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Ọrịa kansa ọbara Lymphoblastic dị oke njọ (T-ALL)-05

Onye Ọrịa: Amaghị aha

Okike:Nwoke

Afọ: afọ iri na ise

Mba: Ndị Chaịna

Nchọpụta ọrịaỌrịa Leukemia Lymphoblastic Dị Akpịrị (T-ALL)

    Mweghachi nke Onye Ọrịa T-ALL Laghachiri Agbanwe na Sistemụ Nrụgide Central Leukemia Mgbe Ọgwụgwọ CAR-T gasịrị


    Ikpe a metụtara otu nwa nwoke dị afọ iri na isii si Northeast China, onye njem ya na-arịa ọrịa leukemia juputara na ihe ịma aka kemgbe a chọpụtara ya ihe karịrị otu afọ gara aga.


    Na Nọvemba 8, 2020, Dawei (aha njirimara) gara n'ụlọ ọgwụ dị n'ógbè ahụ n'ihi isi ike ihu, ihe ọkụ ọkụ, na ọnụ gbagọrọ agbagọ. A chọpụtara na ọ nwere "ọrịa leukemia lymphoblastic dị oke njọ (ụdị mkpụrụ ndụ T)." Mgbe otu usoro ọgwụgwọ induction chemotherapy gasịrị, MRD (ọrịa fọdụrụnụ pere mpe) adịghị mma, wee soro ya na chemotherapy mgbe niile. N'oge a, a hụghị ihe ọ bụla na-adịghị mma na ụmị ọkpụkpụ, a na-agba ya n'akụkụ azụ, na a na-agba ya n'ime ahụ.


    Na Mee 6, 2021, e mere ntụtụ akwara azụ nke nwere ntụtụ intrathecal, nyocha nke mmiri cerebrospinal (CSF) gosikwara "ọrịa leukemia nke sistemụ akwara etiti." Nke a sochiri usoro abụọ nke kemoterapi mgbe niile. Na June 1, ntụtụ akwara azụ nke nwere nyocha CSF gosiri mkpụrụ ndụ na-etobeghị eto. E nyere ntụtụ akwara azụ atọ ọzọ nwere ntụtụ intrathecal, na ule CSF ikpeazụ egosighi mkpụrụ ndụ etuto ahụ.


    Na Julaị 7, Dawei hụrụ anya n'anya aka nri ya, nke mere ka ọ ghara ịhụ ìhè naanị. Mgbe otu usoro ọgwụgwọ chemotherapy gasịrị, anya aka nri ya laghachiri n'ọnọdụ ya.


    N'abalị ise nke ọnwa Ọgọstụ, anya aka nri ya dara ọzọ, nke mere ka ọ kpuo ìsì kpamkpam, anya aka ekpe ya wee ghara ịhụ ya nke ọma. Site n'abalị iri nke ọnwa Ọgọstụ ruo ụbọchị iri na atọ nke ọnwa Ọgọstụ, e mere ya ọgwụgwọ redio nke ụbụrụ dum na spinal cord (TBI), nke mere ka ọ hụkwuo anya n'anya aka ekpe ya, mana anya aka nri ka kpuru ìsì. N'abalị iri na isii nke ọnwa Ọgọstụ, nyocha MRI nke ụbụrụ gosiri obere mmụba na oke nke akwara anya aka nri na chiasm, ebe a hụrụ mmụba ya. Ahụghị ihe mgbaàmà ma ọ bụ mmezi adịghị mma na parenchyma ụbụrụ.


    N'oge a, ezinụlọ ahụ akwadola maka mgbanwe ọkpụkpụ, na-eche naanị ihe ndina n'ime ngalaba mgbanwe ahụ. Ọ dị mwute ikwu na nyocha ndị a na-eme tupu a gbanwee osisi ahụ gosiri nsogbu ndị mere ka ọ ghara ikwe omume ịgbanwe osisi ahụ.

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    Na Ọgọst 30, e mere mgbọ ọkpụkpụ, nke gosiri na MRD nke nwere T lymphocytes na-etobeghị eto nke ruru 61.1%. E mekwara mgbọ ọkpụkpụ azụ site na iji ọgwụ intrathecal, nke gosiri CSF MRD nwere mkpụrụ ndụ 127 zuru oke, nke T lymphocytes na-etobeghị eto nke nwere 35.4%, nke na-egosi nlọghachi nke leukemia kpamkpam.

    Na Ọgọst 31, 2021, Dawei na ezinụlọ ya rutere n'ebe anyị na-agwọ ọrịa CGT. Nnwale ọbara e mere n'ụlọọgwụ gosiri: WBC 132.91×10^9/L; ọdịiche ọbara dị n'akụkụ (morphology): 76.0% nke mgbawa. E nyere ọgwụ chemotherapy induction maka otu usoro ọgwụgwọ.

    Mgbe ha lebachara anya n'ọgwụgwọ Dawei gara aga, o doro anya na T-ALL ya na-agbanwe agbanwe/na-alaghachi azụ nakwa na mkpụrụ ndụ kansa abanyela n'ụbụrụ, na-emetụta akwara anya. Ndị otu ahụike ahụ kpebiri na Dawei mezuru ihe achọrọ maka ndebanye aha na nnwale ahụike CD7 CAR-T.

    Na Septemba 18, e mere nyocha ọzọ: ọdịiche ọbara dị n'akụkụ (morphology) gosiri 11.0% mgbawa. A chịkọtara lymphocytes ọbara dị n'akụkụ akụkụ maka ọdịbendị mkpụrụ ndụ CD7 CAR-T n'otu ụbọchị ahụ, usoro ahụ wee gaa nke ọma. Mgbe a chịkọtachara ya, e nyere chemotherapy iji kwadebe maka ọgwụgwọ immunotherapy mkpụrụ ndụ CD7 CAR-T.

    N'oge ọgwụgwọ chemotherapy, mkpụrụ ndụ tumor mụbara ngwa ngwa. Na Ọktoba 6, ọdịiche ọbara dị n'akụkụ (morphology) gosiri 54.0% mgbawa, a gbanwere usoro ọgwụgwọ chemotherapy iji belata ibu tumor. Na Ọktoba 8, nyocha nke mkpụrụ ndụ ọkpụkpụ gosiri 30.50% mgbawa; MRD gosiri na 17.66% nke mkpụrụ ndụ bụ lymphocytes T na-adịghị ahụkebe.

    N'abalị itoolu nke ọnwa Ọktoba, a gbanyere mkpụrụ ndụ CD7 CAR-T ọzọ. Mgbe a gbanyere mkpụrụ ndụ ahụ ọzọ, onye ọrịa ahụ nwetara ahụ ọkụ na mgbu chịngọm ugboro ugboro. N'agbanyeghị ọgwụgwọ mgbochi ọrịa ka mma, ahụ ọkụ ahụ ejighị nke ọma, ọ bụ ezie na mgbu chịngọm ahụ belatara nwayọ nwayọ.

    N'ụbọchị nke iri na otu mgbe a gbasịrị ọgwụ ahụ ọzọ, ọbara gbawara n'akụkụ ahụ́ ruru pasentị iri ise na anọ; n'ụbọchị nke iri na abụọ, nnwale ọbara gosiri na mkpụrụ ndụ ọbara ọcha na-arị elu ruo 16×10^9/L. N'ụbọchị nke iri na anọ mgbe a gbasịrị ọgwụ ahụ ọzọ, onye ọrịa ahụ nwetara CRS siri ike, gụnyere mmebi obi, nsogbu imeju na akụrụ, hypoxemia, ọbara ọgbụgba afọ na eriri afọ dị ala, na nkụchi. Ọgwụgwọ mgbaàmà na nkwado siri ike, yana mgbanwe plasma, ji nwayọọ nwayọọ meziwanye ọrụ nke akụkụ ahụ ndị metụtara, na-eme ka ihe ịrịba ama dị mkpa nke onye ọrịa ahụ sie ike.

    Na Ọktoba 27, onye ọrịa ahụ nwere ike akwara nke ọkwa 0 n'akụkụ abụọ nke ụkwụ ya. Na Ọktoba 29 (ụbọchị 21 mgbe a gbakechara ya), nnwale MRD nke ụmị ọkpụkpụ gbanwere na ọ dịghị mma.

    N'ọnọdụ ahụ Dawei na-agbaghara kpamkpam, o mere ka ọrụ aka ya dị ike site n'enyemaka nke ndị nọọsụ na ezinụlọ ya, wee jiri nwayọọ nwayọọ nweta ike akwara ruo ọkwa ise. Na Nọvemba 22, e zigara ya na ngalaba mgbanwe mkpụrụ ndụ iji kwadebe maka mgbanwe mkpụrụ ndụ hematopoietic allogeneic.

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