Ọrịa kansa ọbara Lymphoblastic dị oke njọ (B-ALL)-01

A chọpụtara na ọ nwere ọrịa leukemia nke mkpụrụ ndụ B-cell lymphoblastic na Nọvemba 28, 2017.

Ọgwụgwọ site na usoro VDLP na mbụ, na-enweta mbelata akụkụ nke ụmị ọkpụkpụ (akọwaghị nkọwa ndị ọzọ).

Febụwarị 2018: A gbanwere ya gaa na usoro VLCAM. Cytometry nke usoro ọkpụkpụ na-agbapụta n'ọkpụkpụ gosiri 60.13% nke mkpụrụ ndụ B na-etobeghị eto.

Machị 2018: E debanyere aha na nnwale ahụike BiTE. Mbelata ọdịdị na ụmị ọkpụkpụ, enweghị mkpụrụ ndụ na-etobeghị nke ọma site na cytometry flow.

Mee 8, 2018: Anatara m usoro nhazi TBI/CY+VP16, wee soro ya transplant mkpụrụ ndụ algeneic site n'aka nwanne ya nwoke nke kwekọrọ nke ọma (onye nyere AB+ nye onye nnata A+). Mgbake Neutrophil na ụbọchị +11, mgbake megakaryocyte na ụbọchị +12.

Disemba 5, 2018: Mbelata ọkpụkpụ zuru oke, enweghị mkpụrụ ndụ na-etobeghị nke ọma site na cytometry flow. Anatara m infusion lymphocyte donor (DLI) na ọgwụgwọ mgbochi site na iji dasatinib na imatinib iji gbochie nlọghachi azụ.

Febụwarị 2, 2019: Ọmụmụ ihe gosiri na mkpụrụ ndụ ndị na-etobeghị eto ruru 6.5%, usoro mmiri ahụ gosiri na ọ bụ 0.08% lymphoblasts B ndị na-etobeghị eto. E nyere m ọgwụgwọ DLI. Machị 28, 2019: Usoro mmiri ahụ egosighi nsogbu ọ bụla.

Ọgọst 11, 2019: Nlaghachi azụ nke ụmị ọkpụkpụ, ejiri dasatinib gwọọ ya.

Septemba 2, 2019: Ọmụmụ ihe gosiri na mkpụrụ ndụ ndị na-etobeghị eto 3%, cytometry nke mmiri gosiri 0.04% mkpụrụ ndụ ndị na-etobeghị eto. Ọgwụgwọ gara n'ihu na dasatinib, wee soro usoro abụọ nke ọgwụ chemotherapy methotrexate.

Mee 11, 2020: Mbilite n'ọkpụkpụ ọkpụkpụ ọzọ.

Na 2020, enwetara m ọgwụgwọ mkpụrụ ndụ CD19-CAR-T abụọ na ọgwụgwọ mkpụrụ ndụ allogeneic CD19-CAR-T abụọ, mana ọ dịghị nke e nyere mgbaghara.

Ọktoba 26, 2020: E tinyere ya n'ụlọ ọgwụ anyị.

Nchọpụta Ụlọ Nyocha:

Usoro ọbara: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Mkpụrụ ndụ ọbara na-etobeghị eto nke dị n'akụkụ: 63%

Ọdịdị nke ụmị ọkpụkpụ: Hypercellular (ọkwa nke abụọ), 96% lymphoblasts ndị na-etobeghị eto.

Nchọpụta Immunophenotyping: Mkpụrụ ndụ na-egosipụta CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; ngosipụta akụkụ nke CD123. Achọpụtara ya dị ka lymphoblast B na-etobeghị eto.

Mgbanwe nke etuto ahụ ọbara: Ihe na-adịghị mma.

Mkpụrụ ndụ ihe nketa nke leukemia: Mkpụrụ ndụ ihe nketa nke NUP214-ABL1 dị mma.

Nyocha nke kromosome: 46, XX, t(1;9)(p34;p24), tinye(11)(q23)[4]/46, XX, t(1;9)(p34;p24), tinye(11)(q23)x2 [2]/46, XX[3]

Chimerism: Mkpụrụ ndụ ndị sitere na onyinye na-eme ihe ruru 7.71%.

Ọgwụgwọ:

- E nyere usoro ọgwụgwọ ọgwụ VDS, DEX, LASP.

- Nọvemba 20: Mkpụrụ ndụ ọbara na-etobeghị etozu 0%.

- Nchịkọta nke sel ọbara nke nwere onwe ya maka mkpụrụ ndụ CAR-T abụọ nke CD19/22.

- Nọvemba 29: Usoro ọgwụgwọ FC (Flu 50mg x 3, CTX 0.4gx 3).

- Disemba 2 (tupu ntinye mkpụrụ ndụ CAR-T):

- Usoro ọbara: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- Ọdịdị nke ụmị ọkpụkpụ: Hypercellular (ọkwa nke anọ), 68% lymphoblasts ndị na-etobeghị eto.

- Nnyocha ọnụọgụgụ nke mkpụrụ ndụ ihe nketa NUP214-ABL1: 24.542%.

- Cytometry mmiri: 46.31% nke mkpụrụ ndụ na-egosipụta CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, nke na-egosi lymphoblast B na-etobeghị eto.

- Disemba 4: Ntinye nke mkpụrụ ndụ CAR-T abụọ nke CD19/22 (3 x 10^5/kg).

- Mmetụta ọjọọ ndị metụtara CAR-T: Ọkwa 1 CRS, ahụ ọkụ n'ụbọchị nke 6 yana Tmax nke 40°C, ahụ ọkụ na-achịkwa site na ụbọchị nke 10. Ahụbeghị ihe na-egbu egbu na-adịghị mma.

- Disemba 22 (Nyocha nke ụbọchị 18): Mbelata zuru oke nke morphological na ụmị ọkpụkpụ, enweghị mkpụrụ ndụ na-etobeghị nke ọma site na cytometry flow. Nyocha ọnụọgụ nke mkpụrụ ndụ ihe nketa NUP214-ABL1: 0%.