Khansa ya m'magazi ya Lymphoblastic (B-ALL)-01

Anapezeka ndi khansa ya m'magazi ya B-cell lymphoblastic pa Novembala 28, 2017.

Chithandizo cha VDLP poyamba, kukwaniritsa kuchotsedwa kwa mafupa pang'ono (tsatanetsatane sunanenedwe).

February 2018: Ndasintha kugwiritsa ntchito njira ya VLCAM. Kuchuluka kwa maselo a B osakhwima m'thupi kunawonetsa 60.13% ya maselo a B osakhwima omwe anali ndi vuto la khansa.

Marichi 2018: Analembetsa mu mayeso azachipatala a BiTE. Kuchotsedwa kwa morphological mu bonemorrow, palibe maselo osakhwima omwe amapezeka ndi flow cytometry.

Meyi 8, 2018: Analandira njira yochiritsira ya TBI/CY+VP16 kenako anasamutsira maselo oyambira a allogeneic kuchokera kwa m'bale wake wofanana (wopereka AB+ kwa wolandira A+). Kuchira kwa neutrophil pa tsiku +11, kuchira kwa megakaryocyte pa tsiku +12.

Disembala 5, 2018: Kuchotsedwa kwathunthu kwa morphological mu bonemorrow, palibe maselo osakhwima omwe amapezeka ndi flow cytometry. Analandira donor lymphocyte infusion (DLI) ndi chithandizo choteteza ndi dasatinib ndi imatinib kuti apewe kubwereranso.

Pa 2 February, 2019: Kapangidwe ka maselo kanasonyeza 6.5% ya maselo osakhwima, ndipo kachitidwe ka maselo otuluka magazi kanasonyeza 0.08% ya maselo a B osakhwima omwe anali ndi matenda oopsa. Analandira chithandizo cha DLI. Pa 28 March, 2019: Kachitidwe ka maselo otuluka magazi kanasonyeza kuti palibe vuto lililonse.

Ogasiti 11, 2019: Kubwereranso kwa mafupa, kuchiritsidwa ndi dasatinib.

Pa 2 Seputembala, 2019: Kapangidwe ka thupi kanasonyeza 3% ya maselo osakhwima, ndipo kayendedwe ka magazi kanasonyeza 0.04% ya maselo osakhwima. Kupitiriza kulandira chithandizo ndi dasatinib, kutsatiridwa ndi mankhwala a methotrexate chemotherapy kawiri.

Meyi 11, 2020: Kubwereranso kwa mafupa.

Mu 2020, ndinalandira machiritso awiri a CD19-CAR-T cell ndi machiritso awiri a allogeneic CD19-CAR-T cell, koma palibe amene anachira.

Okutobala 26, 2020: Analowa m'chipatala chathu.

Zomwe Zapezeka mu Laboratory:

Kuchuluka kwa magazi: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Maselo osakhwima m'magazi a m'mphepete mwa nyanja: 63%

Kapangidwe ka mafupa: Hypercellular (grade II), 96% ya ma lymphoblast osakhwima.

Kujambula Thupi: Maselo amatulutsa CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; kuwonetsa pang'ono kwa CD123. Kuzindikirika ngati ma lymphoblasts a B osakhwima.

Kusintha kwa chotupa cha m'magazi: Choyipa.

Jini losakanikirana la khansa ya m'magazi: Jini losakanikirana la NUP214-ABL1 lili ndi ubwino.

Kusanthula kwa chromosome: 46, XX, t(1;9)(p34;p24), onjezerani(11)(q23)[4]/46, XX, t(1;9)(p34;p24), onjezerani(11)(q23)x2 [2]/46, XX[3]

Chimerism: Maselo opangidwa ndi opereka ndi 7.71%.

Chithandizo:

- Mankhwala a chemotherapy a VDS, DEX, LASP amaperekedwa.

- Novembala 20: Maselo osakhwima m'magazi a m'mphepete mwa nyanja ndi 0%.

- Kusonkhanitsa ma lymphocyte a magazi a autologous kuti apeze maselo awiri a CD19/22 a CAR-T.

- Novembala 29: Chithandizo cha mankhwala a FC regimen (Flu 50mg x 3, CTX 0.4gx 3).

- Disembala 2 (asanalowetsedwe maselo a CAR-T):

- Kuyeza magazi nthawi zonse: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- Kapangidwe ka mafupa: Hypercellular (grade IV), 68% ya ma lymphoblasts osakhwima.

- Kuwunika kuchuluka kwa jini ya NUP214-ABL1 fusion: 24.542%.

- Flow cytometry: 46.31% ya maselo amaonetsa CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, kusonyeza ma lymphoblast a B osakhwima omwe ali ndi khansa.

- Disembala 4: Kulowetsedwa kwa maselo awiri a CAR-T a autologous CD19/22 (3 x 10^5/kg).

- Zotsatira zoyipa zokhudzana ndi CAR-T: CRS ya Giredi 1, malungo pa Tsiku la 6 ndi Tmax ya 40°C, malungo olamulidwa ndi Tsiku la 10. Palibe poizoni wa mitsempha wowonedwa.

- Disembala 22 (Kuyesa kwa Tsiku la 18): Kuchotsedwa kwathunthu kwa morphological mu mafupa, palibe maselo osakhwima omwe amapezeka ndi flow cytometry. Kuyesa kuchuluka kwa jini ya NUP214-ABL1 fusion: 0%.