{"id":41766,"date":"2023-08-30T09:15:53","date_gmt":"2023-08-30T07:15:53","guid":{"rendered":"https:\/\/www.invarena.cz\/?p=41766"},"modified":"2023-08-30T09:15:54","modified_gmt":"2023-08-30T07:15:54","slug":"hematoonkologie-v-regionu-pohledem-profesora-michaela-doubka","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=41766","title":{"rendered":"Hematoonkologie v regionu pohledem profesora Michaela Doubka"},"content":{"rendered":"\n

Rozhovor s prof. MUDr. Michaelem Doubkem, Ph.D., z\u00e1stupcem p\u0159ednosty Intern\u00ed hematologick\u00e9 a onkologick\u00e9 kliniky LF Masarykovy univerzity a Fakultn\u00ed nemocnice Brno. Toto pracovi\u0161t\u011b funguje jako Centrum vysoce specializovan\u00e9 hematologick\u00e9 p\u00e9\u010de a mimo jin\u00e9 se star\u00e1 o pacienty s\u00a0rakovinou krve.<\/strong><\/p>\n\n\n\n

Kolik lid\u00ed v Jihomoravsk\u00e9m kraji ka\u017ed\u00fdm rokem onemocn\u00ed rakovinou krve?<\/strong><\/p>\n\n\n\n

V\u00a0na\u0161em regionu, kter\u00fd m\u00e1 zhruba 1,3 mili\u00f3nu obyvatel, m\u00e1me ka\u017ed\u00fdm rokem v\u00edce ne\u017e 100 nov\u00fdch p\u0159\u00edpad\u016f leuk\u00e9mi\u00ed. To odpov\u00edd\u00e1 celorepublikov\u00e9mu pr\u016fm\u011bru 11\u201313 nov\u00fdch p\u0159\u00edpad\u016f na 100 000 obyvatel. K\u00a0tomu je ale nutn\u00e9 p\u0159ipo\u010d\u00edtat dal\u0161\u00ed zhoubn\u00e1 onemocn\u011bn\u00ed krve, jako jsou lymfomy, mnoho\u010detn\u00fd myelom nebo myelodysplastick\u00fd syndrom, tak\u017ee dohromady v\u00a0Jihomoravsk\u00e9m kraji evidujeme kolem 300 nov\u00fdch p\u0159\u00edpad\u016f krevn\u00edch n\u00e1dor\u016f za rok. Z\u00a0leukemi\u00ed se nej\u010dast\u011bji se vyskytuje chronick\u00e1 lymfocyt\u00e1rn\u00ed leuk\u00e9mie. Obecn\u011b pak plat\u00ed, \u017ee incidence krevn\u00edch onemocn\u011bn\u00ed je \u010dast\u011bj\u0161\u00ed u mu\u017e\u016f ne\u017e u \u017een.<\/p>\n\n\n\n

D\u016fle\u017eit\u00e9 je v\u0161ak poznamenat, \u017ee d\u00edky modern\u00ed l\u00e9\u010db\u011b, kter\u00e1 se st\u00e1le zdokonaluje, v\u00fdznamn\u011b roste po\u010det pacient\u016f, kte\u0159\u00ed jsou l\u00e9\u010deni dlouhodob\u011b a dlouhodob\u011b tak\u00e9 p\u0159e\u017e\u00edvaj\u00ed. U mnoho\u010detn\u00e9ho myelomu medi\u00e1n p\u0159e\u017eit\u00ed dnes p\u0159esahuje 7 let, u chronick\u00e9 lymfocyt\u00e1rn\u00ed leuk\u00e9mie 12 let a u chronick\u00e9 myeloidn\u00ed leukemie dokonce 20 let. Jen pro na\u0161i kliniku to znamen\u00e1 ro\u010dn\u011b tis\u00edce n\u00e1v\u0161t\u011bv onkologicky nemocn\u00fdch. V\u00fdznamn\u011b se tak zvy\u0161uje z\u00e1t\u011b\u017e nejen center, ale i men\u0161\u00edch hematologick\u00fdch pracovi\u0161\u0165 v regionu.<\/p>\n\n\n\n

V \u010dem vid\u00edte nejv\u011bt\u0161\u00ed p\u0159\u00ednosy centrov\u00e9 p\u00e9\u010de?<\/strong><\/p>\n\n\n\n

Na\u0161e centrum poskytuje pacient\u016fm s n\u00e1dorov\u00fdmi chorobami krvetvorn\u00e9 tk\u00e1n\u011b a m\u00edzn\u00edch uzlin komplexn\u00ed p\u00e9\u010di, tedy ve\u0161kerou diagnostiku i terapii v\u010detn\u011b \u0159e\u0161en\u00ed p\u0159\u00edpadn\u00fdch komplikac\u00ed. Vzhledem k tomu, \u017ee krevn\u00ed n\u00e1dory nejsou zase tak \u010dast\u00e9, je nepochybn\u011b v\u00fdhodn\u00e9, kdy\u017e jsou pacienti soust\u0159ed\u011bni pr\u00e1v\u011b do specializovan\u00fdch pracovi\u0161\u0165, kde maj\u00ed s p\u00e9\u010d\u00ed o n\u011b nejv\u011bt\u0161\u00ed zku\u0161enosti a kde dosahuj\u00ed i nejlep\u0161\u00edch v\u00fdsledk\u016f l\u00e9\u010dby. Z\u00e1rove\u0148 je na centra v\u00e1z\u00e1na i dostupnost nejmodern\u011bj\u0161\u00edch a nejslo\u017eit\u011bj\u0161\u00edch l\u00e9\u010debn\u00fdch metod, jakou je t\u0159eba transplantace kostn\u00ed d\u0159en\u011b nebo imunoterapie pomoc\u00ed geneticky upraven\u00fdch, takzvan\u00fdch CAR-T lymfocyt\u016f, kter\u00e1 je v sou\u010dasnosti v hematoonkologii \u201eboomem\u201c.<\/p>\n\n\n\n

Dal\u0161\u00edm d\u016fle\u017eit\u00fdm aspektem je multidisciplin\u00e1rn\u00ed p\u0159\u00edstup, proto\u017ee pot\u0159ebujeme kvalitn\u00ed radiodiagnostiku, histologii, molekul\u00e1rn\u00ed biologii, chirurgii, neurologii, intenzivn\u00ed medic\u00ednu a podobn\u011b. To znamen\u00e1, \u017ee na\u0161i nemocn\u00ed maj\u00ed pod jednou st\u0159echou dostupnou p\u00e9\u010di jak\u00e9hokoli odborn\u00edka, kter\u00e9ho budou pot\u0159ebovat. Mezioborov\u00fd p\u0159\u00edstup je mimochodem jednou z podm\u00ednek toho, abychom mohli prov\u00e1d\u011bt transplanta\u010dn\u00ed l\u00e9\u010dbu.<\/p>\n\n\n\n

Spolupracujete tak\u00e9 s komplexn\u00edmi onkologick\u00fdmi centry?<\/strong><\/p>\n\n\n\n

Ur\u010dit\u011b. V\u00edme toti\u017e, \u017ee nap\u0159\u00edklad spousta n\u00e1dorov\u00fdch onemocn\u011bn\u00ed \u2013 a\u0165 u\u017e krevn\u00edch, nebo jin\u00fdch \u2013 je zp\u016fsobena vrozenou genetickou dispozic\u00ed \u010dlov\u011bka. Dob\u0159e je to prozkoum\u00e1no u karcinomu prsu nebo vaje\u010dn\u00edku, ale obdobn\u00e1 situace je i u leuk\u00e9mie. Ukazuje se p\u0159itom, \u017ee pacient s rakovinou krve m\u00e1 rovn\u011b\u017e vysok\u00e9 riziko, \u017ee bude m\u00edt, nebo u\u017e m\u011bl, n\u00e1dor jin\u00e9ho org\u00e1nu, a plat\u00ed to i naopak. Jako p\u0159\u00edklad si m\u016f\u017eeme vz\u00edt nemocn\u00e9 s chronickou lymfocyt\u00e1rn\u00ed leuk\u00e9mi\u00ed, kdy se do 5 let od stanoven\u00ed t\u00e9to diagn\u00f3zy u p\u011btiny z nich objev\u00ed jin\u00fd n\u00e1dor, t\u0159eba rakovina k\u016f\u017ee. P\u00e9\u010di o tyto pacienty pak samoz\u0159ejm\u011b zaji\u0161\u0165uj\u00ed komplexn\u00ed onkologick\u00e1 centra.<\/p>\n\n\n\n

Jak\u00e1 je dostupnost modern\u00ed hematoonkologick\u00e9 l\u00e9\u010dby v\u010detn\u011b imunoterapie?<\/strong><\/p>\n\n\n\n

Jsme te\u010f sv\u011bdky toho, \u017ee modern\u00ed l\u00e9\u010dba \u2013 a\u0165 u\u017e jsou to protil\u00e1tky proti n\u00e1dorov\u00fdm bu\u0148k\u00e1m, nebo imunoterapie \u2013 pacient\u016fm s krevn\u00edmi nemocemi v\u00fdznamn\u011b prodlou\u017eila p\u0159e\u017eit\u00ed. Dostupnost a \u00fahrady inovativn\u00edch l\u00e9k\u016f se zlep\u0161ily nap\u0159\u00edklad u chronick\u00e9 lymfocyt\u00e1rn\u00ed leuk\u00e9mie, mnoho\u010detn\u00e9ho myelomu a lymfom\u016f. Na v\u011bt\u0161\u00ed pokrok ov\u0161em je\u0161t\u011b \u010dek\u00e1me u pacient\u016f s akutn\u00ed myeloidn\u00ed leuk\u00e9mi\u00ed, i kdy\u017e i zde doch\u00e1z\u00ed ke zlep\u0161en\u00ed.<\/p>\n\n\n\n

Pokud jde o imunoterapii, vyu\u017e\u00edv\u00e1me ji\u017e zmi\u0148ovan\u00e9 CAR-T lymfocyty. Jedn\u00e1 se o typ b\u00edl\u00fdch krvinek, kter\u00e9 separujeme z t\u011bla pacienta a geneticky je pozm\u011bn\u00edme tak, aby se nau\u010dily rozpozn\u00e1vat ur\u010dit\u00fd znak v n\u00e1dorov\u00fdch bu\u0148k\u00e1ch. Po n\u011bjak\u00e9 dob\u011b se takto upraven\u00e9 lymfocyty vr\u00e1t\u00ed zp\u011bt pacientovi do krevn\u00edho ob\u011bhu, aby mohly zni\u010dit n\u00e1dorov\u00e9 bu\u0148ky. Tato n\u00e1ro\u010dn\u00e1 l\u00e9\u010dba je vhodn\u00e1 p\u0159edev\u0161\u00edm u nemocn\u00fdch s lymfomy a s n\u011bkter\u00fdmi typy akutn\u00edch leuk\u00e9mi\u00ed, kte\u0159\u00ed maj\u00ed velmi odoln\u00e9 onemocn\u011bn\u00ed a jin\u00e9 l\u00e9ky u\u017e u nich nefunguj\u00ed.<\/p>\n\n\n\n

Jin\u00fdm typem imunoterapie jsou protil\u00e1tky, kter\u00e9 r\u016fzn\u00fdmi mechanismy ni\u010d\u00ed n\u00e1dorov\u00e9 bu\u0148ky. U krevn\u00edch n\u00e1dor\u016f nepou\u017e\u00edv\u00e1me tak \u010dasto takzvan\u00e9 \u201echeckpoint\u201c inhibitory, jako je tomu u malign\u00edho melanomu, karcinom\u016f ledviny, plic a dal\u0161\u00edch solidn\u00edch tumor\u016f, nicm\u00e9n\u011b maj\u00ed sv\u00e9 m\u00edsto nap\u0159\u00edklad v l\u00e9\u010db\u011b lymfom\u016f rezistentn\u00edch v\u016f\u010di standardn\u00ed terapii.<\/p>\n\n\n\n

Dost\u00e1vaj\u00ed se do va\u0161eho hematoonkologick\u00e9ho centra pacienti v\u010das?<\/strong><\/p>\n\n\n\n

Asi p\u0159ed deseti lety kolegov\u00e9 d\u011blali anal\u00fdzu, kter\u00e1 uk\u00e1zala, \u017ee medi\u00e1n doby od prvn\u00edch p\u0159\u00edznak\u016f ke stanoven\u00ed diagn\u00f3zy krevn\u00edch onemocn\u011bn\u00ed je v na\u0161em regionu 14\u201328 dn\u00ed a od prvn\u00ed n\u00e1v\u0161t\u011bvy jak\u00e9hokoli l\u00e9ka\u0159e ke stanoven\u00ed diagn\u00f3zy 1\u20133 t\u00fddny. Tak\u017ee u velk\u00e9 v\u011bt\u0161iny pacient\u016f odhal\u00edme n\u00e1dory krve v\u010das. Samoz\u0159ejm\u011b existuj\u00ed i extr\u00e9mn\u00ed p\u0159\u00edpady, kdy je rozvoj nemoci velice prudk\u00fd, nebo se naopak nijak neprojevuje, to znamen\u00e1, \u017ee diagn\u00f3za nemus\u00ed b\u00fdt stanovena v\u010das, nebo je naopak stanovena n\u00e1hodn\u011b.<\/p>\n\n\n\n

Jak funguje spolupr\u00e1ce ambulantn\u00edmi specialisty a praktick\u00fdmi l\u00e9ka\u0159i?<\/strong><\/p>\n\n\n\n

V kontaktu jsme zejm\u00e9na s region\u00e1ln\u00edmi hematology, kte\u0159\u00ed p\u016fsob\u00ed v men\u0161\u00edch nemocnic\u00edch. V\u011bt\u0161inou se zn\u00e1me osobn\u011b, tak\u017ee tam nejsou \u017e\u00e1dn\u00e9 velk\u00e9 bari\u00e9ry ve spolupr\u00e1ci. Prakti\u010dn\u00ed l\u00e9ka\u0159i pak sv\u00e9 pacienty obvykle odes\u00edlaj\u00ed pr\u00e1v\u011b k ambulantn\u00edm hematolog\u016fm a odtud se v p\u0159\u00edpad\u011b pot\u0159eby dost\u00e1vaj\u00ed k n\u00e1m do centra.<\/p>\n\n\n\n

Spolupracujete tak\u00e9 s organizacemi onkologick\u00fdch pacient\u016f v regionu?<\/strong><\/p>\n\n\n\n

M\u00e1me pom\u011brn\u011b bohatou spolupr\u00e1ci s pacientsk\u00fdmi organizacemi, kter\u00e1 je, \u0159ekl bych, obohacuj\u00edc\u00ed pro ob\u011b strany. Pravideln\u011b po\u0159\u00e1d\u00e1me semin\u00e1\u0159e, kde pacient\u016fm mimo jin\u00e9 vysv\u011btlujeme, jak funguje l\u00e9\u010dba krevn\u00edch n\u00e1dor\u016f a co jim v sou\u010dasnosti m\u016f\u017eeme nab\u00eddnout. A oni n\u00e1m zase pom\u00e1haj\u00ed v tom, abychom l\u00e9pe porozum\u011bli jejich pot\u0159eb\u00e1m i mimo medic\u00ednu. Osobn\u011b m\u00e1m velmi dobr\u00e9 kontakty t\u0159eba se sdru\u017een\u00edm Diagn\u00f3za leuk\u00e9mie.<\/p>\n\n\n\n

Da\u0159\u00ed se k\u00a0hemato(onko)logii p\u0159il\u00e1kat mlad\u00e9 l\u00e9ka\u0159e?<\/strong>
Z\u00e1jem o pr\u00e1ci na na\u0161\u00ed klinice, kter\u00e1 funguje jako specializovan\u00e9 centrum, absolventi l\u00e9ka\u0159sk\u00fdch fakult st\u00e1le maj\u00ed, i kdy\u017e je o n\u011bco men\u0161\u00ed, ne\u017e tomu b\u00fdvalo d\u0159\u00edve. Bohu\u017eel v\u00fdrazn\u011b hor\u0161\u00ed je situace v\u00a0men\u0161\u00edch nemocnic\u00edch na\u0161eho kraje, kde ambulantn\u00edch hematolog\u016f rychle ub\u00fdv\u00e1. Mnoho l\u00e9ka\u0159\u016f z\u00a0na\u0161eho pracovi\u0161t\u011b jezd\u00ed do \u0159ady region\u00e1ln\u00edch center na ji\u017en\u00ed Morav\u011b nebo na Vyso\u010din\u011b, aby hematologickou p\u00e9\u010di pomohli pokr\u00fdt. Ale v\u00edm, \u017ee t\u0159eba v\u00a0z\u00e1padn\u00edch nebo severn\u00edch \u010cech\u00e1ch je situace je\u0161t\u011b dramati\u010dt\u011bj\u0161\u00ed<\/p>\n","protected":false},"excerpt":{"rendered":"

Rozhovor s prof. MUDr. Michaelem Doubkem, Ph.D., z\u00e1stupcem p\u0159ednosty Intern\u00ed hematologick\u00e9 a onkologick\u00e9 kliniky LF Masarykovy univerzity a Fakultn\u00ed nemocnice Brno. Toto pracovi\u0161t\u011b funguje jako […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":18804,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-41766","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/41766","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=41766"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/41766\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/18804"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=41766"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=41766"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=41766"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}