Khansa ya m'magazi ya Lymphoblastic (T-ALL)-01

Zochitika zachipatala:

- Kuzindikira: T-cell lymphoblastic lymphoma/leukemia

- Marichi 2020: Anapezeka ndi chifuwa cha paroxysmal ndi misa ya mediastinal, T-cell lymphoblastic lymphoma yotsimikizika ndi biopsy ya mediastinal mass puncture.

- Ndalandira ma chemotherapy 8 ndi ma radiotherapy opitilira 20, zomwe zidapangitsa kuti ma mediastinal mass achepe kwambiri.

- Januwale 16, 2021: Ndinayamba kupweteka m'chiwalo chakumanja cha m'munsi.

- Kuchuluka kwa magazi: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- Kapangidwe ka mafupa a m'mafupa: 95.5% ma lymphoblasts oyambirira.

- Kuchuluka kwa mafinya m'mafupa: 91.77% ya maselo anali ma lymphoblast a T-cell osakhwima.

- Kutsatana kwa majini: Kusintha kwa majini mu majini a NOTCH1, IL7R, ASXL2 kwapezeka.

- Analandira mankhwala a Hyper-CVAD/B, ndipo mankhwala a ESHAP pambuyo pake, onsewa sagwira ntchito bwino ngati kutentha thupi kumapitirira.

- February 18, 2021: Analowa m'chipatala chathu.

- Atadwala malungo, chifuwa cha CT chinasonyeza chibayo.

- Kuchuluka kwa magazi: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Maselo osakhwima m'magazi a m'mphepete mwa thupi: 90%

- Kapangidwe ka mafupa: Hypercellular (IV grade), 85% primitive lymphoblasts.

- Kuteteza thupi ku matenda opatsirana: 87.27% ya maselo anali ma lymphoblast a T-cell owopsa.

- Kusanthula kwa chromosome: 46,XX [24]; mitundu ina itatu ya karyotypes yosazolowereka yawonedwa.

- Majini osinthika:

1. IL7R T244_I245insARCPL mutation positive

2. NOTCH1 E1583_Q1584dup mutation positive

3. ASXL2 Q602R yasintha kukhala ndi kachilombo ka HIV

- Kuwunika majini osakanikirana ndi khansa ya m'magazi: Zoyipa

- Zotsatira za PET/CT: Palibe chotupa chachikulu chomwe chimapezeka m'mafupa onse ndi m'mafupa.

Chithandizo:

- Anayamba kumwa mankhwala a VP chemotherapy, motere: Vincristine (VDS) 3mg kamodzi, Dexamethasone (Dex) 7mg maola 12 aliwonse kwa masiku 9, pamodzi ndi mankhwala oletsa matenda.

- Marichi 1: Maselo osakhwima m'magazi a m'mphepete mwa nyanja atsika kufika pa 7%.

- Marichi 4: Anasonkhanitsa ma lymphocyte a autologous kuti azitha kupanga maselo a CD7-CAR T.

- Marichi 8: Anayamba kugwiritsa ntchito mankhwala a VLP pamodzi ndi mankhwala a Sida benzamine.

- Marichi 14: Analandira FC regimen chemotherapy (Fludarabine 0.35g kwa masiku atatu, Cyclophosphamide 45mg kwa masiku atatu).

- Marichi 17 (kulowetsedwa kwa maselo asanayambe):

- Kusunga chitetezo chamthupi m'mafupa: Maselo 15.14% amaonetsa kuwala kwa CD7, kufooka kwa CD3, kufooka kwa maselo a T, kuchepetsedwa kwa delta (TCRrd), kuwonetsa pang'ono kwa CD99, kusonyeza maselo a T oyambitsa matenda oopsa.

- Marichi 19: Maselo a T a CD7-CAR omwe adalowetsedwa (1 x 10^6/kg).

- Zotsatira zoyipa zokhudzana ndi CAR-T: CRS ya Giredi 1 (malungo), palibe poizoni muubongo.

- Epulo 6 (Tsiku 17): Kapangidwe ka mafupa a m'mafupa kanasonyeza kuchira, kayendedwe ka magazi sikanazindikira maselo owopsa.