Mnyamata akuvutika ndi khansa ya m'magazi ya acute lymphoblastic

Chidziwitso Choyambira cha Wodwala

Mnyamata wazaka 16 anapezeka ndi khansa ya m'magazi ya acute lymphoblastic (B-ALL), yemwe adalandira chithandizo cha chemotherapy koyamba, chithandizo cha maselo a CD19/22 CAR-T, salvage chemotherapy, komanso kuikidwa kwa maselo oyambira a hematopoietic hematopoietic (allo-HSCT) kuchokera kwa woperekayo.

Mkhalidwe wa Wodwala Asanayambe Chithandizo

Asanalandire chithandizo cha allo-HSCT, wodwalayo adakumana ndi kuchulukana kwa maselo oyera m'magazi mwachangu komanso matenda osatha ngakhale kuti adathandizidwa kangapo. Pambuyo pa kulowetsedwa kwa CD19/22 CAR-T pa Epulo 21, 2025 (maselo onse a CAR-T: 6.5×10^7), kuchuluka kwa maselo a CAR-T kudayamba kuwonjezeka kufika pa 3.95×10^6/L pofika tsiku la 7 koma kunachepa kufika pa 0.82×10^6/L pofika tsiku la 14, ndipo maselo ozungulira magazi adakwera kuchoka pa 28.6% kufika pa 87.1%. Kufufuza kwa mafupa pa Meyi 15, 2025, kunawonetsa kuchepa kwakukulu kwa kuchuluka kwa maselo a B osazolowereka (omwe amatulutsa CD34, CD38/CD22 yochepa, CD81/CD19/CD33 yofooka, palibe CD10/CD20/CD79b), zomwe zinatsimikizira kuti palibe kuchira. Madzi a m'mitsempha ya ubongo sanawonetse maselo osazolowereka, koma matenda onse sanathe.

Mkhalidwe wa Wodwala Pambuyo pa Chithandizo

Pambuyo pa allo-HSCT pa Meyi 29-30, 2025 (maselo a CD34+: 8.6×10^6/kg; maselo a mononuclear: 8×10^8/kg), wodwalayo adapeza neutrophil engraftment pofika tsiku la 11 ndi platelet engraftment pofika tsiku la 18. Pofika tsiku la 28 (Juni 27, 2025), kuchuluka kwa magazi kudakwera kwambiri: hemoglobin 99 g/L (kuchokera pamlingo wotsika wakale), maselo oyera amagazi 11.73×10^9/L, ma neutrophils 9.81×10^9/L, ndi ma platelet 79×10^9/L. Kapangidwe ka mafupa a m'mafupa kanawonetsa kuchulukana kogwira ntchito popanda maselo oyamba olakwika, flow cytometry idatsimikizira kuti palibe zolakwika, biopsy idawonetsa kuchulukana kochepa koma maselo owoneka a trilineage opanda ma lymphocytes osakhwima, ndipo STR chimerism idafika 100%, ndikukwaniritsa kukhululukidwa kwathunthu (CR) ndi matenda ochepa otsalira (MRD-). Pofika tsiku la 49 (Julayi 18, 2025), mafuta a m'mafupa anakhalabe akugwira ntchito popanda maselo olakwika, zomwe zinapangitsa kuti CR ndi MRD- zipitirire. Matenda a m'mimba a grade 1 omwe anali ochepa kwambiri analipo koma anachiritsidwa ndi mankhwala, zomwe zinawonetsa kuti matendawo anali ofooka komanso kuti abwerere bwino poyerekeza ndi kuphulika kosalekeza kwa maselo asanalowe m'thupi (kuchokera pa 37.42% mpaka 0%) komanso kuti maselowo sanabwererenso.