- Mankhwala
- Umboni
- Neuroblastoma
- Chotupa Cholimba
- Umboni
- TILS
- Chithandizo cha Maselo a NK
- Myasthenia Gravis (MG)
- Khansa ya m'magazi ya Lymphoblastic (B-ALL)
- Systemic Lupus Erythematosus (SLE)
- Matenda a khansa ya m'magazi (T-ALL)
- Non Hodgkin Lymphoma (NHL)
- Matenda a Myeloma Yambiri (MM)
- Kufalitsa Lymphom Yaikulu ya B-cell
- B-lymphocytic Leukemia
- Myeloma
Khansa ya m'magazi ya Lymphoblastic (B-ALL)-03
Zinthu Za Mlandu:
- Anapezeka ndi khansa ya m'magazi ya B-cell lymphoblastic kumapeto kwa Meyi 2020.
- Kuyeza magazi: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.
- Kapangidwe ka mafupa a m'mafupa: Maselo ochepa okhala ndi 67% ya ma lymphocyte oyambirira.
- Flow cytometry: 82.28% ya maselo amatulutsa CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, CD9 yotulutsa pang'ono, CD13 yotulutsa pang'ono.
- Kuwunika kwa majini a fusion kunali koyipa; WT1 57.3%; palibe majini a fusion ofanana ndi PH omwe adapezeka.
- NSOMBA: TP53 yasintha kukhala yolondola.
- Ma chromosome: 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].
- Ndalandira VCDLP regimen kwa maphunziro awiri popanda kuchira.
- Mankhwala a CAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) pa Julayi 22, 2020, osapitirira.
- Kuchuluka kwa kayendedwe ka magazi m'mafupa pa Seputembala 25, 2020: 7.35% ya maselo amaonetsa ma CD81, CD19, CD10, CD38, CD33, amaonetsa ma CD20, CD45 mofooka.
- Kusanthula kusintha kwa chotupa m'magazi: kusintha kwa TP53.
- Ma chromosome: 46, XY[20].
- Anayamba chithandizo cha CD19-CART.
- Mankhwala a chemotherapy a FC (FLU 62.7mg masiku 4, CTX 1045mg masiku 2).
- Okutobala 1, 2020: Kulowetsedwa kwa maselo a Autologous CD19-CART pa 4.7x10^7/kg.
- CRS giredi 2 yokhala ndi poizoni wa mitsempha ya giredi 1, imakula bwino pambuyo polandira chithandizo chothandizira.
- Okutobala 29, 2020: Kuchira kwathunthu mu mawonekedwe a m'mafupa, palibe maselo owopsa a khansa pa cytometry yoyenda.
- Disembala 31, 2020: Chifuwa chouma, nseru, kusanza, kufooka kwa thupi lonse.
- Kuyeza magazi nthawi zonse: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.
- Kutuluka kwa mafuta m'mafupa kumasonyeza kubwereranso.
- Januwale 2, 2021: Analowa m'chipatala chathu.
- Kuyeza magazi: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.
- Creatinine 134umol/L, kuthamanga kwa magazi kwa gawo lachitatu, mbiri ya matenda ya zaka 4.
- Kugawa magazi m'magazi ozungulira: 62% maselo oyambirira.
- Kujambula kwa Immunophenotyping: 28.48% ya maselo (maselo a nucleotide) amaonetsa CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, amaonetsa pang'ono CD123, TDT, saonetsa CD34, CD19, MPO, CD117, CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, zomwe zimasonyeza ma lymphocyte a B owopsa.
- Kusanthula kusintha kwa chotupa m'magazi: kusintha kwa TP53 R196P kuli ndi zotsatira zabwino.
Chithandizo:
- Analandira VLP chemotherapy, pamodzi ndi chithandizo cha kuthamanga kwa magazi, kuchepetsa creatinine, ndi hydration alkalineization.
- Januwale 19: Kuyeza magazi kunawonetsa WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.
- Kugawa magazi m'magazi a m'mbali: Palibe ma lymphocyte oyambirira.
- Kapangidwe ka mafupa a m'mafupa: Kuchuluka kwa maselo (kalasi ya V), malo ofunikira a digiri ya IV, ndi 42% ya ma lymphocyte oyambirira.
- Flow cytometry: 13.91% ya maselo amatulutsa CD10, cCD79a, CD38, CD81, CD22, samatulutsa CD20, CD34, CD19, zomwe zimasonyeza maselo a B oyambitsa matenda oopsa.
- Karyotype ya chromosome:
- 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, onjezerani(1)(q42),-2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].
- Januwale 20: Ma Lymphocyte anasonkhanitsidwa kuti azitha kupanga maselo a CD22-CART.
- Januwale 21: Anaboola lumbar, anapatsidwa chemotherapy mkati mwa intrathecal kuti apewe khansa ya m'magazi ya m'mitsempha yapakati; kufufuza kwa madzi a m'mitsempha ya ubongo sikunasonyeze vuto lililonse.
- Januwale 22: Analandira Arac, 6MP, L-ASP chemotherapy, ndi FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.
- February 7 (asanalowe m'thupi): Kapangidwe ka mafupa a m'mafupa kanasonyeza 93% ya ma lymphocytes oyambirira.
- Flow cytometry: 76.42% ya maselo amaonetsa CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, saonetsa CD4, CD3, CD13+33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), zomwe zimasonyeza maselo a B oyambitsa matenda oopsa.
- Anayamba kudwala matenda a pakhungu ndi minofu yofewa komanso malungo; anachira atalandira mankhwala opha maantibayotiki.
- February 9: Kulowetsedwa kwa maselo a Autologous CD22-CART (5x10^5/kg).
- Zotsatira zoyipa zokhudzana ndi CAR-T: CRS grade 1, malungo pa Tsiku 6 ndi Tmax 40°C, kutentha kolamulidwa pa Tsiku 10; palibe poizoni wa mitsempha.
- Marichi 11: Kuwunika kwa mafupa kunawonetsa kuchira kwathunthu kwa morphological, flow cytometry sinawonetse maselo owopsa a khansa.
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