ʻO ka maʻi Leukemia Lymphoblastic ʻoʻoleʻa (T-ALL)-04

He kāne 15 makahiki ka mea maʻi, i ʻike ʻia me ka T-cell acute lymphoblastic leukemia (T-ALL me STIL-TAL1 positivity, kahi gene prognostic maikaʻi ʻole) i ka hopena o Dekemaba 2020, a ua mālama ʻia ma kahi haukapila kūloko me nā pōʻaiapuni he nui o ka chemotherapy maʻamau e hoʻokō ai i ke kala piha. Ua hana ʻia kahi hoʻoili cell kumu haematopoietic hemizygous makua kāne-a-keiki kāne ma ka lā 2 Iune 2021, akā naʻe, ua ʻike ʻia kahi relapse iwi i loko o 3 mau mahina ma hope o ka hoʻoili ʻana, a ʻaʻole i kūpono ka pōʻaiapuni 1 o ka chemotherapy. I ka manawa like, ua loaʻa iā ia nā papālina pehu a me ka leaka o ka ea, nā kihi kekee o ka waha, a ua hōʻike kahi puncture lumbar i ka ulu ʻana o ka leukemia o ka ʻōnaehana nerve waena.

ʻO T-ALL me ka STIL-TAL1 positivity, ka hoʻi hou ʻana ma hope o ka hoʻoili ʻana o ka allogeneic, i hui pū ʻia me ka leukemia o ka ʻōnaehana nerve waena, he hihia paʻakikī loa ia e mālama ai i ka wā me ka ʻole o CAR-T. Ua nīnau ka makuakāne o ke keiki e pili ana i ka ʻoihana hematology ma ka Tianjin Cancer Hospital Airport Hospital ma o kāna mau hoaaloha. Ma hope o ke kamaʻilio kikoʻī ʻana, ua hele lākou i ka Tianjin Cancer Hospital Airport Hospital, e ʻimi ana e kākau inoa i kahi hoʻokolohua lapaʻau CAR-T ma ke ʻano he hoʻāʻo hope loa.

Ua hāʻule ka CAR-T mua. Ua hoʻonui koke ʻia nā pūnaewele puʻupuʻu, e hoʻoweliweli ana i kona ola.

Ma ka lā 26 ʻOkakopa 2021, ua hoʻokomo ʻia ka mea maʻi i ka lumi mua o ka ʻOihana Hematology. Ma muli o ka ulu wikiwiki ʻana o nā pūnaewele tumor, ua hana ʻia ka chemotherapy i ka mea maʻi e hōʻemi i ka ukana tumor a loaʻa iā ia ka chemotherapy intrathecal. ʻAʻole i hōʻike ka wai cerebrospinal i ke koena o ka maʻi. Ma hope o ka hoʻopaʻa ʻana, ua hōʻiliʻili ʻia nā lymphocytes o kona makuakāne no ka moʻomeheu cell CAR-T. Ma ka lā 19 Nowemapa, ua hoʻokomo ʻia nā pūnaewele CD7 CAR-T donor i loko o ka mea maʻi.

I kekahi mau lā ma hope o ke kau ʻana, ma mua o ka hoʻonui ʻia ʻana o nā pūnaewele CAR-T, ua ulu koke hou nā pūnaewele puʻupuʻu, me nā pahū nui i ʻike ʻia i loko o ke koko peripheral, e hōʻailona ana i ka hāʻule ʻole o ka lāʻau lapaʻau CAR-T mua.

I kēia manawa, ke hana nei ka Halemai Kanesa ʻo Tianjin Airport i kahi hoʻokolohua lapaʻau o ka CAR-T ākea (CD7 UCAR-T) no ka maʻi leukemia T-lymphoblastic koʻikoʻi. Ua hōʻike nā mākua i ka wikiwiki nui, me ka ʻōlelo ʻana e alualu lākou i kahi manawa kūpono no kā lākou keiki. Ua kūkākūkā ke kime lapaʻau me ka ʻohana a ua hoʻoholo e kākau inoa i ka mea maʻi i ka hoʻokolohua lapaʻau CD7 UCAR-T.

Hoʻomaha piha ʻia ma hope o ka CD7 UCAR-T I kēia manawa 2 mau mahina ma hope o ke kāpili ʻana.

Ma ka lā 2 o Kēkēmapa, ua loaʻa i ka mea maʻi ka hoʻokomo ʻana o nā cell CD7 U-CART me ka lāʻau hoʻēmi ukana tumor a me ka mālama kākoʻo. Ma hope o ka hoʻokomo ʻana, ua loaʻa iā ia ke kuni kiʻekiʻe a me ka luhi no ka manawa lōʻihi. Me ke kākoʻo anti-infective a me ka hydration, ua paʻa kona mau hōʻailona ola a ua hoʻi hou ka mahana o ke kino i ke ʻano maʻamau.

Ua hōʻoia nā loiloi ʻana o ka iwi iwi a me ka wai cerebrospinal i nā lā 18 a me 28 ma hope o CAR-T i ke kala piha ʻana me ka MRD negativity. Ua hoʻomaikaʻi nui ʻia ke kūlana o ke keiki me ka hoʻi ʻana o kona ikaika, ua hoʻōla hou ʻia ka makemake, a ua loaʻa hou i kona makuahine—ka mea i hopohopo mua.

I kēia manawa, ua hana ʻia ka mea maʻi i ka lua o ka HSCT haploidentical ma ka Tianjin Cancer Hospital Airport Hospital a ke noho nei i ke kala piha ʻana i 2 mau mahina ma hope o ke kāpili ʻana.