Kab mob qog ntshav Lymphoblastic mob hnyav (B-ALL)-01

Tau kuaj pom tias muaj mob leukemia B-cell lymphoblastic thaum lub Kaum Ib Hlis 28, 2017.

Thaum xub thawj, siv VDLP regimen kho, thiab ua kom cov pob txha tsis mob lawm (tsis tau qhia meej).

Lub Ob Hlis Ntuj xyoo 2018: Hloov mus rau VLCAM regimen. Kev ntsuas cov ntshav ntws hauv cov pob txha qhia tau tias muaj 60.13% ntawm cov hlwb B tsis loj hlob zoo.

Lub Peb Hlis Ntuj xyoo 2018: Tau sau npe rau hauv BiTE kev sim tshuaj. Kev zam txim ntawm cov hlwb pob txha, tsis muaj cov hlwb malignant immature pom los ntawm flow cytometry.

Tsib Hlis 8, 2018: Tau txais TBI/CY+VP16 kev kho mob tom qab ntawd los ntawm kev hloov pauv hlwb los ntawm cov kwv tij sib phim tag nrho (AB+ tus neeg pub rau A+ tus neeg tau txais). Neutrophil rov zoo rau hnub +11, megakaryocyte rov zoo rau hnub +12.

Lub Kaum Ob Hlis 5, 2018: Cov pob txha tau zoo tag nrho, tsis pom cov hlwb phem uas tsis tau loj hlob zoo los ntawm kev ntsuas cov qe ntshav dawb. Tau txais kev txhaj tshuaj lymphocyte (DLI) thiab kev kho mob tiv thaiv kab mob nrog dasatinib thiab imatinib kom tiv thaiv kev rov qab mob dua.

Lub Ob Hlis 2, 2019: Morphology qhia tau tias muaj 6.5% cov hlwb tsis tau loj hlob, flow cytometry qhia tau tias muaj 0.08% malignant immature B lymphoblasts. Tau txais kev kho mob DLI. Lub Peb Hlis 28, 2019: Flow cytometry qhia tsis muaj qhov txawv txav.

Lub Yim Hli 11, 2019: Kev rov qab mob pob txha dua, kho nrog dasatinib.

Cuaj Hlis 2, 2019: Morphology qhia tau tias muaj 3% ntawm cov hlwb tsis tau loj hlob, flow cytometry qhia tau tias muaj 0.04% ntawm cov hlwb phem uas tsis tau loj hlob. Txuas ntxiv kho nrog dasatinib, ua raws li 2 lub voj voog ntawm methotrexate chemotherapy.

Tsib Hlis 11, 2020: Cov pob txha rov qab mob dua.

Tau txais 2 txoj kev kho mob CD19-CAR-T cell autologous thiab 2 txoj kev kho mob allogeneic CD19-CAR-T cell hauv xyoo 2020, tsis muaj ib txoj kev kho mob tau zoo.

Lub Kaum Hli Ntuj hnub tim 26, 2020: Tau nkag mus rau hauv peb lub tsev kho mob.

Cov Kev Tshawb Pom Hauv Chav Kuaj Mob:

Cov ntshav niaj hnub: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Cov qe ntshav tsis loj hlob: 63%

Cov qauv ntawm cov pob txha pob txha: Hypercellular (qib II), 96% lymphoblasts tsis paub tab.

Kev ntsuam xyuas immunophenotyping: Cov hlwb qhia CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; ib feem ntawm CD123 qhia. Txheeb xyuas tias yog cov lymphoblasts B malignant immature.

Kev hloov pauv ntawm cov qog ntshav: Tsis zoo.

Leukemia fusion gene: NUP214-ABL1 fusion gene zoo.

Kev tshuaj xyuas Chromosome: 46, XX, t(1;9)(p34;p24), ntxiv(11)(q23)[4]/46, XX, t(1;9)(p34;p24), ntxiv(11)(q23)x2 [2]/46, XX[3]

Chimerism: Cov hlwb uas tau los ntawm tus neeg pub muaj txog 7.71%.

Kev Kho Mob:

- Kev siv tshuaj kho mob VDS, DEX, LASP.

- Kaum Ib Hlis 20: Cov qe ntshav tsis loj hlob txaus 0%.

- Kev sau cov lymphocytes ntshav peripheral uas yog autologous los siv rau kev cog qoob loo CD19/22 dual CAR-T cell.

- Kaum Ib Hlis 29: FC regimen chemotherapy (Flu 50mg x 3, CTX 0.4gx 3).

- Lub Kaum Ob Hlis 2 (ua ntej kev txhaj tshuaj CAR-T cell):

- Cov ntshav niaj hnub: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- Cov qauv ntawm cov pob txha hauv pob txha: Hypercellular (qib IV), 68% ​​​​cov lymphoblasts tsis paub tab.

- Kev ntsuam xyuas ntau ntawm NUP214-ABL1 fusion gene: 24.542%.

- Kev ntsuas cov kua dej hauv lub cev: 46.31% ntawm cov hlwb qhia CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, qhia tias cov hlwb B lymphoblast tsis loj hlob zoo.

- Lub Kaum Ob Hlis 4: Kev txhaj tshuaj ntawm cov qe ntshav CD19/22 ob lub CAR-T (3 x 10^5/kg).

- Cov kev mob tshwm sim los ntawm CAR-T: Qib 1 CRS, kub taub hau rau Hnub 6 nrog Tmax ntawm 40 ° C, kub taub hau tswj tau rau Hnub 10. Tsis pom muaj kev lom rau lub paj hlwb.

- Lub Kaum Ob Hlis 22 (Hnub ntsuam xyuas 18): Kev kho mob tiav hauv cov pob txha pob txha, tsis muaj cov hlwb malignant immature pom los ntawm flow cytometry. Kev ntsuam xyuas ntau ntawm NUP214-ABL1 fusion gene: 0%.