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

Siffofin asibiti:

- Ganewar asali: lymphoma na lymphoblastic na T-cell/leukemia

- Maris 2020: An gabatar da shi da tari mai kama da na paroxysmal da kuma babban taro, wanda aka tabbatar da cewa yana ɗauke da cutar T-cell lymphoblastic lymphoma ta hanyar amfani da biopsy na huda ƙwayoyin cuta.

- Na sami zagaye 8 na chemotherapy da kuma fiye da zaman radiotherapy 20, wanda ya haifar da raguwar yawan kitsen mediastinal.

- Janairu 16, 2021: Ciwon ya fara bayyana a ƙasan hannun dama.

- Tsarin jini: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- Tsarin ƙashi: kashi 95.5% na ƙwayoyin lymphoblasts na asali.

- Tsarin kwararar ƙashi: 91.77% na ƙwayoyin halitta lymphoblasts ne marasa ƙarfi.

- Jerin kwayoyin halitta: An gano sauye-sauye a cikin kwayoyin halittar NOTCH1, IL7R, ASXL2.

- An karɓi maganin Hyper-CVAD/B, maganin ESHAP daga baya, duka biyun ba su da tasiri idan zazzabi ya ci gaba da ƙaruwa.

- 18 ga Fabrairu, 2021: An kwantar da ni a asibiti.

- An gabatar da zazzabi, CT na ƙirji ya nuna ciwon huhu.

- Tsarin jini: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Kwayoyin jinin da ba su kai girman da aka saba da su ba: 90%

- Tsarin ƙashi: Hypercellular (sashi na IV), 85% na ƙwayoyin lymphoblasts na asali.

- Tsarin Immunophenotyping: Kashi 87.27% na ƙwayoyin halitta ƙwayoyin T-cell ne masu cutarwa.

- Binciken kwayoyin halitta: 46,XX [24]; an lura da ƙarin nau'ikan karyotypes guda uku marasa kyau.

- Kwayoyin halittar da suka canza:

1. IL7R T244_I245insARCPL maye gurbi mai kyau

2. NOCH1 E1583_Q1584dup maye gurbi tabbatacce

3. Ɗaukar maye gurbin ASXL2 Q602R mai inganci

- Binciken kwayoyin halittar da ke hade da cutar sankarar jini: Mara kyau

- Sakamakon PET/CT: Babu wani muhimmin sinadarin ciwon daji mai yawan aiki a cikin dukkan kwarangwal da kuma ramin ƙashi.

Magani:

- An fara amfani da maganin chemotherapy na VP, an yi cikakken bayani kamar haka: Vincristine (VDS) 3mg sau ɗaya, Dexamethasone (Dex) 7mg kowace awa 12 na tsawon kwanaki 9, tare da maganin hana kamuwa da cuta.

- Maris 1: Kwayoyin jinin da ba su kai girman da aka saba gani ba sun ragu zuwa kashi 7%.

- Maris 4: An tattara ƙwayoyin lymphocytes masu kama da juna don haɓaka ƙwayoyin T na CD7-CAR.

- Maris 8: An fara tsarin VLP tare da maganin Sida benzamine.

- Maris 14: An karɓi maganin chemotherapy na FC (Fludarabine 0.35g na tsawon kwana 3, Cyclophosphamide 45mg na tsawon kwana 3).

- Maris 17 (jiko kafin ƙwayoyin halitta):

- Ragowar immunophenotyping na ƙashi: 15.14% ƙwayoyin halitta suna bayyana haske na CD7, dim CD3, cytoplasmic CD3, T cell receptor restricted delta (TCRrd), bayyanar CD99 a wani ɓangare, yana nuna mummunan ƙwayoyin T na farko.

- Maris 19: Kwayoyin T na CD7-CAR da aka haɗa da kansu (1 x 10^6/kg).

- Illolin da suka shafi CAR-T: CRS na aji 1 (zazzabi), babu guba a cikin jijiyoyi.

- Afrilu 6 (Rana ta 17): Tsarin ƙashi ya nuna sassauci, kuma cytometry na kwarara bai gano ƙwayoyin halitta masu cutarwa ba.