ʻO ka maʻi leukemia lymphoblastic koʻikoʻi (B-ALL)-01

Ua ʻike ʻia he maʻi leukemia lymphoblastic B-cell acute ma Nowemapa 28, 2017.

ʻO ka mālama ʻana me ka regimen VDLP i ka wā mua, e hoʻokō ana i ka hoʻokuʻu hapa ʻana o ka iwi iwi (ʻaʻole i hōʻike ʻia nā kikoʻī).

Pepeluali 2018: Ua hoʻololi ʻia i ka regimen VLCAM. Ua hōʻike ka cytometry kahe ʻana o ka iwi iwi i 60.13% mau pūnaewele B ʻōpiopio malignant.

Malaki 2018: Ua kākau inoa ʻia ma ka hoʻokolohua lapaʻau BiTE. Hoʻokuʻu ʻia ke ʻano o ka iwi i loko o ka iwi, ʻaʻohe mau pūnaewele ʻōpiopio ʻino i ʻike ʻia e ka cytometry kahe.

Mei 8, 2018: Ua loaʻa iaʻu ka regimen hoʻomaʻamaʻa TBI/CY+VP16 a ukali ʻia e ka hoʻoili ʻana o nā cell kumu allogeneic mai kahi hoahānau i kūlike piha (mea hāʻawi AB+ i ka mea loaʻa A+). Hoʻōla ʻia ʻo Neutrophil i ka lā +11, hoʻōla ʻia ʻo megakaryocyte i ka lā +12.

Kekemapa 5, 2018: Hoʻopau piha ʻia ke ʻano o ka iwi i loko o ka iwi, ʻaʻohe mau pūnaewele ʻōpiopio ʻino i ʻike ʻia e ka cytometry kahe. Ua loaʻa i ka donor lymphocyte infusion (DLI) a me ka mālama prophylactic me dasatinib a me imatinib e pale aku i ka hoʻi hou ʻana.

Pepeluali 2, 2019: Ua hōʻike ke ʻano o ka helehelena i 6.5% mau pūnaewele immature, ua hōʻike ka cytometry kahe i 0.08% mau lymphoblast B immature malignant. Ua loaʻa ka lāʻau lapaʻau DLI. Malaki 28, 2019: ʻAʻole i hōʻike ka cytometry kahe i nā ʻano ʻē.

ʻAukake 11, 2019: Hoʻi hou ka iwi iwi, i mālama ʻia me ka dasatinib.

Kepakemapa 2, 2019: Ua hōʻike ke ʻano o ka lāʻau i 3% mau pūnaewele ʻōpiopio, ua hōʻike ka cytometry kahe i 0.04% mau pūnaewele ʻōpiopio ʻino. Hoʻomau ʻia ka mālama ʻana me dasatinib, a ukali ʻia e 2 mau pōʻaiapuni o ka chemotherapy methotrexate.

Mei 11, 2020: Hoʻi hou ka iwi iwi.

Ua loaʻa iā ia ʻelua mau lāʻau lapaʻau cell autologous CD19-CAR-T a me ʻelua mau lāʻau lapaʻau cell allogeneic CD19-CAR-T i ka makahiki 2020, ʻaʻohe mea i loaʻa i ke kala ʻana.

ʻOkakopa 26, 2020: Ua hoʻokomo ʻia i ko mākou haukapila.

Nā ʻIke o ka Hale Hoʻokolohua:

Ka papa hana koko: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Nā pūnaewele koko ʻōpiopio: 63%

ʻAno o ka iwi ʻiʻo: Hypercellular (papa II), 96% lymphoblasts ʻōpiopio.

Immunophenotyping: Hōʻike nā pūnaewele iā CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; hōʻike hapa o CD123. Ua ʻike ʻia he mau lymphoblasts B immature malignant.

Ka loli ʻana o ka puʻupuʻu koko: Maikaʻi ʻole.

Gene fusion leukemia: NUP214-ABL1 fusion gene maikaʻi.

Ka loiloi ʻana o nā chromosome: 46, XX, t(1;9)(p34;p24), hoʻohui(11)(q23)[4]/46, XX, t(1;9)(p34;p24), hoʻohui(11)(q23)x2 [2]/46, XX[3]

Chimerism: ʻO 7.71% ka nui o nā pūnaewele i loaʻa mai nā mea hāʻawi.

Lapaʻau:

- Ua lawelawe ʻia ka papa hana chemotherapy VDS, DEX, LASP.

- Nowemapa 20: Nā pūnaewele ʻōpiopio o ke koko peripheral 0%.

- Hōʻiliʻili ʻana o nā lymphocytes koko peripheral autologous no ka moʻomeheu cell CAR-T pālua CD19/22.

- Nowemapa 29: Kemokalama FC regimen (Flu 50mg x 3, CTX 0.4gx 3).

- Kekemapa 2 (ma mua o ka hoʻokomo ʻana o nā cell CAR-T):

- Ka papa hana koko: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- ʻAno o ka iwi ʻiʻo: Hypercellular (papa IV), 68% lymphoblasts immature.

- Loiloi helu o ka gene fusion NUP214-ABL1: 24.542%.

- Ka cytometry kahe: 46.31% o nā pūnaewele e hōʻike ana iā CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, e hōʻike ana i nā lymphoblasts B ʻōpiopio malignant.

- Kekemapa 4: Hoʻokomo ʻia ʻana o nā pūnaewele CAR-T pālua CD19/22 autologous (3 x 10^5/kg).

- Nā hopena ʻaoʻao e pili ana iā CAR-T: Papa 1 CRS, kuni ma ka Lā 6 me Tmax o 40°C, kuni i kāohi ʻia e ka Lā 10. ʻAʻohe neurotoxicity i ʻike ʻia.

- Kekemapa 22 (Loiloi Lā 18): Hoʻokuʻu piha ʻia ke ʻano o ka iwi i loko o ka iwi ʻiwi, ʻaʻohe mau pūnaewele ʻōpiopio ʻino i ʻike ʻia e ka cytometry kahe. Loiloi helu o ka gene fusion NUP214-ABL1: 0%.