Matenda a Myeloma Yambiri(MM)-01

Kuchira Kwabwino kwa Wodwala wa Myeloma Wambiri Wam'nyumba ndi Chithandizo cha CAR-T Ngakhale Kusowa kwa BCMA

Wodwala wamkazi yemwe adapezeka ndi myeloma ya IgD-λ ya mtundu wa multiple myeloma ya gawo la IIIA mu 2018 adalandira chithandizo choyamba makamaka ndi bortezomib. Pambuyo pa maulendo atatu, adapeza chikhululukiro chonse (CR). Mu Okutobala 2018, adapatsidwa autologous hematopoietic stem cell transplantation ngati chithandizo cholimbitsa, kenako ndi chithandizo chosamalira ndi lenalidomide. Mu Epulo 2020, matendawa adabwereranso, ndipo adapatsidwa chithandizo chachiwiri maulendo 7, zomwe sizinathandize bwino. Kuyambira Disembala 2020 mpaka Epulo 2021, adalandira chemotherapy makamaka ndi daratumumab, koma biopsy ya mafupa idawonetsabe 21.763% maselo a plasma oopsa a monoclonal, okhala ndi unyolo wopanda kuwala wa serum λ pa 1470 mg/L ndi unyolo wopanda kuwala wa mkodzo λ pa 5330 mg/L. Pofika nthawiyi, anali atagwiritsa ntchito mankhwala akuluakulu komanso atsopano omwe amapezeka m'dziko muno, kuphatikizapo kupatsidwa autologous stem cell transplantation, ndi kulowa mu mayeso azachipatala a CAR-T kukhala njira yabwino kwambiri yotsala.

Atatumizidwa ndi madokotala am'deralo, adapita ku Chipatala cha Ludaopei pa Meyi 10, 2021, akuyembekeza kulembetsa mu mayeso awo azachipatala a BCMA CAR-T therapy mu multiple myeloma (MM). Atalowa m'chipatala, anali wofooka chifukwa cha ululu waukulu komanso malungo obwerezabwereza. Kufufuza kwathunthu kunatsimikizira "multiple myeloma, λ light chain type, ISS stage III, R-ISS stage III, mSMART high-risk group."

Kujambula kwa PET-CT kunawonetsa kuwonjezeka kwa kagayidwe kachakudya m'mitsempha yofewa mkati mwa mafupa a femurs ndi tibias, zomwe zikusonyeza kufalikira kwa chotupa. Kufufuza kwa mafupa kunawonetsa maselo 60.13% a plasma omwe ali ndi vuto la monoclonal omwe alibe BCMA.

Chipatala chathu cha CGT chinadziwitsa wodwalayo ndi banja lake za momwe mankhwala omwe alipo pano a BCMA-negative multiple myeloma, omwe ngakhale kuti akhoza kukhala othandiza malinga ndi mabuku ena, alibe deta yeniyeni. Ataganizira mosamala, wodwalayo ndi banja lake anasankha kupitiriza ndi dongosolo la chithandizo.

Pambuyo pokonza ndi FC regimen, maselo a BCMA CAR-T adalowetsedwa pa June 1, 2021, ku Ludaopei Hospital. Wodwalayo adayamba kudwala malungo atalowetsedwa, zomwe zidawongoleredwa pang'onopang'ono ndi chithandizo champhamvu cholimbana ndi matenda komanso chothandizira zizindikiro. Patatha masiku khumi ndi anayi atalowetsedwa, biopsy ya mafupa sinawonetse maselo otsala a plasma a monoclonal. Patatha masiku makumi atatu ndi limodzi atalowetsedwa, biopsy ya mafupa idakhalabe yoipa. Kukhazikika kwa chitetezo chamthupi m'magazi kunali koipa, unyolo wopanda kuwala wa serum λ unali mkati mwa nthawi zonse, ndipo mapuloteni a serum M anali oipa, zomwe zikusonyeza kuti matendawa atha.

Pakadali pano, patatha miyezi yoposa 8 atalandira chithandizo cha BCMA CAR-T cell, wodwalayo akuchira bwino ndipo akusangalala kwambiri ndi zotsatira za chithandizocho.