ʻO ka Myeloma Nui (MM)-01

Hoʻōla maikaʻi ʻia o kahi maʻi Myeloma Multiple Home me ka CAR-T Therapy ʻoiai ʻaʻole i hōʻike ʻia ka BCMA

Ua loaʻa i kahi maʻi wahine i ʻike ʻia me ke kahua IIIA IgD-λ type multiple myeloma i ka makahiki 2018 ka lāʻau lapaʻau mua me ka bortezomib. Ma hope o 3 mau pōʻaiapuni, ua loaʻa iā ia ke kala piha (CR). I ʻOkakopa 2018, ua hana ʻia ʻo ia i ka hoʻoili ʻana o nā cell stem hematopoietic autologous ma ke ʻano he lāʻau hoʻopaʻa, a ukali ʻia e ka mālama ʻana me lenalidomide. I ʻApelila 2020, ua hoʻi hou ka maʻi, a ua hana ʻia ʻo ia i 7 mau pōʻaiapuni o ka lāʻau lapaʻau lua, me ka hopena maikaʻi ʻole. Mai Dekemaba 2020 a hiki i ʻApelila 2021, ua loaʻa iā ia ka chemotherapy me daratumumab, akā ua hōʻike mau ka biopsy iwi i ka 21.763% malignant monoclonal plasma cells, me ke kaulahao māmā serum free λ ma 1470 mg/L a me ke kaulahao māmā urine free λ ma 5330 mg/L. I kēia manawa, ua pau iā ia nā lāʻau lapaʻau maʻamau a me nā mea hou i loaʻa ma ka home, me ka hana ʻana i ka hoʻoili ʻana o nā cell stem autologous, me ke komo ʻana i kahi hoʻokolohua lapaʻau CAR-T ʻo ia ke koho maikaʻi loa i koe.

Ua kuhikuhi ʻia ʻo ia e nā kauka kūloko, a ua hōʻike ʻo ia i ka Halemai ʻo Ludaopei ma Mei 10, 2021, me ka manaʻolana e kākau inoa i kā lākou hoʻokolohua lapaʻau no ka lāʻau lapaʻau BCMA CAR-T i ka myeloma maha (MM). I kona komo ʻana, ua nāwaliwali ʻo ia me ka ʻeha maʻamau a me nā kuni hou. Ua hōʻoia nā hoʻokolohua piha i ka "myeloma maha, ʻano kaulahao māmā λ, kahua ISS III, kahua R-ISS III, hui pilikia kiʻekiʻe mSMART."

Ua hōʻike ka PET-CT scan i ka hoʻonui ʻia o ka hana metabolic i loko o ka nui o nā ʻiʻo palupalu i loko o nā lua iwi o nā femurs a me nā tibias bilateral, e hōʻike ana i ka pili ʻana o ka puʻupuʻu. Ua hōʻike ka biopsy iwi iwi i 60.13% mau cell plasma monoclonal malignant me ka ʻole o ka hōʻike ʻana o BCMA.

Ua hoʻomaopopo kā mākou kikowaena CGT i ka mea maʻi a me kona ʻohana e pili ana i ka pono o nā lāʻau lapaʻau o kēia manawa no ka myeloma multiple BCMA-negative, ʻoiai he kūpono paha e like me kekahi mau palapala, ʻaʻohe ʻikepili paʻa. Ma hope o ka noʻonoʻo pono ʻana, ua koho ka mea maʻi a me kona ʻohana e hoʻomau me ka hoʻolālā lapaʻau.

Ma hope o ka hoʻomaʻamaʻa mua ʻana me ka regimen FC, ua hoʻokomo ʻia nā pūnaewele BCMA CAR-T ma Iune 1, 2021, ma ka Halemai ʻo Ludaopei. Ua loaʻa i ka mea maʻi ke kuni ma hope o ka hoʻokomo ʻana, kahi i hoʻomalu mālie ʻia me ka lāʻau anti-infective ikaika a me ke kākoʻo hōʻailona. He ʻumikumamāhā mau lā ma hope o ka hoʻokomo ʻana, ʻaʻole i hōʻike ka biopsy iwi iwi i nā pūnaewele plasma monoclonal malignant i koe. He kanakolukumamākahi mau lā ma hope o ka hoʻokomo ʻana, ua noho maikaʻi ʻole ka biopsy iwi iwi. Ua maikaʻi ʻole ka immunofixation serum, aia ka serum free light chain λ i loko o ka pae maʻamau, a ua maikaʻi ʻole ka protein serum M, e hōʻike ana i ka hoʻokuʻu piha ʻana o ka maʻi.

I kēia manawa, ʻoi aku ma mua o 8 mau mahina ma hope o ka loaʻa ʻana o ka hoʻokomo ʻana o nā cell BCMA CAR-T, ke noho nei ka mea maʻi i ke kala piha ʻana me ka hoʻōla maikaʻi a me ka ʻoluʻolu nui me ka hopena o ka lāʻau.