Khansa ya m'magazi ya Lymphoblastic (T-ALL)-04

Wodwalayo anali mwamuna wazaka 15, yemwe anapezeka ndi T-cell acute lymphoblastic leukaemia (T-ALL yokhala ndi STIL-TAL1 positivity, jini losayembekezereka) kumapeto kwa Disembala 2020, ndipo analandira chithandizo kuchipatala chapafupi ndi chemotherapy yobwerezabwereza kuti athetse vuto lonse. Kusamutsa maselo oyambira a hemizygous haematopoietic kunachitika pa 2 Juni 2021, koma mwatsoka kubwereranso kwa mafuta m'mafupa kunapezeka patatha miyezi itatu atasamutsidwa, ndipo chemotherapy imodzi sinagwire ntchito. Nthawi yomweyo, anayamba kutupa masaya ndi kutuluka kwa mpweya, ngodya zokhotakhota za pakamwa, ndi kubowola kwa lumbar kunasonyeza kuti matendawa anali khansa ya m'magazi ya mitsempha yapakati.

Matenda a T-ALL okhala ndi STIL-TAL1, kubwereranso msanga pambuyo poika allogeneic, kuphatikiza ndi khansa ya m'magazi ya mitsempha yapakati, ndi vuto lovuta kwambiri kuchiza m'nthawi imeneyo popanda CAR-T. Bambo a mwanayo adafunsa za dipatimenti ya hematology ku Tianjin Cancer Hospital Airport Hospital kudzera mwa anzake. Atalankhulana mwatsatanetsatane, adabwera ku Tianjin Cancer Hospital Airport Hospital, akufuna kulembetsa mu mayeso a CAR-T ngati njira yomaliza.

Maselo oyamba a khansa omwe analephera kugwira ntchito ya CAR-T anachulukana mofulumira, zomwe zinaika moyo wake pachiswe.

Pa 26 Okutobala 2021, wodwalayo adalowetsedwa mu chipinda choyamba cha Dipatimenti ya Hematology. Chifukwa cha kuchulukana mwachangu kwa maselo otupa, wodwalayo adapatsidwa mankhwala a chemotherapy kuti achepetse kuchuluka kwa chotupa ndipo adalandira mankhwala a intrathecal chemotherapy. Madzi a m'mitsempha ya ubongo sanawonetse matenda otsala. Pambuyo pokhazikika, ma lymphocyte a abambo ake adasonkhanitsidwa kuti azitha kupanga maselo a CAR-T. Pa 19 Novembala, maselo a CD7 CAR-T omwe adaperekedwa adalowetsedwa mwa wodwalayo.

Masiku angapo pambuyo pa kulowetsedwa, maselo a CAR-T asanakule, maselo a chotupa anafalikira mofulumira, ndipo kuphulika kwakukulu kunawonedwa m'magazi a m'mphepete mwa magazi, zomwe zinasonyeza kulephera kwa chithandizo choyamba cha CAR-T.

Pa nthawiyi, chipatala cha Tianjin Cancer Hospital Airport Hospital chinali kuchita mayeso azachipatala a CAR-T (CD7 UCAR-T) a khansa ya m'magazi ya T-lymphoblastic. Makolowo adawonetsa kufunikira kwakukulu, ponena kuti ayesetsa ngakhale mwayi wa 1% kwa mwana wawo. Gulu lachipatala linakambirana ndi banjali ndipo linaganiza zolembetsa wodwalayo mu mayeso azachipatala a CD7 UCAR-T.

Kuchira kwathunthu pambuyo pa CD7 UCAR-T Tsopano miyezi iwiri mutapatsidwa chiwalo.

Pa 2 Disembala, wodwalayo analandira chithandizo cha CD7 U-CART cell pamodzi ndi chithandizo chochepetsa kuchuluka kwa chotupa komanso chithandizo chothandizira. Atapatsidwa chithandizo, anakhala ndi malungo amphamvu kwa nthawi yayitali komanso kutopa. Chifukwa chothandizidwa ndi mankhwala oletsa matenda komanso madzi, zizindikiro zake za moyo zinakhazikika ndipo kutentha kwa thupi kunabwerera mwakale.

Kuwunika kwa mafuta a m'mafupa ndi madzi a m'mitsempha pa masiku 18 ndi 28 pambuyo pa CAR-T kunatsimikizira kuti mwanayo wachira kwathunthu chifukwa cha kusasangalala kwa MRD. Matenda a mwanayo adakula kwambiri ndipo mphamvu zake zinabwerera, chilakolako cha chakudya chinabwerera, ndipo amayi ake—omwe kale anali osokonezeka maganizo—anapezanso chiyembekezo.

Pakadali pano, wodwalayo wachitidwa opaleshoni yachiwiri ya haploidentical HSCT ku Tianjin Cancer Hospital Airport Hospital ndipo ali bwino miyezi iwiri atangopatsidwa opaleshoni.