi chuyin vin y khoa hay gia nh. Nhng nu tho lun vi ngi khc cng cnh ng cng c th c li. Hi Bnh bch cu (The Leukaemia Foundation) c vn phng ti cc tiu bang v lnh a. Mun bit thm chi tit, xin in thoi s 1800 620 420 hay xem ti website www.leukaemia.com

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