He tamaiti e whawhai ana ki te mate pukupuku lymphoblastic acute

Ngā Mōhiohio Taketake mō te Tūroro

He tāne 16-tau te pakeke i kitea he mate pukupuku toto lymphoblastic acute (B-ALL), i whiwhi i te rongoā chemotherapy tuatahi, te rongoā CD19/22 CAR-T cell, te rongoā salvage, me te whakawhitinga pūtau take haploidentical allogeneic hematopoietic (allo-HSCT) mai i tētahi mātua i tuku mai i a ia.

Te Āhuatanga o te Tūroro i mua i te Maimoatanga

I mua i te allo-HSCT, i pāngia te tūroro e te tere o te tipu o ngā pūtau toto mā me te mate tonu ahakoa ngā wawaotanga maha. Whai muri i te werohanga CD19/22 CAR-T i te 21 o Paenga-whāwhā, 2025 (ngā pūtau CAR-T katoa: 6.5×10^7), i te tīmatanga ka piki ake te maha o ngā pūtau CAR-T ki te 3.95×10^6/L i te rā 7 engari i heke ki te 0.82×10^6/L i te rā 14, me te pikinga o ngā pūtau toto ā-taha mai i te 28.6% ki te 87.1%. I te whakamātautau hinu wheua i te 15 o Mei, 2025, i kitea he tino heke te tipu me te 37.42% o ngā lymphoblast B rerekē (e whakaatu ana i te CD34, te CD38/CD22 wāhanga, te CD81/CD19/CD33 ngoikore, kāore he CD10/CD20/CD79b), e whakaū ana kāore he whakaoranga. Kāore he pūtau rerekē i kitea i roto i te wai cerebrospinal, engari kāore anō kia ora te mate whānui.

Te Āhuatanga o te Tūroro i Muri i te Maimoatanga

I muri i te allo-HSCT i te 29-30 o Mei, 2025 (ngā pūtau CD34+: 8.6×10^6/kg; ngā pūtau mononuclear: 8×10^8/kg), i tutuki i te tūroro te whakaurunga neutrophil i te rā 11 me te whakaurunga platelet i te rā 18. I te rā 28 (27 o Hune, 2025), i tino pai ake te maha o ngā toto: hemoglobin 99 g/L (mai i ngā taumata iti o mua), ngā pūtau toto mā 11.73×10^9/L, ngā neutrophil 9.81×10^9/L, me ngā platelet 79×10^9/L. I whakaatuhia e te āhua o te hinu wheua he tipu kaha me te kore he pūtau taketake rerekē, i whakaūhia e te flow cytometry kāore he rerekētanga, i tohuhia e te biopsy he tipu iti engari he pūtau trilineage e kitea ana me te kore he lymphocytes kāore i te pakeke, ā, i tae te STR chimerism ki te 100%, i tutuki ai te murunga katoa (CR) me te iti o te mate toenga kino (MRD-). I te rā 49 (Hōngongoi 18, 2025), i noho ora tonu te hinu wheua, kāore he pūtau rerekē, ā, i mau tonu te CR me te MRD-. I puta te mate whēkau graft-versus-host taumata 1 ngawari engari i whakahaerea mā te rongoā, e whakaatu ana i te whai huatanga o te whakahaere me te whakaora i te mate ki te whakataurite ki ngā pupuhi pumau i mua i te whakawhitinga (mai i te 37.42% ki te 0%) me te korenga o te murunga.