Kufalitsa Large B-cell lymphoma (DLBCL)-04

Yankho Lodabwitsa la Bambo Monger: Chithandizo cha Dual CD19/CD20 CAR-T Chabweretsa Chiyembekezo Chatsopano cha DLBCL Yobwerera M'mbuyo

Mbiri ya Odwala 

Rodney Charles Monger, mwamuna wazaka 68 wochokera kunja, adapezeka ndi matenda a B-cell lymphoma (DLBCL) zaka zitatu zapitazo. Anapita kuchipatala cha Tianjin Cancer Hospital mu Ogasiti 2025. Kufufuza kwa lymph node ya chiberekero kunatsimikizira kuti B-cell lymphoma yochokera pakati pa germinal inapezeka. Immunohistochemistry inali ndi CD20, CD19, ndi CD10, yokhala ndi Bcl-6, Bcl-2 (70%+), ndi c-MYC (60%+). Kuyesa majini kunawonetsa kuti BCL2 inakonzedwanso ndi FISH ndi kusintha kwa majini mu majini a EZH2, KMT2D, TNFRSF14, NRAS, ndi TPMT—zizindikiro zomwe zimagwirizana ndi mbiri yaukali komanso yoopsa kwambiri.

Ulendo Woyamba wa Chithandizo 

Mu Ogasiti 2025, a Monger adalandira pola pamodzi ndi mankhwala oletsa kutupa a BTK ndi lenalidomide. Kenako adapatsidwa mankhwala a FC (fludarabine + cyclophosphamide) lymphodepletion chemotherapy. Ngakhale kuti adayesetsa, matenda ake adapitilizabe kukana, zomwe zidapangitsa gulu lachipatala kuti lipereke chithandizo cha maselo a Bioocus CD19/CD20 CAR-T omwe amawaganizira kawiri.

Pa Seputembala 8, 2025, a Monger adalandira chithandizo cha maselo a autologous CD19/CD20 CAR-T. Chodabwitsa n'chakuti, adakumana ndi vutoli. palibe vuto la kutulutsidwa kwa cytokine (CRS)ndi Matenda a neurotoxicity omwe amayambitsidwa ndi maselo (ICANS) omwe alibe mphamvu yoteteza chitetezo chamthupi (immune effect cell-associated neurotoxicity syndrome)—njira yosalala yomupatsa chakudya pambuyo pomupatsa chakudya chomwe chinamuthandiza kukhalabe wokhazikika komanso wosangalala kuyambira tsiku loyamba.

Kukula kwa Maselo a CAR-T: Mwachangu komanso MolimbaKuwunika magazi m'mbali mwa thupi kunasonyeza kukula kwa maselo a CAR-T modabwitsa, zomwe zinatsimikizira kuti maselowa akukula bwino komanso kuti maselowa akukula bwino:

• D4 pambuyo pa kulowetsedwa(Seputembala 12): Maselo a CAR19+ anali 0.50% ya maselo a CD3+ T (mtengo wake wonse ndi 6.04 × 10⁷/L); maselo a CAR20+ anali 0.41% (4.96 × 10⁷/L).
• D7(Seputembala 15): CAR19+ inakwera kufika pa 1.68% (1.40 × 10⁷/L); CAR20+ kufika pa 1.63% (1.36 × 10⁷/L).
• D10(Seputembala 18): CAR19+ yafika 43%maselo a CD3+ T (mtengo wake wonse) 3.13 × 10⁸/L); CAR20+ yafika 32.74%(mtengo wake wonse 3.26 × 10⁸/L).

Kuchuluka kwa ma flow cytometry kunawonetsanso kufalikira koyenera pakati pa ma CD4+ ndi ma CD8+, ndi mawonekedwe amphamvu a CAR awiri. Ma curve owunikira osinthika adawonetsa gawo lomveka bwino la exponential exponential, kusonyeza kuti kapangidwe ka CD19/CD20 kawiri kamathandizira bwino kupirira kwa CAR-T komanso kuchulukana m'thupi.

Mkhalidwe Wamakono ndi Chisamaliro Chothandizira 

Pa kafukufuku waposachedwa (D10), a Monger akupitilizabe kuchita bwino pachipatala. Akugwiritsa ntchito mankhwala opangidwa mwapadera monga acyclovir, compound sulfamethoxazole, orelabrutinib, lenalidomide, ndi mankhwala othandizira, komanso kuyang'anira kuchuluka kwa magazi, ntchito ya chiwindi ndi impso, komanso zizindikiro zotupa malinga ndi dongosolo lotulutsa magazi.

Gulu la Bioocus linapereka chithandizo chokwanira komanso choganizira odwala nthawi yonseyi: malo ogona abwino, chakudya chopatsa thanzi, thandizo la mayendedwe, komanso uphungu wamaganizo kwa a Monger ndi banja lawo. Njira yonseyi inamuthandiza kuganizira kwambiri za kuchira.

Uthenga wa Chiyembekezo 

Nkhani ya a Monger ikuwonetsa kuthekera kosintha kwa chithandizo cha Bioocus dual CD19/CD20 CAR-T kwa odwala omwe ali ndi DLBCL yobwerera m'mbuyo/yosagwira ntchito. Kukula mwachangu komanso kwamphamvu kwa maselo a CAR-T opanda poizoni wambiri kukuwonetsa chitetezo chabwino cha mankhwalawa komanso mphamvu yolimbana ndi chotupa - ngakhale kwa wodwala wachikulire yemwe ali ndi mawonekedwe oopsa a mamolekyulu.

Tikunyadira kuthandiza odwala ngati a Mr. Monger paulendo wawo wobwerera ku thanzi lawo. Nkhani ngati zake zimalimbikitsa kudzipereka kwathu popereka chithandizo chamakono komanso chosintha moyo cha maselo pogwiritsa ntchito chisamaliro chapadera.

Nkhaniyi imanenedwa ndi chilolezo cha wodwalayo. Zotsatira zake zimatha kusiyana; Zotsatira za CAR-T zimadalira biology ya matenda a munthu payekha komanso zinthu zina zachipatala. Kuti mudziwe zambiri kapena kufufuza njira zochiritsira, chonde pitani patsamba lathu la CAR-T Therapy for Non-Hodgkin Lymphoma.