Ciwon sankarar lymphoblastic mai tsanani (T-ALL)-02

Siffofin Asibiti:

- Ganewar asali: Cutar sankarar lymphoblastic mai tsanani ta T-cell

- Farawa: Ƙarshen Maris 2018

- Alamomin farko: Faɗaɗa ƙwayoyin lymph a jiki da yawa

- Tsarin jinin farko: WBC: 39.46*10^9/L, Hb: 129g/L, PLT: 77*10^9/L

- Siffar ƙashi: kashi 92% na fashewar ƙashi

- Tsarin kwararar ruwa: kashi 95.3% na ƙwayoyin halitta marasa kyau da ke bayyanawa

TdT+CD99+CyCD3+CD7stCd5DdimCD4-CD8-mCD3-CD45dim

- Haɗakar kwayoyin halitta: Mara kyau

- Sauye-sauyen kwayoyin halitta: An gano maye gurbin kwayoyin halitta na NOCH1

- Nazarin Chromosome: Karyotype na Al'ada

Tarihin Magani:

- Afrilu 3, 2018: Maganin shigar da jini ta hanyar amfani da tsarin VDCP

- Afrilu 18, 2018: Fashewar ƙashi ta ƙunshi kashi 96%

- Afrilu 20, 2018: An sami sassauci bayan tsarin CAG

- 18 ga Mayu, 2018: Maganin haɗin gwiwa tare da tsarin CMG+VP

- 22 ga Yuni, 2018: Fashewar ƙashi ta ƙashi ta ƙaru zuwa kashi 40%, kuma cutar sankarar jini ta sake dawowa

- 25 ga Yuli, 2018: Tsarin CLAM (clarithromycin+cyclophosphamide+amikacin)

- Dashen ƙwayoyin halitta na Hematopoietic daga ɗan'uwan da ya dace da HLA ta amfani da maganin FLU+BU a ranar 14 ga Agusta

- Kulawa bayan dasawa: Gyaran yanayin ƙashi a wata 1, watanni 3, watanni 6, watanni 9, da watanni 11

- Siffar ƙashi ta nuna sassauci a watanni 16 bayan dasawa, tare da kwararar cytometry yana nuna 0.02% na ƙwayoyin lymphocytes marasa ƙarfi.

- 13 ga Nuwamba, 2020: Tsarin jinin da ke kewaye da wurin da aka bayar da gudummawar ya kai kashi 97.9%

- Kwayoyin halittar jini na gefe: 20%

- Disamba 18, 2020: Tsarin ƙashi: fashewar kashi 60.6%

- Tsarin kwararar jini: 30.85% ƙwayoyin lymphocytes marasa ƙarfi na T

- Binciken ƙwayoyin cuta: 46, XY (20)

- An karɓi maganin chemotherapy na DA a ranar 19 ga Janairu, 2021

- Tsarin ƙashi a ranar 19 ga Janairu, 2021: Hyperplasia na aji na uku, fashewar 16%

- Binciken karyotype na chromosome: 46, XY (20)

- Tsarin kwararar jini: 7.27% na ƙwayoyin halitta (tsakanin ƙwayoyin nukiliya) da aka bayyana CD99bri, CD13, CD38, cbcl-2, cCD3, HLA-ABC bri, CD7bri, da kuma CD5dim da aka bayyana kaɗan, suna nuna ƙwayoyin T marasa ƙarfi

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

- Binciken sauye-sauyen ciwon daji na jini (nau'ikan 86):

1. Ɗaukar maye gurbi na PHF6 K299Efs*13 mai inganci

2. RUNX1 S322* maye gurbi mai kyau

3. FBXW7 E471G maye gurbi mai kyau

4. JAK3 M511I maye gurbi mai kyau

5. Ɗaukar maye gurbi mai kyau na NOCH1 Q2393*

Magani:

- 22 ga Janairu: Tattarawa da kuma haɓaka ƙwayoyin lymphocytes na jini na gefe don CD7-CART

Kafin a yi wa majiyyaci allurar CD7-CART, an ba shi VLP (vincristine, l-asparaginase, prednisone) tare da maganin chemotherapy na bortezomib.

- 3 ga Fabrairu: Maganin chemotherapy na FC (Mai fama da mura 50mg na tsawon kwana 3 + CTX 0.45g na tsawon kwana 3)

- 5 ga Fabrairu (kafin a yi amfani da shi): Siffar bargon ƙashi ta nuna kashi 23% na fashewar.

- Tsarin kwararar jini ya bayyana kashi 4.05% na ƙwayoyin da ke bayyana CD99bri, CD5dim, CD7bri, TDT, cCD3, suna nuna ƙwayoyin T marasa ƙarfi.

- Binciken ƙwayoyin cuta: 46, XY (20)

- Binciken Chimerism (bayan HSCT): Kwayoyin da aka samo daga masu bayarwa sun kai kashi 52.19%.

- 7 ga Fabrairu: Jiko ƙwayoyin CD7-CART masu ɗauke da ƙwayoyin cuta a cikin allurar 5*10^5/kg.

- 15 ga Fabrairu: Kwayoyin jinin da ba su kai girman da aka saba gani ba sun ragu zuwa kashi 2%.

- 19 ga Fabrairu (Rana ta 12 bayan allurar): Majinyacin ya kamu da zazzabi, wanda ya ɗauki tsawon kwanaki 5 kafin a cimma nasarar daidaita zafin jiki.

- Maris 2: Kimantawar ƙashi ta nuna cikakkiyar sassaucin siffa, tare da cytometry na kwarara ba tare da gano ƙwayoyin da ba su kai girman da suka kai ba.