- I-Neupogen (filgrastim) yandisa ama-neutrophils ukuze kuncishiswe ukutheleleka ezigulini ezinomdlavuza webele ezithola ukwelashwa ngamakhemikhali, kodwa ingabangela ubuhlungu bamathambo, umkhuhlane, kanye nokucasuka endaweni yomjovo.
- Kunemiphumela emibi emibi kakhulu, nakuba ingavamile, njengokuqhuma kwe-splenic, izinkinga zamaphaphu, i-capillary leak syndrome, ukulimala kwezinso, i-aortitis, kanye nengozi ye-MDS/leukemia emaqenjini athile.
- Ukusetshenziswa okuphephile kudinga isikhawu esincane samahora angama-24 ngemuva kokwelashwa ngamakhemikhali, ukugcinwa esiqandisini, ukulahla kahle izinto ezibukhali, ukuqapha njalo elabhorethri, kanye nokunaka ukungezwani komzimba (i-latex, i-sorbitol).
- Izindleko, ukufinyelela kuma-biosimilar, izinhlelo zokusekela, kanye nengxoxo eqhubekayo nethimba lezokwelapha kubalulekile ekulinganiseni izinzuzo, izingozi, kanye nokunamathela ekwelashweni.
Ukuthola ukuxilongwa komdlavuza webele kanye nokwelashwa ngamakhemikhali sekuvele kuyinselele enkulu, futhi lapho udokotela ekhuluma ngokusebenzisa i-Neupogen (filgrastim) ukuvikela ezifweni, kuyinto evamile ukukhathazeka ngemiphumela emibi. Lo muthi usebenza ngqo emnkantsheni wamathambo ukwandisa amangqamuzana amhlophe egazi, okuyinto enhle kakhulu ekuvikeleni komzimba, kodwa futhi ingabangela imiphumela emibi engathandeki, futhi kwezinye izimo, emibi kakhulu.
Kulo mhlahlandlela ngesiPutukezi, sizochaza ngokuningiliziwe ukuthi iyini i-Neupogen/filgrastim, isetshenziselwani uma kukhulunywa ngomdlavuza webele kanye nezinye izindlela zokwelapha umdlavuza, ukuthi isetshenziswa kanjani, ukuthi yimiphi imiphumela emibi engaba khona (kusukela kwevame kakhulu kuya kweyivelakancane, kodwa engathi sína), nokuthi yiziphi izinyathelo zokuphepha ongazithatha empilweni yakho yansuku zonke. Umqondo uwukuthi ungaxhumana nethimba lezokwelapha ngokuzethemba kakhudlwana, uqonde izingozi, izinzuzo, kanye nezinketho zokulawula ubuhlungu, ukugcina, izindleko, kanye nezinkinga zokuzala.
Iyini i-Neupogen (filgrastim) futhi isetshenziselwani?
I-Neupogen yigama lokuhweba lomuthi obizwa ngokuthi i-filgrastim, inguqulo yokwenziwa ye-granulocyte colony-stimulating factor (G-CSF). Lesi sici siyinto ekhiqizwa ngumzimba ngokwawo ngokwemvelo ukuze kukhuthazwe umongo wamathambo ukuthi ukhiqize ama-neutrophil engeziwe, uhlobo oluthile lweseli. iseli legazi elimhlophe unesibopho sokulwa namagciwane nezinye izifo.
Ngesikhathi sokwelashwa ngamakhemikhali omdlavuza webele, kuvamile kakhulu ukuthi inani lamaseli amhlophe egazi lehle kakhulu, okushiya umzimba usengozini enkulu yokutheleleka okukhulu kanye nokulaliswa esibhedlela. I-Filgrastim yenzelwe ngqo ukunciphisa le ngozi: isheshisa ukukhiqizwa kwama-neutrophils futhi isiza ekwenzeni ukuhlolwa kwegazi kube ngokwejwayelekile ngokushesha, inciphise isikhathi somkhuhlane we-neutropenic kanye nethuba lezinkinga.
Ngaphezu komdlavuza webele, i-filgrastim isetshenziswa kwezinye izimo eziningana zezokwelapha lapho kudingeka khona ukwandisa inani lamaseli amhlophe egazi. Phakathi kwabo kukhona iziguli ezithola ukwelashwa ngamakhemikhali ngenxa yezinye izimila, abantu abachayeke emisebeni eningi, kanye nalabo abalungiselela ukufakelwa amaseli e-stem (ukuhlanganiswa kwamaseli e-stem). umnkantsha igazi) kanye nokwelashwa kwezinhlobo ezithile ze-neutropenia engapheli enzima.
Kukhona futhi izinhlobo ezibizwa ngokuthi ama-biosimilars, okuyimithi efana kakhulu ne-Neupogen yokuqala ngokusebenza nangokuphepha, evunyelwe yizikhungo ezifana ne-FDA. Phakathi kwezinto ezifana ne-filgrastim kukhona, isibonelo, i-filgrastim-sndz (Zarxio) kanye ne-filgrastim-aafi (Nivestym), ngaphezu kwezinye izinhlobo ezifana ne-Granix, i-Releuko, ne-Nypozi, ezingasetshenziswa ngokushintshana ngokusho kokuhlolwa kodokotela womdlavuza.
Isetshenziswa kanjani i-filgrastim futhi ukwelashwa kuthatha isikhathi esingakanani?
I-Filgrastim inganikezwa ngezindlela ezimbili eziyinhloko: ngokujova ngaphansi kwesikhumba (ngaphansi kwesikhumba) noma ngqo emthanjeni, ngokujova nge-intravenous (IV). Empeleni, indlela yokwelapha engaphansi kwesikhumba ivame kakhulu ezigulini ezinomdlavuza webele ngoba ivumela ukusetshenziswa okulula ekhaya ngemva kokuqeqeshwa okufanele.
Ngokuvamile, umuthi usetshenziswa kanye ngosuku, okungcono ngaso sonke isikhathi ngesikhathi esifanayo, kuze kube yilapho inani lama-neutrophil libuyela ezingeni elibhekwa njengeliphephile. Umthamo oqondile ubalwa ngokusekelwe esisindweni somzimba kanye nesizathu sokusetshenziswa (isb., ukwelashwa ngamakhemikhali, i-neutropenia engapheli, ukulungiselela ukufakelwa, ukuchayeka emisebeni).
Ukwelashwa kokuqala kweziguli ezithola ukwelashwa ngamakhemikhali kufanele kwenzeke okungenani emahoreni angama-24 ngemva kokuphela komjikelezo we-chemotherapy, hhayi ngaphambi noma ngesikhathi esifanayo. Lesi sikhathi sibalulekile ngoba i-filgrastim ivuselela amaseli omnkantsha wamathambo, kanti i-chemotherapy ingawabhubhisa uma evuselelwa kusenesikhathi, okunciphisa izinzuzo zomuthi.
Kumdlavuza webele othola ukwelashwa ngamakhemikhali, indlela ejwayelekile kakhulu ukusebenzisa i-Neupogen nsuku zonke cishe izinsuku ezingu-14 ngemva komjikelezo ngamunye, noma kuze kube yilapho inani legazi libonisa ukuthi ama-neutrophil angaphakathi kwebanga elifanele. Ngokuphambene nalokho, ku-neutropenia engapheli kakhulu, ukusetshenziswa kungase kuqhubeke izinyanga eziningi noma iminyaka, ngaphansi kokuqashwa ngokucophelela yi-hematologist.
Kwezinye izimo ezithile, njenge-neutropenia engapheli enzima, udokotela angakhetha imithamo emibili ngosuku ukuze alondoloze inani elizinzile lama-neutrophil. Ukulungiswa komthamo kungadingeka futhi ngokuhamba kwesikhathi, kwande noma kwehle ngokwemiphumela yokuhlolwa nezimpawu ezivezwe yisiguli.
Ukugcina, ukuphatha kanye nokuphepha kokusetshenziswa ekhaya.
I-Filgrastim kufanele igcinwe esiqandisini, ephaketheni layo lasekuqaleni, ivikelwe ekukhanyeni, futhi akufanele iqandiswe. Eminye imikhiqizo ingagcinwa ekamelweni lokushisa isikhathi esithile; kubalulekile ukuhlola imiyalelo ethile ebhodleleni lakho noma kwisirinji bese ulandela ngokuqinile isikhathi noma umkhawulo wosuku obonisiwe.
Ukuze unciphise ubuhlungu nokusha ngesikhathi sokufaka, kunconywa ukususa isirinji noma i-vial esiqandisini cishe imizuzu engama-30 ngaphambi komjovo, okuvumela umuthi ukuthi ufinyelele izinga lokushisa legumbi ngokwemvelo. Umkhiqizo akufanele ufudunyezwe emanzini ashisayo, kuma-microwave, noma kwezinye izinto zokushisa, futhi akufanele ibhodlela lizanyazanyiswe ngamandla, njengoba lokhu kungalimaza i-molecule.
Ngaphambi kokufaka, kubalulekile ukuhlola isixazululo ngamehlo: uma sinamafu, sinegwebu, siqukethe izinhlayiya, sishintshile umbala, noma sesidlulile usuku lokuphelelwa yisikhathi, akufanele sisetshenziswe. Ibhodlela ngalinye lomthamo owodwa noma isirinji egcwaliswe kusengaphambili ilungele ukusetshenziswa kuphela futhi kumele ilahlwe ngokuphelele ngemva kokusetshenziswa, noma ngabe kukhona ikhambi elisele.
Izinaliti ezisetshenzisiwe, amasirinji, nama-vial akufanele kuphonswe emigqonyeni kadoti evamile noma emigqonyeni yokuvuselela; indlela efanele yokukulahla isesitsheni esiqinile, esingabhobozi esinesivalo esiqinile. Uma lesi sitsha sesigcwele, isiqondiso siwukulandela imithetho yendawo yokulahla izinto ezibukhali noma ubuze ithimba le-pharmacy/le-oncology ukuthi ungaqhubeka kanjani.
Iziguli ezinesifo sokungezwani komzimba ne-latex zidinga ukunakwa okukhethekile ngoba isivikelo senaliti sezinye izirinji ezigcwaliswe kakade siqukethe irabha yemvelo ethathwe ku-latex. Kulezi zimo, kubalulekile ukwazisa udokotela, ongakhetha isethulo esihlukile noma amadivayisi angenalo lolu hlobo, okunciphisa ingozi yokusabela kokungezwani komzimba.
Izinkomba eziyinhloko zezokwelapha ze-Neupogen/filgrastim
Ukusetshenziswa kwe-filgrastim okwaziwa kakhulu ukunciphisa ingozi yokutheleleka kubantu abathola ukwelashwa ngamakhemikhali okubangela ukulahlekelwa okukhulu komnkantsha wamathambo, njengoba kuvame ukwenzeka kumdlavuza webele. Lokhu kunciphisa amathuba okuba nomkhuhlane we-neutropenic, ukulaliswa esibhedlela, kanye nokubambezeleka kwemijikelezo yokwelashwa; umuthi uphinde uthuthukise izindlela zokuzivikela ezifana... i-opsonization.
Lo muthi usetshenziselwa futhi ukwandisa inani lamaseli amhlophe egazi ezigulini ezinezinkinga ezithile zomnkantsha wamathambo, njenge-neutropenia engapheli enzima, kungaba ukuzalwa, umjikelezo, noma i-idiopathic. Kulezi zimo, i-filgrastim isiza ukugcina ama-neutrophils ezingeni elinciphisa ukutheleleka okuphindaphindiwe.
Esinye isibonakaliso esibalulekile sisebantwini abachayeke emithini ethile yemisebe, lapho kunengozi yokulimala okukhulu komnkantsha. I-Filgrastim ingasekela ukubuyiselwa kokukhiqizwa kwamaseli egazi kulezi zimo, njalo ngaphakathi kwezinqubo ezithile.
Ekufakweni kwamaseli e-stem (i-autologous noma i-allogeneic), i-filgrastim ingasetshenziswa "ukuhlanganisa" amaseli avela emnkantsheni ukuze ajikeleze igazi, okwenza kube lula ukuqoqwa yi-leukapheresis. Ngemva kokufakelwa, ingasetshenziswa futhi ukusheshisa ukubuyiselwa kokukhiqizwa kwamangqamuzana amhlophe egazi.
Kubalulekile ukukhumbula ukuthi udokotela angakunikeza i-filgrastim ngezinye izizathu zomuntu ngamunye, ehlola njalo izingozi nezinzuzo. Kuzo zonke izinkomba, ukuhlolwa kwegazi njalo kubalulekile ukuze kuqashwe inani futhi kulungiswe ukwelashwa.
Umjovo we-subcutaneous uphathwa kanjani ngokoqobo?
Uma i-filgrastim inikezwa ekhaya, isiguli noma umnakekeli uthola ukuqeqeshwa okuvela kubasebenzi abahlengikazi ngendlela yokulungisa izinto, ukukhetha indawo yokujova, kanye nokunikeza umjovo ongaphansi kwesikhumba ngokuphephile. Njengomthetho ojwayelekile, umjovo ufakwa emafutheni esiswini (ukugwema i-radius engu-5 cm ezungeze inkaba), ithanga langaphandle, noma, uma omunye umuntu efaka umjovo, ngemuva kwengalo noma izinqe.
Kubalulekile ukushintshanisa (ukushintshanisa) indawo yomjovo ngokusetshenziswa ngakunye ukuze kuncishiswe ukucasuka, ukubomvu, kanye nokuqina kwesikhumba. Ungajovi ezindaweni ezinemivimbo, izibazi, amabala okwelula, isikhumba esivuvukele, esixebukayo, noma isikhumba esibucayi kakhulu.
Ngaphambi nangemva komjovo ngamunye, kuyimpoqo ukugeza izandla zakho kahle ngensipho namanzi, nokulandela imiyalelo ye-aseptic enikezwe yithimba lezokwelapha. Uma umuthi uthinta isikhumba noma amehlo, geza ngokushesha: ngensipho namanzi uma kwenzeka ukuthi isikhumba sithintekile, kanye namanzi amaningi abandayo agobhozayo uma efika emehlweni, ufune usizo lwezokwelapha uma kuvela ukucasuka.
Isixazululo akufanele sinyakaziswe, futhi amasirinji noma amabhodlela awile noma abonakalisiwe akufanele asetshenziswe. Noma nini lapho kukhona ukungabaza ngokubonakala komkhiqizo noma inqubo yokufaka isicelo, kungcono ukuxhumana nodokotela wakho noma nosokhemisi ngaphambi kokusebenzisa.
Uma ukhohlwa umthamo, akukhuthazwa ukuthi umane uphindwe kabili olandelayo; okungcono kakhulu, kufanele ushayele udokotela wakho noma insizakalo ye-oncology bese ucela isiqondiso esithile. Ezimweni eziningi, uchwepheshe wezempilo uzolungisa ishejuli noma aqinisekise ukuthi umthamo ophuthelwe usadinga yini ukunikezwa.
Imiphumela emibi evame kakhulu ye-Neupogen/filgrastim
Umphumela omubi kakhulu we-filgrastim ubuhlungu bamathambo, obuvame ukuzwakala emathangeni, ezinqeni, ezingalweni, ezingalweni, emilenzeni, noma emgogodleni. Lokhu kwenzeka ngoba umongo wethambo ukhuthazwa kakhulu ukukhiqiza amangqamuzana amhlophe egazi, okungadala ukungakhululeki okuphakathi kuya kokukhulu kwezinye iziguli.
Ngaphezu kobuhlungu bamathambo, ubuhlungu bamalunga kanye nobuhlungu bemisipha nakho kuvamile, kanye nobuhlungu bomhlane, ikhanda elibuhlungu, kanye nemizwa yokukhathala noma ubuthakathaka. Kweminye imibiko evela ezigulini ezinomdlavuza webele, ukungakhululeki kwemisipha nemisipha nge-Neupogen kuhlala isikhathi eside kunakwamanye ama-G-CSF asebenza isikhathi eside, njenge-Neulasta (pegfilgrastim).
Eminye imiphumela emibi evamile ihlanganisa umkhuhlane omncane, isicanucanu, ukuhlanza, isifo sohudo, ubuthakathaka obujwayelekile, ukuphuma kwegazi ekhaleni (epistaxis), ukulunywa, ukuqubuka kwesikhumba, kanye nokulahlekelwa izinwele. Ezimweni eziningi, lokhu kusabela kungokwesikhashana futhi kuyathuthuka ngemva kokumiswa kwemijovo noma ngokulungiswa komthamo.
Abanye abantu baqaphela ukucasuka, ukusha, ukubomvu, noma ukulunywa endaweni yokujova, ikakhulukazi uma umuthi usetshenziswa usabanda kakhulu, usuka ngqo esiqandisini. Ukuze unciphise lokhu kungakhululeki, kuyasiza ukushiya isirinji endaweni yokushisa yegumbi cishe imizuzu engama-30 ngaphambi kokufaka nokushintsha izindawo zokujova.
Ithimba lakho le-oncology lingasikisela imithi yokwelapha ubuhlungu efanelekile yokulawula ubuhlungu bamathambo, ligweme imithi evala umkhuhlane (njenge-paracetamol kwezinye izimo) noma ekhulisa ingozi yokopha. Ezimweni ezithile, ama-antihistamine afana ne-loratadine (i-Claritin, kodwa hhayi i-Claritin-D) ayanconywa ukuze kuncishiswe ubuhlungu obuhlobene nokwanda komsebenzi wokuzivikela komzimba.
Ukwehla kwenani lama-platelet kanye nengozi yokopha.
Nakuba i-filgrastim ihloselwe ukwandisa ama-neutrophils, ezinye iziguli zingase zizwe ukwehla kwama-platelet (thrombocytopenia), amaseli abangela ukujiya kwegazi. Lokhu kwandisa ingozi yokopha nokuklwebheka, okudinga ukubhekwa futhi ngezinye izikhathi ukumpontshelwa ama-platelet.
Kubalulekile ukwazisa ithimba le-oncology uma ubona ukuphuka okukhulu ngaphandle kwesizathu esibonakalayo, ukopha kwezinsini, igazi emchameni noma esithweni sakho, noma ukopha kakhulu noma okuvamile ekhaleni. Indle emnyama kakhulu, ebomvu, noma efana nokungalali nayo iyizimpawu eziyisixwayiso.
Ukuze kuncishiswe ingozi yokopha, kunconywa ukugwema izinsingo ezinezinsingo (ukhetha izinsingo zikagesi), ezemidlalo ezithinta umzimba, kanye nemisebenzi enobungozi obukhulu bokuwa noma ukulimala. Kunconywa futhi ukuthi ungasebenzisi i-dental floss noma ama-toothpick phakathi kwamazinyo akho, bese ukhetha ibhulashi lamazinyo elinoboya obuthambile.
Imithi efana ne-aspirin kanye nemithi elwa nokuvuvukala engeyona i-steroidal (ama-NSAID) – i-ibuprofen, i-naproxen, i-celecoxib, phakathi kwezinye – ingandisa ingozi yokopha futhi, ngakho-ke, kufanele isetshenziswe kuphela uma igunyazwe udokotela. Lokhu kusebenza futhi emikhiqizweni ethengiswa ngaphandle kwemithi kadokotela, izithasiselo, kanye nemithi yamakhambi.
Imiphumela emibi kakhulu edinga usizo lwezokwelapha ngokushesha.
Nakuba iziguli eziningi ziyibekezelela kahle i-Neupogen, kunemiphumela emibi engavamile kodwa engaba yingozi edinga ukunakekelwa okuphuthumayo. Ukwazi lezi zimpawu kukusiza ukuthi ufune usizo ngokushesha futhi kugweme izinkinga ezinkulu.
Ukusabela okukhulu kokungezwani komzimba (ukuzwela ngokweqile) kungase kwenzeke, kube nezimpawu ezifana nokuqunjelwa, ukulunywa okuvamile, ukubomvu okukhulu kwesikhumba, ukuvuvukala kobuso, izindebe, ulimi noma umphimbo, ukuphefumula kanzima, ubunzima bokuphefumula noma ukukhuluma, kanye nomuzwa wokuqina esifubeni. Kulezi zimo, kubalulekile ukufuna usizo oluphuthumayo ngokushesha.
Ukuqhekeka noma ukwanda okukhulu kwe-spleen kuyingozi echazwa nge-filgrastim: isiguli singase sibe nobuhlungu obukhulu esiswini esingaphezulu kwesobunxele, ubuhlungu ekhejini lezimbambo elingezansi kwesobunxele, noma ubuhlungu esicongweni sehlombe lesobunxele. Lesi simo singaba sibi kakhulu futhi sidinga ukuhlolwa kwezokwelapha okuphuthumayo noma ukushayelwa ucingo ezikhungweni eziphuthumayo.
Izinkinga zokuphefumula ezifana ne-acute respiratory distress syndrome (ARDS) kanye nokopha kwamaphaphu nazo zibikiwe. Izimpawu ezikhathazayo zifaka phakathi ukuphelelwa umoya, ukuphefumula ngokushesha, ukukhwehlela (ikakhulukazi uma kukhona igazi), ubuhlungu besifuba, umkhuhlane omkhulu, kanye nomuzwa wokungakwazi "ukugcwalisa amaphaphu akho".
Omunye umphumela ongavamile kodwa ongathi sína yi-capillary leak syndrome (noma i-capillary leakage syndrome), lapho izingxenye zegazi "zivuza" ezicutshini nasezimbotsheni zomzimba. Izimpawu zifaka phakathi ukwehla ngokuzumayo komfutho wegazi, isiyezi noma ukuquleka, ubuthakathaka obukhulu, ukuvuvukala okungazelelwe kwezingalo nemilenze, ukukhuluphala ngokushesha, ubunzima bokuphefumula, kanye ngezinye izikhathi nezimpawu zokopha kokugaya ukudla (ukuhlanza igazi noma indle ebukeka njengekhofi, indle emnyama noma enegazi).
Ukulimala kwezinso (i-glomerulonephritis) nakho kungenzeka: ukwehla okukhulu kwenani lomchamo, umchamo omnyama noma obomvu, igwebu eliningi emchameni (iphrotheni), kanye nokuvuvukala kwamaqakala, izinyawo, izandla, noma ubuso kuyizimpawu eziyisixwayiso. Kunoma yisiphi salezi zimo, kubalulekile ukuxhumana nodokotela ngokushesha.
I-Aortitis, i-vasculitis yesikhumba, nezinye izinkinga zokuvuvukala
Umphumela ongejwayelekile kangako, kodwa oqashelwayo, ukuvuvukala kwe-aorta (i-aortitis), umthambo oyinhloko ophuma enhliziyweni. Iziguli zingase zibe nomkhuhlane oqhubekayo, ubuhlungu bomhlane, ubuhlungu besisu, ubuhlungu besifuba, ukukhathala okukhulu, kanye nezimpawu zokuvuvukala eziphakeme ezivivinyweni zelebhu.
Uma usebenzisa i-filgrastim futhi uqala ukuzwa lezi zimpawu ngaphandle kwencazelo ecacile, kubalulekile ukwazisa ithimba lakho lezokwelapha, elingase licele ukuhlolwa kwezithombe ukuqinisekisa noma ukuqeda ukuvuvukala kwe-aorta. Ukwelashwa kuvame ukuhilela ukuyeka imithi futhi ngezinye izikhathi ukusebenzisa... corticosteroids.
I-cutaneous vasculitis ingenye inkinga yokuvuvukala okungenzeka, lapho kukhona ukuvuvukala kwemithambo yegazi esikhumbeni. Kungabonakala njengamabala abomvu noma aphuzi, izindawo ezincane ezibuhlungu noma ezizwelayo esikhumbeni, okuhlala kudinga ukuhlolwa ngudokotela wegazi noma udokotela wezifo zomdlavuza.
Kubantu abane-sickle cell anemia (isifo se-sickle cell), ukusetshenziswa kwe-filgrastim kuye kwahlotshaniswa nezinkinga ezinkulu ze-sickle cell, okuhlanganisa nengozi yokufa. Ngakho-ke, iziguli ezinalo mlando kufanele zazise udokotela wazo ngaphambi kokuqala ukwelashwa futhi ziqashwe ngokucophelela ngesikhathi sokusetshenziswa kwawo.
Ezimweni ezimbi kakhulu, kukhona nemibiko yokwanda okukhulu kwamangqamuzana amhlophe egazi (i-leukocytosis ephawulekayo), okungabangela izimpawu ezifana nomkhuhlane, ukujuluka ebusuku, ukwehla kwesisindo, ukuphazamiseka kokubona, kanye nokuphelelwa umoya. Lesi simo sivame ukutholakala ngokuhlolwa kwelebhu futhi selashwe ngokushintsha noma ukuyeka imithi.
Izingozi zesikhathi eside: i-MDS, i-leukemia, kanye nomdlavuza wesibili.
Ezigulini ezine-neutropenia engapheli eyingozi kakhulu evela ekuzalweni, kunengozi eyaziwayo yokuthola i-myelodysplastic syndrome (MDS) noma i-leukemia eminyakeni edlule. Le ngozi ibonakala ihlobene kakhulu nesifo esiyisisekelo uqobo, kodwa ukusetshenziswa isikhathi eside kwe-filgrastim kusho ukuthi lezi ziguli zidinga ukubhekwa eduze kakhulu, okuhlanganisa nokunaka izimpawu zelebhu ezifana nokuthi Izinduku ze-Auer.
Amacala e-MDS kanye ne-leukemia nawo achazwe kubantu abanomdlavuza webele noma wamaphaphu abathola i-filgrastim ngokuhlanganiswa ne-chemotherapy kanye/noma i-radiotherapy. Lezi zenzakalo zingavela eminyakeni eminingi ngemva kokwelashwa komdlavuza futhi zibhekwa njengomdlavuza wesibili, okuyinto engavamile kodwa ebalulekile ukuyisho.
Ngenxa yale ngozi, ochwepheshe abaningi batusa ukuthi iziguli ezithole ukwelashwa okuhlanganisiwe okuyingozi kakhulu zihlolwe igazi eliphelele okungenani kanye ngonyaka ngemva kokuphela kokwelashwa. Noma yiluphi ushintsho oluqhubekayo kufanele luhlolwe yi-hematologist.
Uma ubona izimpawu ezifana nomkhuhlane oqhubekayo, ukukhathala okukhulu ngaphandle kwesizathu esibonakalayo, ukuphuka okulula, ukopha okungavamile, noma ukwehla kwesisindo okungachazeki, kufanelekile ukufuna ukuhlolwa kwezokwelapha ngisho nangemva kweminyaka eminingi yokusebenzisa i-filgrastim. Ukuxilongwa kusenesikhathi kwesifo segazi esingaba khona kuthuthukisa izinketho zokwelapha.
Ukukhulelwa, ukuzala kanye nokuncelisa
Kusenemininingwane enganele eqinisekile ngokuphepha kwe-filgrastim ngesikhathi sokukhulelwa, ngakho-ke umuthi awunconywa kwabesifazane abakhulelwe ngaphandle kokuthi inzuzo idlula ingozi futhi udokotela enquma kanjalo. Noma ubani okhulelwe, osola ukuthi ukhulelwe, noma ohlela ukukhulelwa kudingeka axoxe ngokuningiliziwe ngokusetshenziswa kwe-Neupogen nethimba lakhe lezokwelapha.
Ngokuphathelene nokuzala, akwaziwa ngokuqinisekile ukuthi ukuchayeka kwengane ku-filgrastim kungabangela ukukhubazeka kokuzalwa; ngakho-ke, kunconywa ukugwema ukukhulelwa noma ukukhulelisa umlingani ngenkathi uphathwa. Izindlela zokuvimbela inzalo ezisebenzayo zinconywa kakhulu kulo lonke ukwelashwa.
Ngisho noma ukuya esikhathini kuyeka okwesikhashana ngenxa ye-chemotherapy, noma uma indoda ikholelwa ukuthi ayikhiqizi isidoda, kungenzeka ukuthi kukhona amathuba okuzala. Ngakho-ke, ukuvikelwa kufanele kugcinwe kuze kube yilapho udokotela eqinisekisa ukuthi akusekho ingozi yokukhulelwa okungafunwa phakathi nalesi sikhathi.
Ngokuphathelene nokuncelisa, isincomo esijwayelekile ukuthi ungancelisi ngenkathi usebenzisa i-Neupogen, ngaphandle kokuthi udokotela wakho akutshele ngenye indlela. Uma isiguli sikhulelwa noma sithola ukuthi siyancelisa ngenkathi sisebenzisa lo muthi, sidinga ukwazisa ngokushesha udokotela waso wezifo zomdlavuza noma isazi segazi ukuze uhlelo lokwelashwa luhlolwe kabusha.
Isexwayiso mayelana nokungezwani komzimba, i-latex, i-sorbitol, kanye ne-sodium.
Abantu abanomlando wokungezwani komzimba ne-filgrastim, i-pegfilgrastim, ezinye izingxenye zefomula, ukudla, udayi, noma izithasiselo kudingeka babike lokhu kudokotela wabo ngaphambi kokuqala i-Neupogen. Noma yikuphi ukusabela okungathi sína kwangaphambilini kulolu hlobo lomuthi kuyisizathu sokuhlola kabusha ukusetshenziswa kwawo.
Eminye imikhiqizo iqukethe i-latex ebhodleleni lezinaliti, okuyinto efanele kulabo abanokungezwani komzimba okuqinisekisiwe nerabha yemvelo. Kulesi simo, ochwepheshe bezempilo kufanele bakhethe inketho engenayo i-latex ukuze bagweme ingozi yokungezwani komzimba.
I-Neupogen iqukethe ne-sorbitol, umthombo we-fructose; iziguli ezinokungabekezelelani ne-fructose okuzuzwe njengefa (isifo esingavamile sofuzo) akufanele zisebenzise lo muthi ngaphandle kwesiqondiso esikhethekile kakhulu. Ezinganeni ezingakwazi ukudla noma ukuphuza amaswidi ngoba zihlushwa isicanucanu, ukuhlanza, ukuvuvuka kwesisu, noma uhudo, kubalulekile ukukhuluma nodokotela ngaphambi kokubanika i-filgrastim.
Ngokuphathelene nokuqukethwe kwe-sodium, isirinji ngasinye esigcwaliswe kusengaphambili siqukethe ngaphansi kuka-23 mg, okwenza kube cishe "okungenasodium". Lokhu kuvame ukusebenza kuphela ezigulini ezidla ukudla okunosawoti omningi kakhulu.
Ukuqapha, ukuhlolwa kwegazi kanye nokusebenzisana kwezidakamizwa
Ngesikhathi sokusetshenziswa kwe-filgrastim, kubalulekile ukuba nokuhlolwa kwegazi njalo, ikakhulukazi inani legazi eliphelele, ukuhlola ukuthi ukwelashwa kuyasebenza yini nokuthi akukho yini ukwanda okukhulu kwamangqamuzana amhlophe egazi noma ukwehla kwama-platelet. Kuye ngesimo sezokwelapha, udokotela angase acele nokuhlolwa kokusebenza kwezinso, izimpawu zokuvuvukala, futhi, kwezinye izimo, ukuhlolwa kwezithombe.
I-Filgrastim ingaphazamisa ezinye izivivinyo zelebhu, ngakho-ke kubalulekile ukwazisa bonke ochwepheshe bezempilo kanye namalabhorethri ukuthi usebenzisa lo muthi. Lokhu kufaka phakathi odokotela bamazinyo, odokotela bezinzwa, kanye nabanye ochwepheshe abangase ba-ode ukuhlolwa.
Imithi ethile ingasebenzisana ne-filgrastim; isibonelo, imithi evuselela ukukhishwa kwe-neutrophil, njenge-lithium, ingase ithuthukise eminye yemiphumela yayo. Ngaphezu kwalokho, uhlu lonke lwemithi, izithasiselo, amavithamini, itiye, kanye nemikhiqizo yemvelo yokusetshenziswa okuqhubekayo kufanele kubikwe kudokotela.
Ungalokothi uqale, uyeke, noma ushintshe umthamo wanoma yimuphi umuthi (kungakhathaliseki ukuthi unikezwa ngodokotela, uthengiswa ngaphandle kwemithi kadokotela, noma wemvelo) ngaphandle kokukhuluma nochwepheshe wezempilo oqapha icala lakho. Lokhu kubaluleke kakhulu ngesikhathi sokwelashwa ngamakhemikhali kanye nokusetshenziswa kwe-filgrastim, lapho ibhalansi phakathi kokusebenza kahle kanye nokuphepha ibucayi.
Uma kwenzeka kusolwa ukuthi i-filgrastim idlulele ngokweqile, isiguli noma umnakekeli kufanele axhumane ngokushesha nesikhungo sokulawula ubuthi noma isevisi yezimo eziphuthumayo. Kubalulekile ukunikeza ulwazi mayelana nokuthi yimuphi umuthi osetshenzisiwe, inani, kanye nesikhathi sosuku ukuze iqembu likwazi ukunikeza isiqondiso esifanele.
Izici eziwusizo: ukuthi ungayitholaphi imithi, umshwalense, kanye nezindleko.
I-Filgrastim ingatholakala kumakhemisi akhethekile, kumakhemisi okuthengisa, ezinsizakalweni zokulethwa kwezincwadi, noma ngqo emitholampilo, emahhovisi odokotela, kanye nasemagumbini okufaka imithi, kuye ngezwe kanye nohlobo lokumbozwa kwezempilo. Ezimweni eziningi, insizakalo yomdlavuza ngokwayo ithatha izintambo zokuhlela ukuhlinzekwa, ihambisana nohlelo lwezempilo.
Kwezinye izinhlelo, i-Neupogen ingase ibuyiselwe ngohlelo lwakho lomshuwalense wezempilo oluyinhloko, uhlelo lwemithi kadokotela, noma ngezinhlelo zomphakathi. Kukhona nezinhlelo zokusiza iziguli kanye namakhadi okukhokha ngokubambisana anciphisa inani lokukhokha ngokubambisana kubantu abanomshuwalense wangasese ofanelekile.
Izindleko zokugcina zesiguli ziyahlukahluka kakhulu kuye ngohlobo lomshuwalense, izwe, isifunda, ikhemisi elikhethiwe, nokuthi ngabe imijovo idinga ukunikezwa ehhovisi likadokotela noma esibhedlela. Kwezinye izimo, ukuvakashelwa kwezicelo kungase kubize imali eyengeziwe, into okufanele icaciswe kusengaphambili.
Amanye amalabhorethri, njengomkhiqizi wokuqala we-Neupogen, agcina izinhlelo ezithile zokusekela ngezimali kulabo abangakwazi ukukhokhela izindleko zokwelashwa. Kuhle ukukhuluma nethimba le-oncology noma umnyango wezinsizakalo zomphakathi wesibhedlela ukuthola ukuthi zikhona yini izinketho zalolu hlobo ezitholakalayo.
Uma izindleko ziyinkinga enkulu, kungenzeka futhi ukuxoxa nodokotela wakho ngokusetshenziswa kwe-filgrastim biosimilars, okuvame ukuba nentengo encintisanayo ngenkathi kugcinwa ukulingana kokwelapha okuqinisekisiwe. Kodwa-ke, lesi sinqumo kufanele senziwe njalo ngokubambisana nochwepheshe.
Imibiko yeziguli kanye nokuhlangenwe nakho okusebenzayo nge-Neupogen.
Iziguli eziye zathola ukwelashwa ngamakhemikhali ngenxa yomdlavuza webele zivame ukubika ukuthi i-Neupogen ibe usizo kakhulu ekubuyiseleni inani lamaseli amhlophe egazi, ivimbela ukubambezeleka kokwelashwa kanye nokunciphisa isikhathi sokwehluleka okukhulu kwesistimu yokuzivikela komzimba. Abesifazane abaningi babika ukuthi amandla abo akhuphukile ezinsukwini ezimbalwa ngemva kokuba amazinga abo amandla esejwayelekile.
Ngakolunye uhlangothi, ukungakhululeki kwamathambo kungenye yezihloko ezixoxwa kakhulu ezithangamini zeziguli; abanye abantu bakuchaza ngokuthi "ubuhlungu obujulile" ezinqeni nasemathangeni, ngezinye izikhathi obuhlala njalo kunobuhlungu bemisipha obuzwakala kwamanye ama-G-CSF. Noma kunjalo, abaningi babika ukuthi, njengoba imijikelezo iqhubeka, bafunda ukubikezela izimpawu futhi basebenzise imithi yokunciphisa ubuhlungu enconywayo ngesikhathi esifanele.
Iziguli eziningana zithi, ngemva kokujova kaningana, ukuhlolwa kwegazi kwazo kubonisa amangqamuzana abomvu egazi emazingeni ajwayelekile kanye namangqamuzana amhlophe egazi kanye nama-neutrophil "phezulu kakhulu," njengoba kulindelekile ngokwelashwa. Lokhu kwanda kokubala kuvame ukuhambisana nomuzwa oqhubekayo wamandla amakhulu nokugxila.
Kubalulekile ukukhumbula ukuthi ukulandisa komuntu ngamunye, yize kuwusizo ekuqondeni okuhlangenwe nakho okusebenzayo, akuthathi indawo yesiqondiso esivela eqenjini lezempilo. Noma yimiphi imiphumela emibi, ukungakhululeki okukhulu, noma ukukhathazeka ngemithi kufanele kuxoxwe ngayo ngqo nodokotela wakho, owazi umlando wakho wezokwelapha ophelele.
Kuyo yonke inqubo, ukuba nendawo yokubuza imibuzo, ukukhuluma ngokwesaba imiphumela emibi, nokuxoxa ngezinye izindlela zokuphatha ubuhlungu kwenza umehluko omkhulu ekunamatheleni ekwelashweni kanye nekhwalithi yokuphila. I-Neupogen/filgrastim iyithuluzi elinamandla lokunciphisa ukutheleleka kwabesifazane abathola ukwelashwa ngamakhemikhali ngenxa yomdlavuza webele, kodwa ukusetshenziswa kwayo okuphephile kuncike ekuqaphelweni okuseduze, ukuxhumana okuhle nethimba lezempilo, kanye nokunamathela eziqondisweni zokugcina, zokusebenzisa, kanye nezokuqapha.