L\u00f6semi, lenfoma ve multipl miyelom gibi bir\u00e7ok hematolojik hastal\u0131kta iyile\u015ftirici bir tedavi se\u00e7ene\u011fi sunan k\u00f6k h\u00fccre nakli, uygun don\u00f6r\u00fcn bulunmas\u0131 ve ba\u011f\u0131\u015f\u00e7\u0131n\u0131n sa\u011fl\u0131k durumunun ayr\u0131nt\u0131l\u0131 de\u011ferlendirilmesiyle ba\u015fl\u0131yor. HLA uyumu, k\u00f6k h\u00fccre kayna\u011f\u0131n\u0131n do\u011fru belirlenmesi ve ba\u011f\u0131\u015f\u00e7\u0131 takibi, nakil s\u00fcrecinin ba\u015far\u0131s\u0131nda b\u00fcy\u00fck \u00f6nem ta\u015f\u0131yor. D\u00fcnyada y\u0131lda yakla\u015f\u0131k 90 bin k\u00f6k h\u00fccre nakli yap\u0131labiliyor. Memorial Diyarbak\u0131r Hastanesi Hematoloji B\u00f6l\u00fcm\u00fc\u2019nden Prof. Dr. Vefki G\u00fcrhan Kad\u0131k\u00f6yl\u00fc, \u201c16 Eyl\u00fcl D\u00fcnya Kemik \u0130li\u011fi Ba\u011f\u0131\u015f\u00e7\u0131lar\u0131 G\u00fcn\u00fc\u201d kapsam\u0131nda k\u00f6k h\u00fccre ba\u011f\u0131\u015f\u00e7\u0131l\u0131\u011f\u0131nda don\u00f6r se\u00e7imi, HLA uyumu ve k\u00f6k h\u00fccre toplama y\u00f6ntemleri hakk\u0131nda \u00f6nemli bilgiler verdi.<\/p>\n
K\u00f6k h\u00fccre nakli bir\u00e7ok hastal\u0131kta uygulanabiliyor<\/strong><\/p>\n K\u00f6k h\u00fccre nakli; l\u00f6semi, lenfoma, multipl miyelom, miyeloproliferatif hastal\u0131klar ve miyelodisplastik sendromun yan\u0131 s\u0131ra n\u00f6roblastom, glioblastom, Ewing sarkomu, medulloblastom ve \u00e7oklu tedavi s\u0131ralar\u0131na yan\u0131ts\u0131z kanserlerde de uygulanabilen bir tedavi se\u00e7ene\u011fidir. Talasemi, orak h\u00fccreli anemi ve aplastik anemi gibi genetik ve hematolojik hastal\u0131klar ile depo hastal\u0131klar\u0131, imm\u00fcn yetersizlikler ve otoimm\u00fcn hastal\u0131klar da KHN\u2019nin uyguland\u0131\u011f\u0131 hastal\u0131klar aras\u0131nda yer almaktad\u0131r. Kanserlerde KHN\u2019nin temel amac\u0131, kanser h\u00fccrelerinin ortadan kald\u0131r\u0131lmas\u0131d\u0131r. Bunun i\u00e7in k\u00f6k h\u00fccrelerin hastaya verilmesinden \u00f6nce kemoterapi, imm\u00fcno-kemoterapi veya t\u00fcm v\u00fccut \u0131\u015f\u0131nlamas\u0131 gibi haz\u0131rlama tedavileri uygulanmaktad\u0131r. Ayr\u0131ca k\u00f6k h\u00fccrelerdeki lenfositlerin kanser h\u00fccrelerini yok etme etkisinden de yararlan\u0131lmaktad\u0131r. Ba\u011f\u0131\u015f\u0131kl\u0131k sistemi hastal\u0131klar\u0131nda ise ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin yeniden d\u00fczenlenmesi ama\u00e7lanmaktad\u0131r.<\/p>\n Don\u00f6r se\u00e7iminde HLA uyumu \u00f6nem ta\u015f\u0131yor<\/strong><\/p>\n Hastaya k\u00f6k h\u00fccrelerini veren ki\u015fiye don\u00f6r, yani ba\u011f\u0131\u015f\u00e7\u0131 ad\u0131 verilmektedir. Don\u00f6rlere k\u00f6k h\u00fccre ba\u011f\u0131\u015f\u0131n\u0131n kar\u015f\u0131l\u0131k beklemeden ve kendi iradeleriyle yap\u0131ld\u0131\u011f\u0131 konusunda bilgi verilmesi ve onamlar\u0131n\u0131n al\u0131nmas\u0131 gerekmektedir. 18 ya\u015f\u0131n alt\u0131ndaki don\u00f6rlerde ebeveynlerden onam al\u0131nmas\u0131 gerekmektedir. Akraba don\u00f6rler i\u00e7in \u00fcst ya\u015f s\u0131n\u0131r\u0131 genellikle 60 olarak kabul edilirken, T\u00dcRK\u00d6K akraba d\u0131\u015f\u0131 don\u00f6rler i\u00e7in 50 ya\u015f\u0131n\u0131 s\u0131n\u0131r kabul etmektedir. Baz\u0131 \u00fclkelerde bu s\u0131n\u0131r 60-65 ya\u015f aras\u0131nda de\u011fi\u015fmektedir. Ancak don\u00f6r\u00fcn ya\u015f\u0131ndan \u00e7ok sa\u011fl\u0131k durumu ve kemik ili\u011fi rezervi \u00f6nem ta\u015f\u0131maktad\u0131r. Don\u00f6r taramas\u0131nda hasta ve don\u00f6r i\u00e7in \u00f6ncelikle insan l\u00f6kosit antijenlerinin (HLA) tiplendirmesi yap\u0131lmaktad\u0131r. HLA uyumu; naklin ba\u015far\u0131s\u0131, graft versus host hastal\u0131\u011f\u0131 (GVHH), graft yetersizli\u011fi ve mortalite a\u00e7\u0131s\u0131ndan \u00f6nemli rol oynamaktad\u0131r. Aile i\u00e7i tarama karde\u015f, anne, baba ve di\u011fer akrabalardan ba\u015flamaktad\u0131r. HLA-A, HLA-B ve HLA-DRB1 a\u00e7\u0131s\u0131ndan 5\/6 tama yak\u0131n, 6\/6 ise tam uyumlu kabul edilmektedir. Akraba taramalar\u0131nda HLA uyumu yakla\u015f\u0131k y\u00fczde 25 oran\u0131nda bulunmaktad\u0131r.<\/p>\n Akraba d\u0131\u015f\u0131 uygun don\u00f6r de bulunabiliyor<\/strong><\/p>\n Uyumlu akraba don\u00f6r bulunamad\u0131\u011f\u0131nda akraba d\u0131\u015f\u0131 don\u00f6r taramas\u0131 yap\u0131lmaktad\u0131r. T\u00fcrkiye\u2019de bu ama\u00e7la K\u0131z\u0131lay b\u00fcnyesindeki T\u00dcRK\u00d6K\u2019e ba\u015fvurulabilmektedir. KHN merkezleri, hastan\u0131n HLA verilerini T\u00dcRK\u00d6K veri taban\u0131ndaki don\u00f6rlerle kar\u015f\u0131la\u015ft\u0131rarak uygun don\u00f6rleri belirlemektedir. T\u00fcrkiye\u2019de uygun don\u00f6r bulunamamas\u0131 halinde \u0130stanbul\u2019da TRIS ve Ankara\u2019da TRAN arac\u0131l\u0131\u011f\u0131yla d\u00fcnyan\u0131n farkl\u0131 \u00fclkelerindeki don\u00f6r veri tabanlar\u0131nda tarama yap\u0131labilmektedir. Akraba d\u0131\u015f\u0131 don\u00f6rlerde HLA-A, HLA-B, HLA-C, HLA-DRB1 ve HLA-DQ1 de\u011ferlendirilirken 9\/10 tama yak\u0131n, 10\/10 tam uyumlu kabul edilmektedir. Uygun akraba veya akraba d\u0131\u015f\u0131 don\u00f6r bulunamad\u0131\u011f\u0131nda 5-8\/10 uyuma sahip, en az yar\u0131 uyumlu don\u00f6rlerden haploidentik allojeneik KHN yap\u0131labilmektedir. HLA uyumsuzlu\u011fu artt\u0131k\u00e7a GVHH, graft yetersizli\u011fi ve mortalite riski de artmaktad\u0131r.<\/p>\n Don\u00f6rlerin sa\u011fl\u0131k durumu ayr\u0131nt\u0131l\u0131 de\u011ferlendiriliyor<\/strong><\/p>\n K\u00f6k h\u00fccre don\u00f6rlerinde genetik ge\u00e7i\u015fli hastal\u0131klar, fiziksel sorunlar, ailede kanser \u00f6yk\u00fcs\u00fc, aktif ve ila\u00e7 kullan\u0131m\u0131n\u0131 gerektiren hastal\u0131klar, psikiyatrik ve bula\u015f\u0131c\u0131 hastal\u0131klar ara\u015ft\u0131r\u0131lmaktad\u0131r. Ayr\u0131ca gebelik, kan transf\u00fczyonu, seyahat, t\u0131bbi giri\u015fim, kimyasal ve fiziksel etmenlere maruziyet, aile ve al\u0131\u015fkanl\u0131klar de\u011ferlendirilmekte ve detayl\u0131 fizik muayene yap\u0131lmaktad\u0131r. KHN aday\u0131 don\u00f6rden tam kan, p\u0131ht\u0131la\u015fma ve biyokimyasal testler, kan grubu ve kad\u0131nsa gebelik testi yap\u0131lmaktad\u0131r. Kan grubu uyumsuzlu\u011fu, nakil i\u00e7in ret nedeni de\u011fildir. CMV, hepatit B ve C, HIV, toksoplazma, sifiliz ve HSV testleri yap\u0131lmaktad\u0131r. Hemoglobinopatili hastalar\u0131n naklinde kullan\u0131lacak don\u00f6rlerde hemoglobin elektroforezi yap\u0131lmaktad\u0131r. Ayr\u0131ca kardiyoloji ve g\u00f6\u011f\u00fcs hastal\u0131klar\u0131, kad\u0131nlarda ise kad\u0131n hastal\u0131klar\u0131 kons\u00fcltasyonu gerekmektedir. Bu de\u011ferlendirmelerin sonucunda don\u00f6rler k\u00f6k h\u00fccre ba\u011f\u0131\u015f\u00e7\u0131s\u0131 olarak kabul edilebildi\u011fi gibi ge\u00e7ici veya kal\u0131c\u0131 olarak reddedilebilmektedir.<\/p>\n K\u00f6k h\u00fccre kayna\u011f\u0131na g\u00f6re farkl\u0131 y\u00f6ntemler kullan\u0131l\u0131yor<\/strong><\/p>\n K\u00f6k h\u00fccre kayna\u011f\u0131 olarak \u00e7o\u011funlukla periferik k\u00f6k h\u00fccre olmak \u00fczere kemik ili\u011fi ve g\u00f6bek kordonu kullan\u0131labilmektedir. Kemik ili\u011fi; kemik ili\u011fi yetersizli\u011fi ve genetik hastal\u0131klar gibi k\u00f6t\u00fcc\u00fcl olmayan hematolojik hastal\u0131klar\u0131n yan\u0131 s\u0131ra hematolojik kanserlerde de kullan\u0131labilmektedir. Anestezi ve hastaneye yat\u0131\u015f gerektirmesi, i\u015fleme ba\u011fl\u0131 kanama ve a\u011fr\u0131 ile engraftman\u0131n daha ge\u00e7 olmas\u0131 dezavantajlar\u0131 aras\u0131nda yer almaktad\u0131r. G-CSF gibi b\u00fcy\u00fcme fakt\u00f6rlerinin kullan\u0131lmamas\u0131, kateter tak\u0131lmamas\u0131 ve aferez yap\u0131lmamas\u0131 ise avantaj sa\u011flamaktad\u0131r. Periferik k\u00f6k h\u00fccreler, kanser hastalar\u0131n\u0131n yan\u0131 s\u0131ra k\u00f6t\u00fcc\u00fcl olmayan hastal\u0131klar\u0131n KHN\u2019sinde de kullan\u0131labilmektedir. D\u00f6rt-be\u015f g\u00fcn uygulanan G-CSF\u2019ye ba\u011fl\u0131 kemik a\u011fr\u0131s\u0131 ve ate\u015f, kateter gereksinimi, aferez ili\u015fkili komplikasyonlar, bir-\u00fc\u00e7 kez aferez yap\u0131lmas\u0131 ve GVHH riskinin daha s\u0131k g\u00f6r\u00fclmesi dezavantajlar\u0131 aras\u0131nda bulunmaktad\u0131r. Anestezi uygulanmamas\u0131 ve engraftman\u0131n daha k\u0131sa s\u00fcrede ortaya \u00e7\u0131kmas\u0131 ise avantaj sa\u011flamaktad\u0131r. G\u00f6bek kordonu genellikle \u00e7ocuklarda tam uyumlu akraba ve akraba d\u0131\u015f\u0131 don\u00f6r bulunamad\u0131\u011f\u0131nda kullan\u0131lmaktad\u0131r. \u00c7ift g\u00f6bek kordonu tercih edilebilmekte ve eri\u015fkinlerde de k\u00f6k h\u00fccre kayna\u011f\u0131 olarak kullan\u0131labilmektedir. Engraftman\u0131n uzun s\u00fcrmesi, ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin ge\u00e7 toparlanmas\u0131 ve y\u00fcksek riskli kanser hastalar\u0131nda n\u00fcks olas\u0131l\u0131\u011f\u0131n\u0131n y\u00fcksek olmas\u0131 dezavantajlar\u0131 aras\u0131nda yer almaktad\u0131r.<\/p>\n K\u00f6k h\u00fccre ba\u011f\u0131\u015f\u00e7\u0131lar\u0131 takip ediliyor<\/strong><\/p>\n K\u00f6k h\u00fccre don\u00f6rleri G-CSF uygulamas\u0131ndan sonra 10 y\u0131l, G-CSF uygulanmayan don\u00f6rler ise 12 ay takip edilmektedir. Don\u00f6rlerde ortaya \u00e7\u0131kan komplikasyonlar\u0131n b\u00fcy\u00fck b\u00f6l\u00fcm\u00fc erken d\u00f6nemde g\u00f6r\u00fclmektedir. G-CSF ili\u015fkili ge\u00e7 d\u00f6nem p\u0131ht\u0131la\u015fmaya e\u011filim, kalp damar hastal\u0131klar\u0131 ve l\u00f6semi riskinin yap\u0131lan \u00e7al\u0131\u015fmalarda y\u00fcksek oranda bulunmad\u0131\u011f\u0131 belirtilmektedir. K\u00f6k h\u00fccre ba\u011f\u0131\u015f\u0131nda don\u00f6r\u00fcn g\u00f6n\u00fcll\u00fc olmas\u0131, uygun \u015fekilde bilgilendirilmesi, sa\u011fl\u0131k durumunun ayr\u0131nt\u0131l\u0131 e\u011ferlendirilmesi ve ba\u011f\u0131\u015f sonras\u0131nda takip edilmesi b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n Kaynak: (BYZHA) Beyaz Haber Ajans\u0131<\/p>\n","protected":false},"excerpt":{"rendered":" L\u00f6semi, lenfoma ve multipl miyelom gibi bir\u00e7ok hematolojik hastal\u0131kta iyile\u015ftirici bir tedavi se\u00e7ene\u011fi sunan k\u00f6k h\u00fccre nakli, uygun don\u00f6r\u00fcn bulunmas\u0131 ve ba\u011f\u0131\u015f\u00e7\u0131n\u0131n sa\u011fl\u0131k durumunun ayr\u0131nt\u0131l\u0131 de\u011ferlendirilmesiyle ba\u015fl\u0131yor.<\/p>\n","protected":false},"author":1,"featured_media":34174,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[23],"tags":[],"class_list":["post-34173","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-saglik"],"_links":{"self":[{"href":"https:\/\/akdenizolay.com.tr\/index.php\/wp-json\/wp\/v2\/posts\/34173","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/akdenizolay.com.tr\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/akdenizolay.com.tr\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/akdenizolay.com.tr\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/akdenizolay.com.tr\/index.php\/wp-json\/wp\/v2\/comments?post=34173"}],"version-history":[{"count":1,"href":"https:\/\/akdenizolay.com.tr\/index.php\/wp-json\/wp\/v2\/posts\/34173\/revisions"}],"predecessor-version":[{"id":34175,"href":"https:\/\/akdenizolay.com.tr\/index.php\/wp-json\/wp\/v2\/posts\/34173\/revisions\/34175"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/akdenizolay.com.tr\/index.php\/wp-json\/wp\/v2\/media\/34174"}],"wp:attachment":[{"href":"https:\/\/akdenizolay.com.tr\/index.php\/wp-json\/wp\/v2\/media?parent=34173"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/akdenizolay.com.tr\/index.php\/wp-json\/wp\/v2\/categories?post=34173"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/akdenizolay.com.tr\/index.php\/wp-json\/wp\/v2\/tags?post=34173"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}