Foreword:
As early as 1970's, the scientist has already discover human body's moving vegetative organization compatibility and leukocyte antigen(Human leukocyte antigen, brief name HLA) is near concern and erupt a measurement method of exhibit the HLA.Afterward the soup in American Seattle doctor Ma3 Shi4(Dr. Thomas), for the sake of smoothly progress different body marrow transplant, emanation line treatment and chemistry treatment which make use of strong dint are the ways that the immunity repress, and the book be availably reduced different body marrow to transplant by these two technical developments behind of reject phenomenon and transplant a body to resist host paroxysm occurrence.The success of soup doctor Ma3 Shi4, can make the marrow transplantation smoothly develop, as a result openned the marrow transplant of new era.But transplant along with the marrow the case number year by year passes to increase, discover that some patients still keep contracting cancer after the marrow transplant.Just because of such, we can not help to ask, the marrow transplant behind whether still Li cancer?Marrow transplant of patient whether than general health have a higher Li cancer a probability?
Would accept marrow transplantation increase the opportunity of Li cancer?
According to the covariance, the patient who accepts marrow transplantation really compares a general health to have a higher Li cancer a probability.As for the marrow transplants the patient's Li cancer probability why will increase, have to classify the Li cancer that the marrow transplantation increase first, the probability is actually the malignant tumor which delivers sex or time hair at first.First, if the patient has already contracted a malignant tumor before the marrow transplant, but after the marrow transplant, the malignant tumor that is originally relapse after still can'ting cure of or cure of and this be the first circumstance.In this kind of case, the tumor contract is still an original malignant tumor, so should stare at it to transplant oneself a treatment for the marrow invalid.
If the patient didn't contract a malignant tumor before the marrow transplant, but contracted a malignant tumor after the marrow transplant, or the patient transplant to in front and back contract a different malignant tumor respectively in the marrow, is the malignant tumors which belongs to new occurrence because of these two kinds of Li cancers of circumstances, generally call of time hair malignant tumor(secondary malignancy).Give examples to say, if patient what to contract is an impatient marrow before the marrow transplant leukemia, after the marrow transplant it impatient marrow although leukemia already completely recovered, subsequent but again again contract blood relationship lump, in this, because impatient marrow leukemia and blood relationship lump belong to a different malignant tumor, at this time the malignant tumor of new occurrence be so-called time hair malignant tumor.Wanting what to explain here BE, even transplant to in front and back and together contract impatient marrow a leukemia in the marrow, want ～only it a second type a dissimilarity, the malignant tumor of lately second type take place still keeps belonging to the malignant tumor of a hair at this time.
Know after delivering a sex and time dissimilarity which delivers a sex malignant tumor at first, we then can furthermore clear.If the sufferer is in the marrow before transplant although do not contract a malignant tumor, the still more generally healthy has a higher Li cancer a probability after the marrow transplant;If sufferer's marrow transplant ago have already contracted a malignant tumor, though have already completelied attain to alleviate after cure, but after the marrow transplant in addition to delivered sex tumor to relapse at first of may, time hair the incidence rate of the malignant tumor also compares generally healthy want Gao.In fact what people worry, mostly is the marrow transplant behind actually it delivers at first of can the malignant tumor relapse?In fact and in addition, time hair the occurrence of the malignant tumor be not a few to see, is also worthy of everyone pay attention to of one of the problem focuses.
Actually marrow patient after transplant its Li cancer probability why will increase, we cure according to the marrow transplantation of treat a distance, be divided into 3 to speak, include a chemistry treatment and project a line treatment, and different body marrow to transplant to describe respectively.
Project a line treatment
We know ° from wide tragedy of island, nuclear explosion in Nagasaki much relevant radiation at cancer-causing the effect of aspect.What radiation cause causes cancer death in, the leukemia takes up 1/6 of the total amount and the scientist notices the research of leukemia very much, because it is a human body to suffer from the cancer disease that the radiation appeared at the earliest stage behind.The outbreak peak of leukemia about takes place after project light upon 5-9 years, but the outbreak peak of other cancers will take place in 15 years around.Wide island, nuclear explosion in Nagasaki already more than 40 year, most of the leukemia sufferers all have already be taken bad, but other cancers still continue to appear medium.
Investigate a manifestation over a long period of time from the Japanese nuclear explosion survival, accept a low doses(about 250 milli- west Fu the following), have no clinical symptom, the incidence rates of leukemia or other solid cancers all with ordinary people's homology.But for the sake of the cause of radiation safety, international project the protection committee(ICRP) did a conservative and very important assumption:Human body as long as accept radiation, ignore amount of is how much, all have already caused cancer and badly inherit of probability existence, have no low limit quantity a value, and cancer-causing or badly inherit of probability with accept amount of into a direct proportion(straight line relation), the amount of is high more and contract of the probability be also big more and this kind of circumstance becomes a probability effect.
As for project whether the occurrence which delivers sex tumor of line treatment and time has relativity or not?Basis a comprehensive is statistics by the research induce by 13 clinical trials of 1962-1992 A.D., the kid, who contract an impatient lymphatic leukemia(ALL) but survive, totally has 56 patients to take place important medical treatment affairs and include 8 patients to alleviate to expect to die in the disease, 4 relapse, 44 appear a hair tumor, but among them of 41 is with project line treatment relevant.Greatly part of time hair the tumor be an all positive or low and malignant degree.Occurrence time hair the risk of the tumor, 259 patients who accept 597 patients who project the treatment and have never accept to project a treatment compare and have already shown the Zhao higher incidence rate.(p value=0.04)Therefore aim at a kid who contract the impatient lymphatic leukemia(ALL), project the occurrence which delivers sex tumor of line treatment and time to contain relativity, and will result in slight ascension of death rate.
Project the time that the line treatment cause hair tumor, if is last skin cancer(carcinoma) or the words of tumor(sarcoma), time hair the tumor is mostly take place in to project the scope that the line treatment project light upon.If the sufferer is once accepting to project line to project light upon a treatment, the nature more had never accepted emanation line to project light upon a treatment of the sufferer has a higher Li cancer a probability.
The chemistry cure
In addition to projecting a line treatment, the chemistry cures to also probably cause the time deliver sex tumor.The time that the chemistry treatment cause hair the leukemia usually has two kinds of types:
(1)Expose after the alkylating agents or radiation a leukemia of develop, most often take place in 3 －s in 7 years, usually at develop a leukemia before will have a period of time to express a marrow to turn to living badly comprehensive disease(myelodysplastic syndroem), after often make progress into FAB a classification the leukemia of the M1 or M2, and have the 5th or the 7th characteristic of chromosomes variation.
(2)The time having relation with the depressant of topoisomerase II hair leukemia, 2 －s which take place after expose usually present M4 or M5 phenotypes in 3 years, and often with the 11 qs 23 and 21 qs 22 and 3 qs 23 chromosomes turn relevant.
The time that the chemistry treatment cause hair tumor, in addition to leukemia and lymphoid lump outside, also include up the skin cancer and the tumor.
If the sufferer once accepted the whole body emanation line treatment and the chemistry treatment of Gao Ji4 Liang2 before transplant in the marrow, theoretically natural compare the sufferer who accepted Gao Ji4 Liang2 chemistry a treatment has a higher Li cancer a probability, but because the opportunity increase by it is really an extremely minute, do not present a meaningful difference on any covariance of cultural heritage.
The different body marrow transplant
Time hair the tumor probably takes place after project line treatment after, chemistry cure after, certainly maying also take place in merge project line cure and chemistry cure.So merge different body marrow transplantation can increment time the opportunity of the hair tumor occurrence?To answer this question the most ideal way is comparison"the different body transplant" with"transplanted from the body" after, time whether the opportunity of the hair tumor occurrence has difference or not.There is a research show, aim at to accept blood stem cell or marrow to transplant of 157 relapse or hard cure of He2 Jie2 Jin's surname lymphoid lump patient, different body blood stem cell or marrow the transplantation apparently has a transplantation thing to resist a tumor effect(Graft-versus-tumor effect), and occurrence time hair the risk of the tumor ratio from body transplant lower.Certainly the aim at to relapse or hard cure of He2 Jie2 Jin's surname lymphoid lump patient, the nature can't lead conclusion to state other disease, but the different body marrow transplant oneself really exist transplantation thing to resist a tumor effect(Graft-versus-tumor effect), probably lower the risk of a hair tumor.
The different body marrow transplantation will lower the immunity dint of the sufferer, so increased a sufferer to contract the risk of "transplant empress lymphoid increase born nature disease", this kind of disease related to EBV(Epstein-Barr virus) and specially and easily take place in the marrow transplantation of clean the T cell.According to the covariance, accept the different body marrow transplant of person's hasing 0.6% around will contract "transplant empress lymphoid increase born nature disease".The marrow transplant therefore and actually can increment time hair the occurrence of the tumor, haven't had cultural heritage to tell us an integrity in fact of answer.
Conclusion
The patient who accepts marrow transplantation really compares a general health to have a higher Li cancer a probability, but if the doctor suggests to accept marrow transplantation, absolutely can't stop eating on account of a hiccup, for the sake of a little Li cancer probability increase by worry, but miss the opportune moment of the best treatment.
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