Te Mate Pūkahukahu Lymphoblastic Koretake (B-ALL)-03

Ngā Āhuatanga o te Pūkoro:

- I kitea he mate toto toto pūkahukahu pūtau-B i te mutunga o Mei 2020.

- Te whakamātautau toto: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- Te āhua o te hinu wheua: He iti te pūtau me te 67% o ngā pūtau toto taketake.

- Te tātaritanga rere o te pūtau: 82.28% o ngā pūtau e whakaatu ana i te CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, e whakaatu ana i te CD9 i te taha, e whakaatu ngoikore ana i te CD13.

- Kāore i kitea he ira whakakotahi e pā ana ki te PH, he pai te WT1 57.3%; kāore i kitea he ira whakakotahi e pā ana ki te ALL.

- IKA: He pai te whakarerekētanga TP53.

- Ngā ira-ira: 63-58, XXY, +Y, +1, +del(1)(q41q42), -2, -3, +6, -7, +8, -9, +10, -12, -13, +14, +15, -17, +18, -20, +22(cp16)/46, XY[4].

- I whiwhi i te maimoatanga VCDLP mō ngā akoranga e rua, kāore he murunga.

- Te rongoā CAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) i te 22 o Hūrae, 2020, kāore anō kia murua.

- Te whakamātautau rere o te hinu wheua i te 25 o Hepetema, 2020: 7.35% o ngā pūtau e whakaatu ana i te CD81, CD19, CD10, CD38, CD33, me te CD20, CD45 e whakaatu ngoikore ana.

- Tātaritanga ira whakarerekētanga o te pukupuku toto: ira whakarerekētanga TP53.

- Ngā ira-ira: 46, XY[20].

- I tīmata te rongoā CD19-CART.

- Te rongoā FC (REWHA 62.7mg x 4 rā, CTX 1045mg x 2 rā) rongoā chemotherapy.

- 1 o Oketopa, 2020: Te werohanga pūtau CD19-CART aunoa i te 4.7x10^7/kg.

- CRS taumata 2 me te paitini roro taumata 1, i pai ake i muri i te maimoatanga tautoko.

- 29 Oketopa 2020: Kua tino marino te āhua o te hinu wheua, kāore he pūtau kino taketake i runga i te ine ira.

- 31 Hakihea 2020: Maremare maroke, whakapairuaki, ruaki, ngoikore whānui.

- Te whakamātautau toto: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- Ko te mimiti o te hinu wheua e tohu ana i te hokinga mai o te mate.

- 2 o Hānuere, 2021: I whakaurua ki tō mātou hōhipera.

- Te whakamātautau toto: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

- Creatinine 134umol/L, toto toto tiketike wāhanga 3, hītori hauora o 4 tau.

- Te whakarōpūtanga toto ā-taha: 62% ngā pūtau taketake.

- Te Tātaritanga Ārai Mate: 28.48% o ngā pūtau (ngā pūtau whai pūtake) e whakaatu ana i te CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, e whakaatu ana i te CD123, TDT, kāore e whakaatu i te CD34, CD19, MPO, CD117, CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, e tohu ana i ngā pūtau toto kino taketake B.

- Tātaritanga ira whakarerekētanga toto: he pai te ira whakarerekētanga TP53 R196P.

Te maimoatanga:

- I whiwhi i te rongoā VLP chemotherapy, me te rongoā mō te toto toto tiketike, te whakaiti i te creatinine, me te whakapūmau i te waikawa.

- Hanuere 19: I whakaatuhia e te mahinga toto he WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Whakarōpūtanga toto ā-taha: Kāore he lymphocytes taketake.

- Te āhua o te hinu wheua: Te nui o ngā pūtau (tohu V), ngā wāhi matua o te tohu IV, me te 42% o ngā pūtau toto taketake.

- Ine rere o te pūtau: 13.91% o ngā pūtau e whakaatu ana i te CD10, cCD79a, CD38, CD81, CD22, kāore e whakaatu i te CD20, CD34, CD19, e tohu ana i ngā pūtau B taketake kino.

- Te momo ira tangata:

- 35,XY,-2,-3,-4,-5,-7,-9,-12,-13,-16,-17,-20[8]/35,XY,+X,-2,-3,-4,-5,-7,-9,-10,-12,-13,-16,-17,-20[1]/36,XY,tāpiri(1)(q42),-2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].

- Hanuere 20: I kohia ngā pūtau lymphocyte mō te ahurea pūtau CD22-CART.

- Hanuere 21: I mahia te pokanga o te lumbar, i tukuna te chemotherapy intrathecal hei ārai i te leukemia pūnaha io matua; kāore he āhuatanga rerekē i kitea i roto i te whakamātautau wai cerebrospinal.

- 22 o Hānuere: I whiwhi i te rongoā Arac, 6MP, L-ASP chemotherapy, me te rongoā FC (Flu 50mg x 3, CTX 0.5gx 3).

- 7 o Pēpuere (i mua i te werohanga): I whakaatuhia e te āhua o te hinu wheua he 93% o ngā pūtau toto taketake.

- Te tātaritanga rere o te pūtau: 76.42% o ngā pūtau e whakaatu ana i te CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, kāore e whakaatu i te CD4, CD3, CD13+33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), he tohu tēnei mō ngā pūtau B taketake kino.

- Kua pā mai te mate kiri me ngā kiko ngohengohe me te kirika; kua pai ake i muri i te rongoā paturopi.

- 9 o Pēpuere: Te werohanga pūtau CD22-CART aunoa (5x10^5/kg).

- Ngā pānga taha e pā ana ki te CAR-T: CRS taumata 1, kirika i te Rā 6 me te Tmax 40°C, pāmahana whakahaeretia i te Rā 10; kāore he paitini roro.

- Maehe 11: I whakaatuhia e te aromatawai hinu wheua te murunga katoa o te āhua, kāore i whakaatuhia e te flow cytometry ngā pūtau kino taketake.