ʻO ka lupus erythematosus ʻōnaehana (SLE)-05

He wahine 32 makahiki ʻo Ms. C me ka mōʻaukala o ka maʻi ʻana i ka systemic lupus erythematosus (SLE) i ʻelua makahiki i hala. ʻO kāna mau hōʻailona mua, ʻo ia ka nephritis koʻikoʻi, ka ʻāʻī, a me nā ʻulaʻula. ʻOiai ua loaʻa iā ia nā lāʻau lapaʻau immunosuppressive he nui (me nā glucocorticoids, hydroxychloroquine, a me rituximab), ua mau kona kūlana me ka ʻole o ka hoʻomalu ʻia.

Kūlana ma mua o ka mālama ʻana:

Nā Hōʻailona: ʻEha nui a me ka pehu ʻana o nā hono, nā ʻulaʻula mau, ka luhi nui, a me ka hoʻāla hou ʻana o ka nephritis.

Nā ʻIke o ka Hale Hoʻokolohua:

# Ka helu SLEDAI-2K: 16

# Nā pae antibody DNA anti-double-stranded serum: Kiʻekiʻe ma luna o ka pae maʻamau

# Hoʻohui i nā pae C3 a me C4: Ma lalo o ka pae maʻamau

Kaʻina Hana Lapaʻau:

1. Koho ʻana o ka mea maʻi: Ma muli o ka pono ʻole o nā lāʻau lapaʻau kuʻuna a me ke koʻikoʻi o kona kūlana, ua kākau inoa ʻia ʻo Ms. C i kahi hoʻokolohua lapaʻau no ka lāʻau lapaʻau CAR-T cell.

2. Hoʻomākaukau: Ma mua o ka loaʻa ʻana o ka hoʻokomo ʻana o nā pūnaewele CAR-T, ua hana ʻia ʻo Ms. C i ka chemotherapy maʻamau e hoʻopau i nā lymphocytes e kū nei a hoʻomākaukau no ka hoʻolauna ʻana o nā pūnaewele CAR-T.

3. Hoʻomākaukau Kelepona:

# Ua hoʻokaʻawale ʻia nā pūnaewele T mai ke koko o Ms. C.

# Ua hana ʻia kēia mau pūnaewele T i loko o ka hale hana hoʻokolohua e hōʻike i nā mea loaʻa antigen chimeric (CAR) e kuhikuhi ana i nā antigens CD19 a me BCMA.

4. Hoʻokomo ʻia ʻana o ke Kelepona: Ma hope o ka hoʻonui ʻia ʻana a me ka hoʻāʻo ʻana i ka maikaʻi, ua hoʻokomo hou ʻia nā pūnaewele CAR-T i hana ʻia i loko o ke kino o Ms. C.

5. Nānā ʻana i ka maʻi hoʻopaʻa: Ua nānā ʻia ʻo Ms. C ma ka haukapila no 25 mau lā ma hope o ka hoʻokomo ʻana i ka lāʻau e nānā i nā hopena ʻaoʻao a loiloi i ka pono.

Nā Hopena Lapaʻau:

1. Pane Pōkole:

# Hoʻomaikaʻi ʻana i nā hōʻailona: I loko o ʻekolu pule ma hope o ke kāwili ʻana, ua ʻike ʻo Ms. C i ka emi nui ʻana o ka ʻeha a me ka pehu ʻana o nā hono, a ua mae mālie kona mau ʻulaʻula.

# Nā Hopena o ka Keʻena Hoʻokolohua: ʻElua lā ma hope o ke kāwili ʻana, ua hoʻopau loa ʻia nā pūnaewele B i loko o ke koko o Ms. C, e hōʻike ana i ka hoʻopaʻa pono ʻana e nā pūnaewele CAR-T.

2. Loiloi Waena (3 mahina):

# Ka helu SLEDAI-2K: Ua hoʻemi ʻia i 2, e hōʻike ana i ka hoʻōla nui ʻana o ka maʻi.

# Hana o ka Puʻupaʻa: Ka emi nui ʻana o ka proteinuria, me ka nephritis ma lalo o ka kaohi.

# Nā Māka Immunological: Ua emi nā pae o nā antibodies DNA anti-double-stranded, a ua hoʻi nā pae complement C3 a me C4 i ka maʻamau.

3. Nā Hopena Lōʻihi (12 mahina):

# Hoʻomau ʻia ke kala ʻana: Ua mālama ʻo Ms. C i ke kala ʻana me ka ʻole o ka lāʻau lapaʻau no hoʻokahi makahiki me ka ʻole o nā hōʻailona o ka hoʻi hou ʻana o ka SLE.

# Palekana: Ma waho aʻe o ka cytokine release syndrome (CRS) ʻoluʻolu, ʻaʻole i loaʻa iā Ms. C nā hopena ʻino. Ua hoʻōla mālie kona ʻōnaehana pale ma hope o ka mālama ʻana, a ʻaʻole i hōʻike nā pūnaewele B e puka hou mai ana i ka pathogenicity.

Ma keʻano holoʻokoʻa, ua hōʻike ke kūlana o Ms. C i ka hoʻomaikaʻi kupaianaha a me ke kala mau ʻana ma hope o ka lāʻau lapaʻau CAR-T cell, e hōʻike ana i ka hiki o kēia lāʻau lapaʻau no ka SLE koʻikoʻi a paʻakikī hoʻi.

Hōʻike hoʻāʻo kelepona CART: