Yaɗuwar babban lymphoma na ƙwayoyin B (DLBCL), nau'in tsakiyar ƙwayoyin cuta wanda ba na ƙwayoyin cuta ba, wanda ya shafi ramin hanci da sinuses-02

A watan Maris na 2021, wani majiyyaci namiji mai shekaru 52 daga Arewa maso Gabashin China ya gano yana da ciwon hanci a lokacin da ake duba lafiyarsa akai-akai. Ya fuskanci alamun toshewar hanci, ciwon kai, rashin gani sosai, da gumi na dare, ba tare da zazzabi ko rage kiba ba.

Binciken farko ya nuna yawan tabon nama mai laushi wanda ya shafi ramin hanci na dama da sinuses, wanda ya shafi muhimman tsare-tsare kamar kewayar jiki, tushen kwanyar gaba, sinus na sphenoid, da kuma sinus na ethmoid na hagu akan MRI. Binciken cututtuka na sinus na dama na maxillary ya nuna cewa akwai babban lymphoma na B-cell (DLBCL), wanda ba shi da ƙwayoyin cuta.

Immunohistochemistry (IHC) ya nuna yawan kamuwa da cuta tare da bayyanar Ki-67 sau biyu (90%+), CD20 (+), c-Myc (>80%+), Bcl-2 (>90%), Bcl-6 (+), CD10 (-), Mum1 (+), CD79a (+), CD30 (-), da CyclinD1 (-), ba tare da gano ƙaramin RNA mai lambar Epstein-Barr (EBER) ba.

Fluorescence in situ hybridization (FISH) ta gano sauye-sauyen Bcl-6 da c-myc, amma babu sauye-sauyen kwayoyin halitta na Bcl-2. Tsarin tsara na gaba (NGS) ya tabbatar da sauye-sauye a cikin kwayoyin halittar MYD88, CD79B, IGH-MYC, BAP1, da TP53, wanda ke nuna babban matakin lymphoma na B-cell tare da sauye-sauyen MYC da BCL2 da/ko BCL6.

Tomography na Positron emission tomography (PET-CT) ya nuna tarin nama mai laushi marasa tsari a cikin ramin hanci na dama da kuma babban sinus, kimanin girman 6.3x3.8cm, tare da iyakoki marasa bambanci. Rauni ya miƙe sama zuwa cikin sinus na dama na ethmoid, a waje zuwa bangon tsakiya na kewaye da yankin intraorbital, da kuma a baya zuwa sinus na sphenoid da tushen kwanyar. Rauni ya nuna ƙaruwar shan fluorodeoxyglucose (FDG) tare da matsakaicin SUV na 20. An lura da kauri na mucosal a cikin ethmoid na hagu da mafi girman sinus, tare da metabolism na FDG na yau da kullun.

Majinyacin ya riga ya yi wa R2-CHOP, R-ESHAP, BEAM+ASCT, da kuma maganin rediyo na gida, inda aka lura da ci gaban cutar. Saboda juriyar chemotherapy da kuma yawan shigar ƙwayoyin cuta da dama (gami da huhu, hanta, saifa, da ƙashi), an gano majinyacin da ke fama da cutar DLBCL mai hana kamuwa da cutar. Cutar ta ci gaba da sauri tare da babban mamayewa, matakan LDH masu yawa, an gyara maki 5 na International Prognostic Index (NCCN-IPI), maye gurbi na TP53, da kuma nau'in MCD, inda ya sake dawowa cikin watanni 6 bayan dashen kansa.

Bayan an yi maganin bridge, majiyyacin ya sami maganin steroid na ɗan lokaci ba tare da sakamako mai kyau ba. Daga baya an yi masa maganin rigakafi na CD79 monoclonal tare da bendamustine da mechlorethamine hydrochloride, wanda ya haifar da raguwa sosai a matakan LDH da raguwar ƙari.

Bayan an yi nasarar shirya maganin CAR-T, majinyacin ya yi amfani da maganin rage ƙwayoyin lymphocyte (lymphodepletion) chemotherapy tare da tsarin FC, inda ya cimma nasarar kawar da ƙwayoyin lymphocyte da aka yi niyya da kuma mummunan leukopenia. Duk da haka, kwana uku kafin a yi amfani da maganin CAR-T, majinyacin ya kamu da zazzabi, herpes zoster a yankin lumbar, da kuma ƙaruwar matakan lactate dehydrogenase (LDH) a cikin jini har zuwa 25.74ng/ml, wanda ke nuna yiwuwar kamuwa da cuta mai kama da gauraye (AE). Idan aka yi la'akari da ƙaruwar haɗarin kamuwa da cutar CAR-T saboda kamuwa da cuta mai aiki, wanda zai iya haifar da mummunan sakamako, majinyacin ya sami maganin rigakafi masu faɗi-faɗi waɗanda ke rufe cututtuka daban-daban.

Bayan allurar CAR-T, majinyacin ya kamu da zazzabi mai tsanani a ranar da aka yi wa jiko, inda ya ci gaba da yin numfashi, ya yi ta zubar jini, sannan ya kara ta'azzara alamun cutar huhu a rana ta uku. Hotunan CT na jijiyoyin huhu a rana ta biyar sun nuna yadda gilashin ƙasa suka yi duhu da canje-canje a tsakanin jijiyoyin, wanda hakan ya tabbatar da zubar jini a huhu. Duk da farko an guji amfani da steroids saboda yuwuwar hana CAR-T, da kuma maganin tallafi da aka mayar da hankali kan kula da kamuwa da cuta, yanayin majinyacin ya nuna ƙarancin ci gaba.

A rana ta bakwai, an gano faɗaɗa yawan kwafin kwayar halittar CAR a cikin jinin gefe, wanda hakan ya haifar da daidaita magani da ƙaramin methylprednisolone (40mg-80mg). Bayan kwana biyar, raguwar ƙwayoyin huhu a ɓangarorin biyu, kuma an shawo kan alamun cutar hemoptysis.

A rana ta takwas, maganin CAR-T ya nuna inganci mai ban mamaki. Cikin wata ɗaya kacal da aka yi da maganin CAR-T, majinyacin ya sami cikakkiyar sassauci (CR). Binciken da aka yi daga baya har zuwa Yulin 2023 ya tabbatar da cewa majinyacin yana cikin CR, wanda ke nuna cewa yana da cikakken amsawa ga maganin CAR-T da kuma yuwuwar warkewa.