Lymphoma yog dab tsi?
Lymphoma yog ib lo lus siv rau ib pawg ntawm ntau dua 80 kab mob sib txawv uas pib thaum cov qe ntshav hu ua lymphocytes ua qog noj ntshav. Peb muaj ob hom lymphocytes tseem ceeb, cov no suav nrog B-cell lymphocytes thiab T-cell lymphocytes.
T-cell lymphomas yog mob qog noj ntshav ntawm T-cell lymphocytes, thiab muaj tsawg dua li B-cell lymphomas. Yuav kom nkag siab txog T-cell lymphomas, koj yuav tsum xub nkag siab zoo txog lymphoma. Thov mus saib peb lub vev xaib Lymphoma yog dab tsi rau kev saib xyuas ntawm lymphoma.
Nkag siab T-cell Lymphocytes
T-cell lymphocytes yog ib feem tseem ceeb ntawm peb lub cev tiv thaiv kab mob tiv thaiv peb tiv thaiv kab mob thiab kab mob, thiab tswj peb lub cev tiv thaiv kab mob tiv thaiv kab mob autoimmune. Nws lub cev tiv thaiv kab mob tshwm sim thaum peb lub cev tiv thaiv kab mob tsis ua haujlwm dhau los lossis ua txhaum thiab pib tawm tsam peb lub cev es tsis txhob kis kab mob thiab kab mob.
Hais txog T-cell Lymphocytes
- T-hlwb yog tsim nyob rau hauv peb cov pob txha pob txha, paub tab nyob rau hauv peb thymus, tab sis muaj peev xwm nyob rau hauv ib feem ntawm peb lymphatic system - nrog rau peb cov qog nqaij hlav.
- Feem ntau T-hlwb yuav tsum tau qhib kom ua haujlwm tau zoo. Lawv feem ntau yog so hauv peb cov thymus lossis lwm qhov ntawm peb cov kab mob lymphatic, thiab tsuas yog sawv thiab tua kab mob thaum lwm lub cev tiv thaiv kab mob qhia rau lawv paub tias muaj kab mob lossis kab mob los tua. Thaum lawv sawv, T-hlwb tuaj yeem taug kev mus rau txhua qhov ntawm peb lub cev txhawm rau tiv thaiv kab mob lossis kab mob.
- Qee cov T-hlwb yog lub luag haujlwm rau "kev tswj hwm" lub cev tiv thaiv kab mob. Qhov no txhais tau hais tias ib zaug ib qho kev kis tau raug rhuav tshem, tus "Regulatory T-cells" Qhia rau lwm lub cev tiv thaiv kab mob kom "sawv" kom lawv tsis txhob sib ntaus sib tua thiab ua rau muaj kev puas tsuaj rau peb cov hlwb zoo.
- Natural Killer (NK) hlwb feem ntau hu ua “NK T-cells”. Lawv yog cov tshuaj tiv thaiv kab mob tshwj xeeb uas paub txog thiab rhuav tshem cov qog nqaij hlav cancer. Tsis zoo li lwm cov T-hlwb, NK hlwb tsis tas yuav tsum tau ua kom muaj zog tiv thaiv qog noj ntshav. Lawv npaj txhij los tawm tsam txhua lub sijhawm, thiab nquag txav mus los ntawm koj lub cev ntawm kev saib xyuas cov hlwb uas muaj kev hloov pauv qog noj ntshav.
- Tom qab sib ntaus sib tua kab mob los yog kab mob, qee cov T-cell ua "Memory T-cells". Lawv nco ntsoov txhua yam uas yuav tsum paub txog tus kab mob thiab yuav ua li cas tiv thaiv nws. Txoj kev ntawd, yog tias peb puas tau kis tus kab mob tib yam los yog kab mob dua, peb lub cev tiv thaiv kab mob tuaj yeem tua tau sai thiab zoo.
- Qee cov T-hlwb pab lwm lub cev tiv thaiv kab mob, xws li B-cell lymphocytes ua haujlwm zoo. Cov T-cell no hu ua "Pab T-cells ".
T-cell lymphomas yog dab tsi?
T-cell lymphomas yog ib hom Non-Hodgkin Lymphoma (NHL) uas tsim los ntawm T-cell lymphocytes. Lawv tsis tshua muaj, thiab feem ntau T-cell lymphomas tsim los ntawm cov laus T-cells. Cov T-cell lymphomas feem ntau cuam tshuam rau cov neeg laus dua 60 xyoo thiab muaj ntau dua rau cov txiv neej dua li poj niam.
Txawm li cas los xij, qee zaum T-cell lymphoma tuaj yeem tsim los ntawm T-cells tsis paub qab hau. Qhov no hu ua lymphoblastic lymphoma thiab hom no muaj ntau dua hauv cov menyuam yaus thiab cov hluas.
Ua rau T-cell lymphoma
Peb tsis paub dab tsi ua rau T-cell lymphoma. Muaj qee qhov kev tshawb fawb qhia tias qee yam yuav ua rau koj muaj kev pheej hmoo ntawm kev tsim cov qog ntshav qog ntshav, tab sis feem ntau cov neeg uas muaj kev pheej hmoo yuav tsis tsim cov qog ntshav qog ntshav. Qee qhov kev pheej hmoo raug txheeb xyuas suav nrog:
- Kev kis kab mob tib neeg T-lymphotropic virus type 1 (HTLV-1) yog txuas nrog kev loj hlob ntawm cov neeg laus T-cell leukemia/lymphoma (ATLL).
- Cov kab mob yav dhau los nrog Epstein-Barr tus kab mob (EBV) txuas nrog kev txhim kho ntawm ntau hom qog ntshav, suav nrog angioimmunoblastic T-cell lymphoma (AITL).
- Enteropathy-associated T-cell lymphoma (EATL) yog txuas nrog tus kab mob celiac.
Cov tsos mob ntawm T-cell lymphomas
Nrog ib ncig ntawm 20 ntau hom T-cell lymphoma uas tuaj yeem pib hauv txhua qhov chaw ntawm koj lub cev, cov tsos mob ntawm cov neeg uas muaj T-cell lymphoma tuaj yeem sib txawv heev.
Muaj qee cov tsos mob uas tshwm sim hauv ntau tus neeg mob qog nqaij hlav, thiab lwm tus hu ua B-cov tsos mob uas koj yuav tsum tau qhia rau koj tus kws kho mob sai. Cov tsos mob no tau pom nyob rau hauv cov duab hauv qab no, tab sis kom pom qhov tob ntawm cov tsos mob nyem rau ntawm qhov txuas hauv qab no cov duab.
Kev kuaj mob thiab theem ntawm T-cell lymphomas
T-cell lymphomas tuaj yeem nyuaj rau kev kuaj mob vim peb lub ntsiab. Cov no suav nrog:
- lawv tuaj yeem pib hauv txhua qhov chaw ntawm koj lub cev
- ntau cov tsos mob zoo ib yam li cov pom hauv lwm yam mob, thiab
- lawv tsis tshua muaj ntau tus kws kho mob (GP kws kho mob) tsis tau saib xyuas ib tus neeg uas muaj T-cell lymphoma.
Thawj kauj ruam kom tau txais kev kuaj mob yog kom muaj kev kuaj mob ntawm cov qog nqaij hlav o lossis lwm qhov chaw ntawm koj lub cev cuam tshuam. Qhov no yuav suav nrog kev kuaj tawv nqaij yog tias koj cov qog ntshav qog ua rau koj cov tawv nqaij.
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staging
Kev Tshaj Tawm
Tej zaum koj yuav xav tau kev ntsuam xyuas
Tej zaum koj yuav xav tau ntau hom kev ntsuam xyuas kom kuaj tau T-cell lymphoma, ua haujlwm tawm koj cov subtype, theem thiab qib. Saib cov vis dis aus hauv qab no kom hnov los ntawm Tus Kws Pab Tswv Yim Haematologist Dr Dejan Radeski txog qhov kev sim koj xav tau.
Yuav kho T-cell lymphoma li cas?
Hom kev kho mob uas koj xav tau rau T-cell lymphoma yuav nyob ntawm seb hom kab mob qog ntshav qab zib li cas, txawm tias nws tsis quav ntsej lossis txhoj puab heev, koj cov tsos mob thiab koj tus kheej nyiam. Hauv qab no yog cov ntsiab lus ntawm qee hom kev kho mob uas koj tuaj yeem muab.
Kev kho hluav taws xob siv hluav taws xob x-rays (kua hluav taws xob), los tua cov qog nqaij hlav cancer. Nws tuaj yeem siv los ua kev kho mob ntawm nws tus kheej, lossis nrog lwm yam kev kho mob xws li kws khomob.
Muaj ntau qhov laj thawj uas koj tus kws kho mob tuaj yeem hais qhia kev kho hluav taws xob rau koj. Nws tuaj yeem siv los kho thiab kho qee yam lymphomas thaum ntxov, lossis txhim kho cov tsos mob. Qee cov tsos mob xws li mob lossis qaug zog tuaj yeem tshwm sim yog tias koj cov qog lymphoma loj dhau, lossis ua rau koj cov hlab ntsha lossis qaum qaum. Nyob rau hauv cov ntaub ntawv no, cov hluav taws xob yog muab rau shrink lub qog thiab txo lub siab. Txawm li cas los xij, nws tsis yog tsim los siv los kho.
Radiotherapy ua haujlwm li cas?
X-rays ua rau kev puas tsuaj rau lub cell DNA (cov khoom siv caj ces ntawm lub cell) uas ua rau nws tsis tuaj yeem ua rau lymphoma kho nws tus kheej. Qhov no ua rau lub cell tuag. Nws feem ntau yuav siv li ob peb hnub lossis txawm lub lis piam tom qab kev kho hluav taws xob pib rau lub hlwb kom tuag. Qhov kev cuam tshuam no tuaj yeem kav ntev li ob peb lub hlis, txawm li cas los xij, txawm tias lub hlis tom qab koj kho tiav, cov qog nqaij hlav qog nqaij hlav cancer tseem tuaj yeem raug rhuav tshem.
Hmoov tsis zoo, hluav taws xob tsis tuaj yeem qhia qhov txawv ntawm koj cov qog nqaij hlav qog noj ntshav thiab tsis muaj qog noj ntshav. Yog li ntawd, koj tuaj yeem tau txais cov kev mob tshwm sim uas cuam tshuam rau koj cov tawv nqaij thiab cov khoom nruab nrog cev nyob ze ntawm thaj chaw koj tab tom kho hluav taws xob. Ntau txoj kev siv hluav taws xob niaj hnub no tau dhau los ua qhov tseeb ntau dua rau lub hom phiaj ntawm kev mob qog noj ntshav ntau dua, txawm li cas los xij vim tias X-ray yuav tsum dhau los ntawm koj cov tawv nqaij thiab lwm cov ntaub so ntswg mus txog lymphoma, tag nrho cov chaw no tseem tuaj yeem cuam tshuam.
Koj tus kws kho mob hluav taws xob hluav taws xob (tus kws kho mob tshwj xeeb uas ua haujlwm nrog hluav taws xob) lossis tus kws saib xyuas neeg mob yuav tuaj yeem tham nrog koj txog cov kev mob tshwm sim uas koj tuaj yeem tau txais, nyob ntawm qhov chaw ntawm koj cov qog. Lawv kuj tseem tuaj yeem qhia koj txog qee cov khoom siv tawv nqaij zoo los tswj cov tawv nqaij uas koj tau txais.
Tshuaj kho mob (chemo) tau siv los kho mob qog noj ntshav tau ntau xyoo. Muaj ntau hom tshuaj chemo thiab koj yuav muaj ntau dua ib hom tshuaj kho mob los kho koj CLL lossis lymphoma. Txhua yam kev mob tshwm sim uas koj tau txais yuav nyob ntawm seb cov tshuaj khomob twg koj muaj.
chemo ua haujlwm li cas?
Tshuaj kho mob ua haujlwm los ntawm kev tawm tsam ncaj qha rau cov hlwb uas loj hlob sai. Qhov no yog vim li cas nws feem ntau ua haujlwm zoo rau kev txhoj puab heev - lossis loj hlob lymphomas. Txawm li cas los xij, nws tseem yog qhov kev txiav txim siab no tawm tsam cov cell loj hlob sai uas tuaj yeem ua rau tsis muaj kev phiv tshwm sim hauv qee tus neeg, xws li plaub hau poob, qhov ncauj mob thiab mob (mucositis), xeev siab thiab raws plab.
Vim tias cov tshuaj chemo tuaj yeem cuam tshuam rau txhua lub cell loj hlob sai, thiab tsis tuaj yeem qhia qhov sib txawv ntawm cov hlwb noj qab haus huv thiab cov qog nqaij hlav qog noj ntshav - nws yog hu ua "kev kho mob", txhais tau tias txhua lub cev ntawm koj lub cev tuaj yeem cuam tshuam los ntawm kev mob tshwm sim los ntawm chemo.
Cov kws khomob sib txawv tawm tsam cov lymphoma ntawm ntau theem ntawm kev loj hlob. Qee cov tshuaj tua kab mob qog noj ntshav uas tau so, qee qhov tawm tsam cov uas nyuam qhuav loj hlob tuaj, thiab qee qhov tua cov qog ntshav qog ntshav uas loj heev. Los ntawm muab cov tshuaj chemo uas ua haujlwm ntawm cov hlwb hauv ntau theem, muaj peev xwm tua cov qog ntshav qog ntshav ntau dua thiab tau txais txiaj ntsig zoo dua. Los ntawm kev siv tshuaj khomob sib txawv, peb tuaj yeem txo cov koob tshuaj me me uas tseem yuav txhais tau tias muaj kev phiv tsawg dua los ntawm txhua yam tshuaj, thaum tseem tau txais txiaj ntsig zoo tshaj plaws.
Monoclonal antibodies (MABs) yog thawj zaug siv los kho lymphoma thaum xyoo 1990's lig. Txawm li cas los xij, nyob rau xyoo tas los no, ntau cov tshuaj tiv thaiv kab mob monoclonal tau tsim. Lawv tuaj yeem ua haujlwm ncaj qha rau koj cov qog ntshav qog ntshav lossis nyiam koj lub cev tiv thaiv kab mob rau koj cov qog ntshav qog ntshav los tua thiab tua nws. MABs yooj yim los txheeb xyuas vim tias thaum koj siv lawv lub npe (tsis yog lawv lub npe), lawv ib txwm xaus nrog peb tsab ntawv "mab".
Monoclonal antibodies ua haujlwm li cas?
Monoclonal antibodies tsuas yog ua haujlwm tawm tsam lymphoma yog tias lawv muaj cov proteins tshwj xeeb rau lawv. Tsis yog tag nrho cov qog ntshav qog ntshav yuav muaj cov cim no, thiab qee qhov yuav muaj ib qho cim thaum lwm tus yuav muaj ntau dua. Piv txwv ntawm cov proteins pom ntawm T-cell lymphoma hlwb uas yuav raug tsom los ntawm cov tshuaj tiv thaiv monoclonal yog CD30 thiab CCR4.
Qee cov qog ntshav qog ntshav loj hlob nrog cov cim tshwj xeeb ntawm cov cell uas koj cov hlwb noj qab haus huv tsis muaj. Cov phiaj xwm kev kho mob yog cov tshuaj uas tsuas paub txog cov cim tshwj xeeb, yog li nws tuaj yeem qhia qhov txawv ntawm lymphoma thiab cov hlwb noj qab haus huv.
Cov phiaj xwm kev kho mob tom qab ntawd txuas mus rau qhov cim ntawm lub lymphoma cell thiab txwv tsis pub nws tsis tau txais cov cim qhia kom loj hlob thiab kis tau. Qhov no ua rau lymphoma tsis tuaj yeem tau txais cov as-ham thiab lub zog nws xav tau kom loj hlob, ua rau lymphoma cell tuag.
Los ntawm kev txuas tsuas yog cov cim ntawm cov qog ntshav qog ntshav, kev kho mob tuaj yeem zam kev ua rau koj cov hlwb noj qab haus huv. Qhov no ua rau muaj kev phiv tsawg dua li kev kho mob zoo li chemo, uas tsis tuaj yeem qhia qhov txawv ntawm lymphoma thiab cov hlwb noj qab haus huv.
Ntau hom kev kho mob, qee cov tshuaj khomob thiab kev tiv thaiv kab mob tiv thaiv kab mob yog siv los ntawm qhov ncauj ua ntsiav tshuaj lossis tshuaj ntsiav. Kev kho mob qog noj ntshav los ntawm qhov ncauj feem ntau hu ua "kev kho qhov ncauj". Nws yog ib qho tseem ceeb kom paub yog tias koj qhov kev kho qhov ncauj yog kev kho mob los yog kev kho mob. Yog koj tsis paub meej nug koj tus kws kho mob lossis tus kws saib xyuas neeg mob.
Cov kev mob tshwm sim uas koj yuav tsum tau saib xyuas, thiab koj tswj lawv li cas yuav txawv nyob ntawm seb hom kev kho qhov ncauj twg koj tau noj.
Lub stem cell los yog pob txha hloov pauv yog dab tsi?
Kev hloov cov qia cell yog txheej txheem uas yuav siv tau los kho koj cov qog ntshav qog ntshav, lossis ua kom koj nyob hauv kev zam txim ntev dua yog tias muaj feem ntau koj cov qog ntshav qab zib yuav rov qab los (rov qab los). Koj tus kws kho mob kuj tseem tuaj yeem pom zoo kom hloov cov qia cell rau koj thaum koj cov qog ntshav qab zib.
Kev hloov ntawm qia cell yog ib txoj kev nyuaj thiab cuam tshuam uas tshwm sim hauv theem. Cov neeg mob uas tau hloov cov qia cell yog thawj zaug npaj nrog kev kho mob ib leeg lossis ua ke nrog kev kho hluav taws xob. Kev kho mob chemotherapy siv nyob rau hauv qia cell transplants yog muab nyob rau hauv ntau dua koob tshuaj tshaj li niaj zaus. Qhov kev xaiv ntawm chemotherapy muab rau theem no yog nyob ntawm hom thiab lub hom phiaj ntawm kev hloov pauv.
Xav paub ntau ntxiv txog Stem Cell Transplants
Yog xav paub ntxiv txog kev hloov cov qia cell saib peb cov nplooj ntawv hauv qab no.
Stem cell hloov – ib tug txheej txheem cej luam
Autologous qia cell hloov - siv koj tus kheej qia hlwb
Allogeneic qia cell hloov - siv lwm tus (tus neeg pub dawb) cov qia hlwb
Kev phais yuav raug siv los tshem tawm cov lymphoma tag nrho. Qhov no yuav ua tau yog tias koj ib cheeb tsam ntawm lymphoma uas tuaj yeem tshem tau yooj yim.
Kev sim tshuaj kho mob yog ib txoj hauv kev tseem ceeb los nrhiav kev kho tshiab, lossis kev sib txuas ntawm kev kho mob los txhim kho cov txiaj ntsig rau cov neeg mob qog nqaij hlav. Lawv kuj tuaj yeem muab sijhawm rau koj los sim cov kev kho tshiab uas tsis tau pom zoo yav dhau los rau koj hom lymphoma.
Qee cov kev kho mob raug sim hauv kev sim tshuaj rau ntau yam T-cell lymphomas uas koj tuaj yeem nug koj tus kws kho mob txog xws li:
- Azaciditidine (anttimetabolite - Pyrimidine Nucleoside Analogue)
- Anti CD-7 allogeneic CAR T-cell (gene / cellular kho)
- Valemetostat Tosylate (inhibitor ntawm EZH1 thiab EZH2)
- AZD4573 (CDK inhibitor)
- DR-01 (anti-CD94 antibody)
- AZD4205 (JAK inhibitor)
- Anti-CD70 Allogeneic CRISPR-Cas9 (Engineered T Cells)
- PTX-100 (GGTI-2418) - (Geranylgeranyltransferase I Inhibitor)
- CX-5461 (DNA RNA synthesis inhibitor)
- Venetoclax (BCL2 inhibitor)
Yog xav paub ntxiv txog kev sim tshuaj, thov mus saib peb lub vev xaib ntawm Nkag siab txog kev sim tshuaj ntsuam xyuas los ntawm nyem qhov no.
Prognosis ntawm T-cell lymphoma
Kev kuaj mob yog qhov zoo npaum li cas koj yuav tsum teb rau kev kho mob lymphoma thiab seb qhov tshwm sim yuav zoo li cas.
Ntau tus neeg teb tau zoo rau kev kho mob thiab mus rau hauv kev zam txim txawm li cas los xij, txawm tias koj tau txais cov lus teb zoo thaum ntxov, T-cell lymphomas feem ntau rov qab los thiab xav tau kev kho mob ntau dua ib zaug.
Qee tus neeg yuav tsis teb rau thawj kab kev kho mob thiab yuav tsum tau sim ntau hom kev kho mob kom tau txais cov qog ntshav qab zib. Lymphoma uas tsis teb rau kev kho mob hu ua refractory.
Koj tus kheej qhov kev mob tshwm sim yog qhov tshwj xeeb heev thiab nyob ntawm ntau yam xws li:
- subtype ntawm T-cell lymphoma koj muaj thiab nws theem
- koj lub hnub nyoog thiab kev noj qab haus huv tag nrho
- genetic yam uas yuav cuam tshuam rau kev kho mob
- Koj lub cev teb zoo npaum li cas rau kev kho mob.
Lub hom phiaj ntawm kev kho mob
Lub hom phiaj ntawm kev kho mob yuav suav nrog kev kho mob, ua kom tiav lossis tshem tawm ib nrab. Nws yog ib qho tseem ceeb kom muaj kev cia siab meej txog koj txoj kev kho mob kom koj thiaj li npaj tau yam koj xav tau.
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Ua kom tiav kev zam txim
Kev zam ib nrab
Hom T-cell Lymphoma
T-cell lymphomas tuaj yeem loj hlob qeeb (indolent) lossis loj hlob sai (nruj). Feem ntau T-cell lymphomas yog txhoj puab heev. Nyem rau ntawm cov ntsiab lus hauv qab no kom paub txog cov subtypes sib txawv.
Aggressive T-cell lymphomas
- Peripheral T-cell lymphoma (PTCL)
- Peripheral T-cell lymphoma - tsis qhia lwm yam (PTCL-NOS)
- Cutaneous T-cell lymphoma (CTCL)
- Anaplastic Loj Cell Lymphoma (ALCL)
- Tus neeg laus T-cell Leukemia/Lymphoma (ATLL)
- Lymphoblastic lymphoma (T & B-cell neeg laus)
- Enteropathy-associated T-cell Lymphoma (EATL)
- Monomorphic Epithelioltropic plab hnyuv T-cell Lymphoma (MEITL).
Indolent T-cell lymphomas
Ntsiab lus
- T-cell lymphomas tsim thaum T-cell lymphocytes hloov pauv thiab ua rau mob qog noj ntshav.
- T-cell lymphocytes (T-cells) yog ib feem tseem ceeb ntawm koj lub cev tiv thaiv kab mob, tswj kev tiv thaiv kab mob, tiv thaiv kab mob thiab kab mob, thiab pab lwm lub cev tiv thaiv kab mob ua haujlwm zoo dua.
- Txawm hais tias T-hlwb yog ib hom qe ntshav dawb, lawv feem ntau tsis nyob hauv koj cov ntshav zoo li lwm cov qe ntshav.
- T-hlwb yog tsim nyob rau hauv koj cov pob txha pob txha thiab ces mus rau koj lub thymus qhov chaw uas koj txuas ntxiv mus thiab loj hlob. Tom qab ntawd lawv nyob hauv koj cov thymus thiab cov qog nqaij hlav tab sis tuaj yeem mus rau txhua qhov ntawm koj lub cev.
- Muaj li ntawm 20 yam sib txawv ntawm T-cell lymphoma thiab txhua qhov tsawg heev.
- Cov tsos mob tuaj yeem ua tau cov tsos mob ntawm lymphoma los yog muaj feem xyuam rau ib feem ntawm koj lub cev qhov chaw uas cov lymphoma loj hlob tuaj.
- Cov tsos mob B muaj tshwm sim hauv qee qhov T-cell lymphomas. Qhia rau koj tus kws kho mob paub yog tias koj muaj cov tsos mob no.
- Muaj ntau hom kev kho mob rau T-cell lymphoma thiab kev kho mob uas koj tau txais yuav nyob ntawm seb koj hom subtype, hnub nyoog thiab kev noj qab haus huv tag nrho, cov tsos mob thiab koj tus kheej nyiam.
- T-cell lymphomas tuaj yeem teb tau zoo rau kev kho mob, tab sis feem ntau rov ua dua. Tej zaum koj yuav tau kho ntau zaus.
- Koj tsis nyob ib leeg thiab tuaj yeem tiv tauj peb Cov Kws Kho Mob Lymphoma los ntawm nias rau ntawm Hu Rau Peb khawm nyob hauv qab ntawm qhov screen.
