Kufalitsa Large B-cell lymphoma (DLBCL)-03

Mu Marichi 2021, a Wang (dzina losatsimikizika) mwadzidzidzi adamva kupweteka kwa m'mimba kumanja, poyamba adaganiziridwa kuti ndi kusapeza bwino m'mimba, ndipo sanafune thandizo lachipatala mwachangu. M'miyezi iwiri yotsatira, adakumana ndi zizindikiro za kupweteka kwa m'mimba kumanja mobwerezabwereza, zomwe zidamupangitsa kuti akafunse dokotala kuchipatala chapafupi. Kujambula kwa CT kunawonetsa zolakwika m'matumbo ndi kukula kwa ma lymph nodes a retroperitoneal.

Madokotala adalimbikitsa kuti apimidwe colonoscopy ndi biopsy kuti adziwe matenda ena, zomwe zidatsimikizira kuti "kufalikira kwa lymphoma yayikulu ya B-cell," chotupa choopsa chomwe chimadziwika kuti lymphoma. PET-CT idatsimikiziranso kuti zilonda zambiri za nodular hypermetabolic m'thupi lake lonse, zomwe zazikulu kwambiri ndi 4.3 * 4.1 * 4.5cm.

Mothandizidwa ndi banja lake, a Wang adachitidwa chemotherapy ya R-CHOP kanayi. PET-CT yotsatira pambuyo pa chemotherapy idawonetsa kuti wodwalayo wachira pang'ono.

Komabe, chithandizo chotsatira chinabweretsa mavuto aakulu kwa a Wang, monga kutsekeka kwa matumbo, kubowoka, ndi peritonitis yoopsa. Madokotala a opaleshoni ya m'mimba ndi madokotala omwe ankamuthandiza anagwirizana pa dongosolo la opaleshoni, kuchita opaleshoni yochotsa m'matumbo ndi kutulutsa madzi, pamodzi ndi chisamaliro chothandizira zizindikiro, ndikuwongolera bwino zizindikiro za m'mimba.

Kujambula kwa PET-CT komwe kunatsatira kunawonetsa kuchuluka kwa zilonda ndi kukula kwa chotupa. Kuti athetse bwino maselo a chotupa, madokotala anasintha njira yolimbikitsira ya chemotherapy ndipo analimbikitsa kuti asinthe maselo oyambira a hematopoietic.

Atakumana ndi zovuta zingapo, a Wang adakumana ndi mavuto akuluakulu akuthupi komanso amalingaliro pamene matenda awo anali kuipiraipira. Kulowa kwa chotupa kunawonedwa m'malo osiyanasiyana, ndipo zilonda zatsopano za multifocal nodular hypermetabolic zinakulitsa kwambiri dera la khansa. Chifukwa cha zotupa m'thupi lawo lonse, a Wang adavutika ndi ululu wosatha, zomwe zidawapangitsa kuti azivutika kugona pansi ndikugona chifukwa cha ululu.

Atataya mtima, a Wang adaphunzira za chithandizo cha CAR-T, chithandizo chatsopano cha CAR-T cell immunotherapy chomwe chidapangidwira odwala omwe ali ndi lymphoma ya B-cell yomwe yabwereranso kapena yokana.

Asanalandire chithandizo cha CAR-T, kafukufuku wa lymph node m'chigawo chakumanja cha inguinal anasonyeza kuti CD19 ndi CD20 zili bwino, zomwe zinapereka njira zenizeni zochizira maselo a CAR-T. Pulofesa Yu anakonza kafukufuku wathunthu wa thupi, zomwe zinapangitsa kuti pakhale dongosolo la chithandizo cha CAR-T la Bambo Wang.

Pa Julayi 25, 2022, a Wang adalandira chithandizo cha CD19/20 CAR-T cell kuchipatala, ndipo chithandizocho chikuyenda bwino. Kuyang'aniridwa mosamala ndi chisamaliro chothandizira kwambiri kunaletsa zotsatirapo zoyipa pambuyo polandira chithandizo popanda mavuto omwe angawononge moyo.

Pasanathe miyezi itatu, pofika pa 10 Okutobala, 2022, PET-CT scan yotsatira inatsimikizira kuti matendawa abwerera mwakale, ndipo kuwunika konse kunasonyeza kusintha kwakukulu pa thanzi lake.

Pa nthawi yotsatira, a Wang nthawi zonse ankachitidwa CT, MRI, kapena PET-CT scan, zonse zomwe zimatsimikizira kuti ali ndi chilema chonse. Pakadali pano, thanzi lawo likadali labwino, kupitirira nthawi yonse yomwe adachira kwa miyezi yoposa 14.