Diffuse large B-cell lymphoma (DLBCL), hom kab mob tsis yog germinal center, uas cuam tshuam rau lub qhov ntswg thiab sinuses-02

Thaum Lub Peb Hlis Ntuj xyoo 2021, ib tug txiv neej hnub nyoog 52 xyoo los ntawm sab qaum teb sab hnub tuaj Suav teb tau pom tias muaj pob khaus hauv qhov ntswg thaum lub sijhawm kuaj mob niaj hnub. Nws muaj cov tsos mob ntawm qhov ntswg txhaws, mob taub hau, pom tsis meej, thiab hws hmo ntuj, tsis muaj kub taub hau lossis poob phaus.

Cov kev kuaj thawj zaug qhia tau hais tias muaj cov nqaij mos mos loj heev uas cuam tshuam rau sab xis ntawm lub qhov ntswg thiab cov sinuses, cuam tshuam rau cov qauv tseem ceeb xws li lub qhov ntswg, lub hauv paus pob txha taub hau pem hauv ntej, sphenoid sinus, thiab sab laug ethmoid sinus ntawm MRI. Kev kuaj mob ntawm sab xis ntawm lub qhov ntswg maxillary qhia tau hais tias muaj diffuse large B-cell lymphoma (DLBCL), hom kab mob tsis yog germinal center subtype.

Immunohistochemistry (IHC) qhia txog kev nkag mus rau hauv lub cev ntau heev nrog kev qhia ob npaug ntawm Ki-67 (90%+), CD20 (+), c-Myc (>80%+), Bcl-2 (>90%), Bcl-6 (+), CD10 (-), Mum1 (+), CD79a (+), CD30 (-), thiab CyclinD1 (-), tsis muaj RNA me me uas tau kuaj pom los ntawm Epstein-Barr tus kab mob (EBER).

Kev siv fluorescence in situ hybridization (FISH) tau kuaj pom Bcl-6 thiab c-myc translocations, tab sis tsis muaj Bcl-2 gene translocation. Next-generation sequencing (NGS) tau lees paub qhov mutations hauv MYD88, CD79B, IGH-MYC, BAP1, thiab TP53 genes, qhia tias muaj high-grade B-cell lymphoma nrog MYC thiab BCL2 thiab/lossis BCL6 translocations.

Positron emission tomography-computed tomography (PET-CT) qhia txog cov nqaij mos mos tsis sib xws hauv qhov ntswg sab xis thiab lub qhov ntswg sab saud, kwv yees li 6.3x3.8cm, nrog rau cov ciam teb tsis meej. Qhov mob nthuav dav mus rau sab xis ethmoid sinus, sab nraud mus rau phab ntsa medial ntawm lub qhov ntswg thiab thaj tsam intraorbital, thiab tom qab mus rau sphenoid sinus thiab lub hauv paus pob txha taub hau. Qhov mob tau pom tias muaj fluorodeoxyglucose (FDG) uptake ntau ntxiv nrog SUVmax ntawm 20. Mucosal thickening tau pom nyob rau sab laug ethmoid thiab lub qhov ntswg sab saud, nrog rau FDG metabolism ib txwm muaj.

Tus neeg mob tau dhau los ua R2-CHOP, R-ESHAP, BEAM+ASCT, thiab kev kho mob hauv zos, thiab pom tias tus kab mob loj zuj zus tuaj. Vim yog tsis kam kho mob chemotherapy thiab muaj ntau yam kab mob (xws li ntsws, siab, po, thiab pob txha), tus neeg mob tau kuaj pom tias muaj DLBCL uas tsis kho tau. Tus kab mob no tau loj hlob sai heev nrog kev kis mus rau lwm qhov, LDH ntau dua, qhov qhab nia International Prognostic Index (NCCN-IPI) hloov kho (NCCN-IPI) ntawm 5, TP53 mutation, thiab MCD subtype, thiab rov qab mob dua hauv 6 lub hlis tom qab hloov pauv tus kheej.

Tom qab kev kho mob txuas ntxiv, tus neeg mob tau txais kev kho mob steroid ib ntus nrog kev teb tsis zoo. Kev kho mob tom qab ntawd suav nrog CD79 monoclonal antibodies ua ke nrog bendamustine thiab mechlorethamine hydrochloride, ua rau cov theem LDH txo qis thiab pom tseeb tias qog nqaij hlav me me.

Tom qab npaj tau CAR-T kev kho mob zoo lawm, tus neeg mob tau txais kev kho mob lymphocyte depletion (lymphodepletion) nrog rau FC regimen, ua tiav qhov kev tshem tawm ntawm lymphocyte thiab tom qab ntawd leukopenia hnyav. Txawm li cas los xij, peb hnub ua ntej CAR-T infusion, tus neeg mob tau kub taub hau, herpes zoster hauv thaj tsam lumbar, thiab cov serum lactate dehydrogenase (LDH) nce mus txog 25.74ng/ml, qhia txog qhov ua tau tias muaj kev sib xyaw ua ke ntawm kev kis kab mob (AE). Xav txog qhov kev pheej hmoo ntawm CAR-T infusion vim yog kev kis kab mob, uas ua rau muaj kev tuag taus, tus neeg mob tau txais cov tshuaj tua kab mob dav dav uas npog ntau yam kab mob.

Tom qab muab CAR-T infusion, tus neeg mob tau kub taub hau heev rau hnub uas muab infusion, ua rau ua tsis taus pa, ua tsis taus pa, thiab cov tsos mob ntawm lub ntsws hnyav zuj zus tuaj rau hnub thib peb. Kev kuaj CT angiography ntawm cov hlab ntsha hauv lub ntsws rau hnub thib tsib qhia tau tias muaj cov qhov muag tsis pom tseeb thiab cov kev hloov pauv ntawm cov hlab ntsha hauv lub ntsws, ua pov thawj tias muaj ntshav hauv lub ntsws. Txawm hais tias thaum xub thawj tsis noj tshuaj steroids vim muaj peev xwm txo CAR-T, thiab kev kho mob txhawb nqa uas tsom mus rau kev tswj kev kis kab mob, tus neeg mob tus mob tau zoo dua me ntsis.

Nyob rau hnub xya, pom tau tias muaj kev loj hlob ntawm CAR gene copy number hauv cov ntshav peripheral, ua rau muaj kev hloov kho kev kho mob nrog methylprednisolone tsawg (40mg-80mg). Tsib hnub tom qab, cov kab mob ntsws ob sab tau txo qis, thiab cov tsos mob ntawm hemoptysis tau tswj tau zoo heev.

Txog hnub yim, kev kho mob CAR-T tau ua pov thawj tias muaj txiaj ntsig zoo kawg nkaus. Tsuas yog ib hlis ntawm kev kho mob CAR-T, tus neeg mob tau txais kev zam txim tag nrho (CR). Kev kuaj mob tom qab ntawd txog rau lub Xya Hli 2023 tau lees paub tias tus neeg mob tseem nyob hauv CR, qhia txog kev teb tob rau kev kho mob CAR-T thiab muaj peev xwm kho tau.