Kab mob qog ntshav Lymphoblastic mob hnyav (B-ALL)-02

Cov yam ntxwv ntawm rooj plaub:

- Tsib Hlis 19, 2019: Kuaj pom tias muaj mob qog ntshav B-cell lymphoblastic leukemia (B-ALL)

- Ua rau muaj ntau yam mob qog nqaij hlav thiab lymphadenopathy

- Cov ntshav ntsuas: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, cov lymphocytes tsis zoo 4%

- Cov qauv ntawm cov pob txha hauv pob txha: 80.2% cov lymphoblasts tsis paub tab (blasts)

- Kev kuaj mob immunophenotyping: 74.19% ntawm cov hlwb yog cov hlwb B-lineage malignant uas qhia CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, thiab qhia ib feem ntawm cIgM. Kev kuaj mob: B-ALL (Theem Pre-B)

- Fusion gene: MLL-ENL zoo, Philadelphia chromosome-zoo li (Ph-zoo li) screen tsis zoo

- Chromosome: 46, XX, t(11;19)(q23;p13), del(20)(q12) [3]/46, XX [7]

- Kev kho mob VDLD thawj zaug tau ua tiav kev zam txim ntawm kev tiv thaiv kab mob tom qab 1 lub hlis, MLL-ENL quantitative PCR 0.026%

- Txuas ntxiv siv tshuaj chemotherapy raws li cov txheej txheem rau menyuam yaus, MLL-ENL quantitative PCR 0 tom qab lub voj voog thib 4. Txuas ntxiv siv tshuaj chemotherapy.

- Lub Peb Hlis Ntuj xyoo 2020: Cov kab mob tseem ceeb ntawm cov pob txha hauv lub cev tiv thaiv kab mob 0.35%, MLL-ENL quantitative PCR 0.53%, qhia txog kev rov qab mob dua. Tsev neeg tsis kam hloov hlwb. Txuas ntxiv kho mob chemotherapy rau 3 lub voj voog.

- Lub Xya Hli 2020: Cov pob txha rov qab mob dua.

- Kaum Ib Hlis 11, 2020: Kev siv tshuaj kho mob hauv lub qhov (intrathecal chemotherapy), CSF immunological residual disease 66%, kuaj pom tias muaj mob leukemia hauv lub paj hlwb. Kev siv tshuaj kho mob hauv lub qhov rov ua ob zaug, CSF tsis muaj mob.

- Lub Kaum Ob Hlis 31, 2020: Tau nkag mus rau hauv peb lub tsev kho mob.

- Cov ntshav niaj hnub: WBC 3.99 x 10^9/L, HGB 66 g/L, PLT 57 x 10^9/L

- Tus lej ntawm cov ntshav tawg ntawm cov hlab ntsha: 69%

- Cov qauv ntawm cov pob txha hauv pob txha: 90% ntawm cov lymphoblasts tsis paub tab (blasts)

- Kev ntsuam xyuas cov noob caj noob ces (immunophenotyping): 84.07% ntawm cov hlwb qhia CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, qhia ib feem ntawm CD24, CD15dim, qhia tias cov noob caj noob ces B lymphoblasts tsis loj hlob zoo.

- Cov noob sib xyaw ua ke: MLL-ENL cov noob sib xyaw ua ke zoo, muaj PCR ntau 44.419%

- Kev hloov pauv caj ces: KMT2D mutation zoo (keeb kwm ntawm cov noob caj ces)

- Chromosome karyotype: 46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3), ntxiv(14)(q34), -17, +mar [7]/46, idem, t(3;16)(p21;p13.3) [1]/46, XX [13]

- PET-CT: Kev nce ntxiv ntawm cov metabolism hauv tag nrho cov pob txha thiab cov pob txha pob txha, muaj kev xav tias muaj leukemia rov qab los; splenomegaly nrog rau kev nce ntxiv ntawm cov metabolism, tej zaum yuav muaj leukemia.

- Tau ua kev txhaj tshuaj rau lub duav thiab tshuaj kho mob rau hauv lub qhov quav ib zaug lawm, tsis pom muaj qhov txawv txav hauv kev kuaj mob ntsig txog CSF.

Kev Kho Mob:

- Ob lub lis piam ntawm VLP chemotherapy, peripheral ntshav blasts 5% rau lub Ib Hlis 18.

- Lub Ib Hlis 25: Cov ntshav ntws mus rau hauv cov hlab ntsha tau tawg 91%, kho nrog CTX, Ara-C, 6-MP chemotherapy.

- Lub Ob Hlis 3: Cov ntshav ntws los ntawm cov hlab ntsha loj hlob 22%.

- Lub Ob Hlis 4: Sau 50ml cov ntshav peripheral rau kev cog qoob loo CD19-CART.

- MTX 1g, FC chemotherapy (Kab mob khaub thuas 15mg txhua hnub x 3 hnub, CTX 0.12g txhua hnub x 3 hnub).

- Lub Ob Hlis 13 (ua ntej txhaj tshuaj): Cov qauv ntawm cov pob txha hauv pob txha qhia tau tias muaj 87.5% ntawm cov qog nqaij hlav tawg, cov txheej txheem cytometry qhia tau tias muaj 79.4% ntawm cov qog nqaij hlav tawg phem.

- Kev tshuaj xyuas cov noob caj noob ces MLL-ENL fusion: 42.639%.

- Lub Ob Hlis 14: Kev txhaj tshuaj rau cov hlwb CART ntawm qhov koob tshuaj 5 x 10^5/kg.

- Cov kev mob tshwm sim tsis zoo uas cuam tshuam nrog CAR-T: Qib 1 CRS (kub taub hau), tsis muaj tshuaj lom rau lub paj hlwb.

- Hnub 20 tom qab txhaj tshuaj: Cov ntshav kuaj pom tias muaj qog loj hlob tuaj, CART cell feem pua ​​yog 0.07%.

- Kev kho mob CART cell tsis zoo.

- Lub Peb Hlis 8, 2021: Cov ntshav niaj hnub: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- Cov ntshav tawm ntawm cov hlwb: 83%. Cov ntshav ntawm cov hlwb uas tau sau 60ml rau kev cog noob CD19/CD22 dual CART.

- Kho nrog cytarabine thiab dexamethasone los tswj cov mob qog nqaij hlav.

- Lub Peb Hlis 18: FC chemotherapy (Kab mob khaub thuas 15mg txhua hnub x 3 hnub, CTX 0.12g txhua hnub x 3 hnub).

- Lub Peb Hlis 22 (ua ntej txhaj tshuaj): Kev ntsuas ntshav: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Cov qauv ntshav ntawm cov hlab ntsha: 6% blasts.

- Cov qauv ntawm cov pob txha pob txha: 91% blasts. Cov seem hauv cov pob txha pob txha: 88.61% cov hlwb uas qhia CD38, CD19, cCD79a, CD81, CD22, qhia tias yog cov malignant immature B lymphoblasts.

- Kev tshuaj xyuas cov noob caj noob ces MLL-ENL fusion: 62.894%.

- Kev tshuaj xyuas chromosome karyotype: 46, XX, del(1)(p36.1), del(11)(q13), t(11;19)(q23;p13.3), ntxiv(14)(q34), -17, +mar [2]/46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3), ntxiv(14)(q34).

- Lub Peb Hlis 23: Kev txhaj tshuaj rau cov hlwb CART ntawm qhov koob tshuaj ntawm 3 x 10^5/kg.

- Txij li hnub tim 26 lub Peb Hlis mus: Kub taub hau tas li thiab tom qab ntawd o tuaj rau hauv lub cev.

- Lub Peb Hlis 29: Cov qauv ntshav ntawm cov hlab ntsha: 92% blasts; cov transaminases thiab bilirubin nce siab.

- Plaub Hlis 2: Pib muaj qaug dab peg, kho nrog diazepam.

- Plaub Hlis 2 (Hnub 10): Pib kho methylprednisolone tau 3 hnub.

- CRS kev ua xua: Qib 3, CRES: Qib 3.

- Plaub Hlis 8 (Hnub 16): Kev ntsuam xyuas cov pob txha qhia tau tias muaj kev zam txim tag nrho, cov flow cytometry tsis pom muaj cov qog nqaij hlav phem; MLL-ENL fusion gene quantitative analysis: 0.