Ciwon sankarar lymphoblastic mai tsanani (B-ALL)-01

An gano cutar sankarar jini mai tsanani ta B-cell lymphoblastic leukemia a ranar 28 ga Nuwamba, 2017.

Da farko ana yin magani da tsarin VDLP, ana samun sassaucin ɓangaren ƙashi (ba a bayar da cikakken bayani ba).

Fabrairu 2018: An canza zuwa tsarin VLCAM. Tsarin kwararar ƙashi ya nuna kashi 60.13% na ƙwayoyin B marasa ƙarfi.

Maris 2018: An yi rijista a gwajin asibiti na BiTE. Ragewar yanayin ƙashi a cikin ƙashi, babu ƙwayoyin halitta marasa ƙarfi da aka gano ta hanyar cytometry na kwarara.

8 ga Mayu, 2018: An karɓi tsarin gyaran TBI/CY+VP16 sannan aka dasa ƙwayoyin halitta na allogeneic daga ɗan'uwa mai cikakken daidaito (mai ba da gudummawa AB+ zuwa mai karɓar A+). An dawo da Neutrophil a rana ta +11, an dawo da megakaryocyte a rana ta +12.

Disamba 5, 2018: Cikakken gyaran jiki a cikin bargo, babu ƙwayoyin da ba su kai girman da aka gano ta hanyar kwararar cytometry. An karɓi jiko na lymphocyte mai bayarwa (DLI) da maganin rigakafi tare da dasatinib da imatinib don hana sake dawowa.

Fabrairu 2, 2019: Tsarin halittar jiki ya nuna kashi 6.5% na ƙwayoyin da ba su kai ba, kuma tsarin kwararar jini ya nuna kashi 0.08% na ƙwayoyin B marasa balaga. An yi masa maganin DLI. Maris 28, 2019: Tsarin kwararar jini bai nuna wata matsala ba.

Agusta 11, 2019: Komawa bayan ƙashi, an yi masa magani dasatinib.

Satumba 2, 2019: Nazarin yanayin halittar jiki ya nuna kashi 3% na ƙwayoyin da ba su kai ba, kuma binciken kwararar jini ya nuna kashi 0.04% na ƙwayoyin da ba su kai ba. Ci gaba da magani da dasatinib, sannan aka biyo baya da zagaye 2 na maganin chemotherapy na methotrexate.

11 ga Mayu, 2020: Sake dawowar ƙashi.

An yi mini maganin ƙwayoyin CD19-CAR-T guda biyu da kuma maganin ƙwayoyin allogeneic CD19-CAR-T guda biyu a shekarar 2020, amma babu wanda ya sami sauƙi.

26 ga Oktoba, 2020: An kwantar da ni a asibiti.

Binciken Dakunan Gwaji:

Tsarin jini: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Kwayoyin jinin da ba su kai girman da aka saba da su ba: 63%

Tsarin ƙashi: Hypercellular (sashe na II), 96% lymphoblasts marasa girma.

Tsarin Immunophenotyping: Kwayoyin halitta suna bayyana CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; wani ɓangare na bayyanar CD123. An gano shi a matsayin ƙwayoyin lymphoblasts marasa ƙarfi.

Sauye-sauyen ciwon jini: Mara kyau.

Kwayar halittar haɗin gwiwar cutar sankarar bargo: Kwayar halittar haɗin gwiwa ta NUP214-ABL1 mai kyau.

Binciken ƙwayoyin cuta: 46, XX, t(1;9)(p34;p24), ƙara(11)(q23)[4]/46, XX, t(1;9)(p34;p24), ƙara(11)(q23)x2 [2]/46, XX[3]

Chimerism: Kwayoyin da aka samo daga masu bayarwa suna da kashi 7.71%.

Magani:

- An yi amfani da tsarin maganin chemotherapy na VDS, DEX, LASP.

- 20 ga Nuwamba: Kwayoyin jinin da ba su kai girman da aka saba gani ba 0%.

- Tarin ƙwayoyin lymphocytes na jini na gefe don ƙwayoyin CAR-T guda biyu na CD19/22.

- Nuwamba 29: Tsarin maganin chemotherapy na FC (Mura 50mg x 3, CTX 0.4gx 3).

- 2 ga Disamba (kafin shigar ƙwayoyin CAR-T):

- Tsarin jini: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- Tsarin ƙashi: Hypercellular (sashe na IV), 68% lymphoblasts marasa girma.

- Kimantawa mai yawa na kwayar halittar haɗin NUP214-ABL1: 24.542%.

- Tsarin kwararar jini: kashi 46.31% na ƙwayoyin halitta suna bayyana CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, wanda ke nuna ƙwayoyin lymphoblasts marasa ƙarfi.

- Disamba 4: Jiko ƙwayoyin CAR-T guda biyu na CD19/22 masu ɗauke da ƙwayoyin cuta (3 x 10^5/kg).

- Illolin da suka shafi CAR-T: CRS na aji 1, zazzabi a rana ta 6 tare da Tmax na 40°C, zazzabin da aka sarrafa a rana ta 10. Ba a lura da gubar jijiyoyi ba.

- Disamba 22 (Kimantawa ta Rana ta 18): Cikakkiyar gyaran yanayin ƙashi a cikin bargon ƙashi, babu ƙwayoyin halitta marasa ƙarfi da aka gano ta hanyar cytometry na kwarara. Kimantawa mai yawa na kwayar halittar haɗin NUP214-ABL1: 0%.