Gbasaa nnukwu lymphoma B-cell (DLBCL), ụdị etiti na-abụghị nke nje, nke gụnyere oghere imi na sinuses-02

Na Machị 2021, otu nwoke dị afọ iri ise na abụọ si Northeast China chọpụtara na imi ya na-agba agba n'oge a na-eme nnyocha. O nwetara ihe mgbaàmà nke mkpọchi imi, isi ọwụwa, anya na-adịghị mma, na ọsụsọ n'abalị, na-enweghị ahụ ọkụ ma ọ bụ ibu arọ.

Nnyocha mbụ gosiri oke anụ ahụ dị nro nke gụnyere oghere imi aka nri na sinuses, na-emetụta akụkụ dị mkpa dịka orbit, ntọala okpokoro isi aka ekpe, sinus sphenoid, na sinus ethmoid aka ekpe na MRI. Nnyocha ọrịa nke sinus aka nri maxillary gosiri na lymphoma B-cell dị iche iche (DLBCL), nke bụ ụdị etiti na-abụghị nke germinal.

Immunohistochemistry (IHC) gosiri nnukwu mwakpo site na ngosipụta abụọ nke Ki-67 (90%+), CD20 (+), c-Myc (>80%+), Bcl-2 (>90%), Bcl-6 (+), CD10 (-), Mum1 (+), CD79a (+), CD30 (-), na CyclinD1 (-), na-enweghị obere RNA nke Epstein-Barr nke a na-achọpụta (EBER).

Fluorescence in situ hybridization (FISH) chọpụtara mgbanwe Bcl-6 na c-myc, mana enweghị mgbanwe mkpụrụ ndụ ihe nketa Bcl-2. Usoro nhazi ọgbọ ọhụrụ (NGS) kwadoro mgbanwe na mkpụrụ ndụ ihe nketa MYD88, CD79B, IGH-MYC, BAP1, na TP53, na-egosi lymphoma mkpụrụ ndụ B dị elu nwere MYC na BCL2 na/ma ọ bụ mgbanwe BCL6.

Tomography nke Positron emission tomography-computed tomography (PET-CT) gosiri oke anụ ahụ dị nro na-adịghị mma n'ime oghere imi aka nri na imi dị elu, ihe dị ka 6.3x3.8cm n'ogo, yana ókèala na-adịghị ahụkebe. Nje ahụ gbatịkwuru elu gaa na sinus ethmoid aka nri, n'èzí ruo na mgbidi etiti nke orbit na mpaghara intraorbital, na n'azụ ruo na sphenoid sinus na ntọala okpokoro isi. Nje ahụ gosipụtara mmụba nke fluorodeoxyglucose (FDG) na-enweta site na SUV kacha nke 20. A hụrụ ọkpụrụkpụ mucosal na ethmoid aka ekpe na imi dị elu, yana metabolism FDG nkịtị.

Onye ọrịa ahụ agafeela R2-CHOP, R-ESHAP, BEAM+ASCT, na ọgwụgwọ redio mpaghara, a hụkwara ọganihu ọrịa ahụ. N'ihi iguzogide chemotherapy na nnukwu ntinye aka n'ọtụtụ akụkụ ahụ (gụnyere ngụgụ, imeju, splin, na ọkpụkpụ), a chọpụtara na onye ọrịa ahụ nwere DLBCL na-adịghị ike. Ọrịa ahụ gara n'ihu ngwa ngwa na nnukwu mwakpo, ọkwa LDH dị elu, akara International Prognostic Index (NCCN-IPI) gbanwere nke 5, mgbanwe TP53, na ụdị MCD, na-enweta nlọghachi n'ime ọnwa isii mgbe a gbanwere ya.

Mgbe ọgwụgwọ bridge gasịrị, onye ọrịa ahụ natara ọgwụgwọ steroid nwa oge mana ọ naghị anabata ya nke ọma. Ọgwụgwọ ndị e mechara gụnyere ọgwụ mgbochi monoclonal CD79 yana bendamustine na mechlorethamine hydrochloride, nke butere mbelata dị ukwuu na ọkwa LDH na mbelata nke etuto ahụ a na-ahụ anya.

Mgbe emechara nkwadebe nke ọgwụgwọ CAR-T nke ọma, onye ọrịa ahụ natara ọgwụ chemotherapy nke na-ebelata lymphocyte (lymphodepletion) site na usoro FC, na-enweta mwepụ lymphocyte achọrọ na leukopenia siri ike sochiri ya. Agbanyeghị, ụbọchị atọ tupu ntinye CAR-T, onye ọrịa ahụ malitere ahụ ọkụ, herpes zoster na mpaghara lumbar, na ọkwa lactate dehydrogenase (LDH) dị elu ruo 25.74ng/ml, nke na-egosi na enwere ike inwe ihe egwu dị iche iche nke ọrịa na-efe efe (AE). N'ịtụle mmụba nke ohere nke ntinye CAR-T n'ihi ọrịa na-efe efe, nke nwere ike ibute ọnwụ, onye ọrịa ahụ natara ọgwụ nje sara mbara nke na-ekpuchi ọtụtụ nje.

Mgbe a mịnyechara CAR-T, onye ọrịa ahụ malitere ịrịa ahụ ọkụ dị elu n'ụbọchị a mịnye ya, na-aga n'ihu na-enwe nkụchi obi, na-eme ka ọbara gbapụta, na-eme ka ihe mgbaàmà akpa ume ka njọ n'ụbọchị nke atọ. N'ụbọchị nke ise, CT angiography nke akwara akpa ume gosiri na enyo enyo gbasasịrị agbasasị na mgbanwe n'etiti akpa ume, na-akwado ọbara ọgbụgba akpa ume. N'agbanyeghị na e zere steroid mbụ n'ihi na CAR-T nwere ike igbochi ya, na ọgwụgwọ nkwado lekwasịrị anya na njikwa mgbochi ọrịa, ọnọdụ onye ọrịa ahụ gosipụtara obere mmụba.

N'ụbọchị nke asaa, achọpụtara mmụba dị ukwuu nke ọnụọgụ mkpụrụ ndụ ihe nketa CAR n'ọbara dị n'akụkụ, nke mere ka e mee mgbanwe ọgwụgwọ site na iji obere methylprednisolone (40mg-80mg). Ụbọchị ise ka nke ahụ gasịrị, ọnụọgụ akpa ume abụọ belatara, a chịkwara mgbaàmà hemoptysis nke ọma.

N'ụbọchị nke asatọ, ọgwụgwọ CAR-T gosipụtara irè dị egwu. N'ime otu ọnwa nke ọgwụgwọ CAR-T, onye ọrịa ahụ nwetara mgbaghara zuru oke (CR). Nnyocha ndị sochirinụ ruo Julaị 2023 gosiri na onye ọrịa ahụ ka nọ na CR, na-egosi mmeghachi omume miri emi maka ọgwụgwọ CAR-T na ike ịgwọ ya.