Kupita Patsogolo mu Kugawa kwa Ziwopsezo za T-ALL: Kugawa Kochokera ku NGS Kumazindikiritsa Magulu Ang'onoang'ono Omwe Ali ndi Chiwopsezo Chachikulu

Mu kafukufuku wopambana wofalitsidwa mu Magazi, ofufuza agwiritsa ntchito njira yotsatira yowerengera matenda (NGS) kuti akonze kugawa kwa chiopsezo cha T-cell acute lymphoblastic leukemia (T-ALL). Dongosolo lokonzedwa bwinoli la magulu limapereka njira yolondola kwambiri yodziwira zotsatira za odwala ndikuzindikira magulu ang'onoang'ono omwe ali pachiwopsezo chachikulu, zomwe zingatsegule njira zochizira zomwe zimapangidwira munthu payekha.

Kafukufukuyu, womwe unaphatikizapo odwala akuluakulu 198 a T-ALL ochokera mu kafukufuku wa GRAALL-2003/2005 ndi odwala ana 242 a T-ALL ochokera mu kafukufuku wa FRALLE2000T, unagwiritsa ntchito njira yowunikira majini 72 okhudzana ndi khansa. Pakati pa zomwe zapezeka, kusintha kwa NOTCH1 kunali kofala kwambiri mwa akuluakulu, komwe kumapezeka mu 77% ya milandu, kutsatiridwa ndi kusintha kwa CDKN2A (66%) ndi kusintha kwa PHF6 (50%). Kusanthula kwatsatanetsatane kwa majini kumeneku kunathandiza ofufuzawa kugawa odwala m'magulu omwe ali pachiwopsezo chachikulu komanso omwe ali pachiwopsezo chochepa, zomwe zimakhudza kwambiri zomwe akuyembekezera.

Dongosolo latsopano logawa magawo lochokera ku NGS linapangidwa, lomwe linawonetsa luso lapamwamba loneneratu kuchuluka kwa kubwereranso kwa matendawa, kupulumuka konse, komanso kupulumuka popanda matenda poyerekeza ndi njira zakale. Kafukufukuyu adapeza odwala omwe ali pachiwopsezo chochepa ngati omwe ali ndi kusintha kwina (monga, NOTCH1/FBXW7, PHF6, EP300) popanda kusintha kwina koopsa (monga, kusintha kwa PI3K panjira, TP53, ndi IDH1/2). Odwala awa anali ndi chiwopsezo chobwereranso kwa zaka 5 (CIR) cha 21%, pomwe omwe ali pachiwopsezo chachikulu adakumana ndi CIR yayikulu kwambiri ya 47%.

Kuphatikiza apo, kuphatikiza zomwe zapezeka mu NGS ndi zinthu zachipatala monga kuchuluka kwa maselo oyera m'magazi (WBC) ndi kuchuluka kwa matenda otsalira (MRD) kunapangitsa kuti pakhale chitsanzo chabwino kwambiri cha chiopsezo chomwe chinagawa odwala m'magulu atatu: chiopsezo chachikulu, chiopsezo chapakati, ndi chiopsezo chochepa. Chitsanzochi chinakhala chothandiza kwambiri posiyanitsa odwala omwe angapindule ndi chithandizo champhamvu kwambiri, makamaka omwe ali ndi majini oopsa.

Zomwe zapezeka mu kafukufukuyu zikuwonetsa kuthekera kwa NGS kukonza maulosi a nthawi yoti munthu apeze matenda ndikuwongolera kukonzekera chithandizo kwa odwala T-ALL akuluakulu komanso ana. Mwa kuphatikiza chidziwitso cha majini ndi deta yachipatala, madokotala amatha kuzindikira bwino odwala omwe angapindule ndi mankhwala atsopano, monga zoletsa za PI3K ndi zoletsa zosankhidwa za IDH1/IDH2.

Pamene kafukufukuyu akutsegulira njira njira zothandizira payekha, iyensoo imabweretsa mafunso ofunikira okhudza kugwiritsidwa ntchito kwa gululi m'magulu osiyanasiyana a anthu komanso njira zamakono zochiritsira. Ngakhale kuti kugawa magulu pogwiritsa ntchito NGS kuli ndi chiyembekezo, kafukufuku wowonjezereka akufunika kuti atsimikizire kuti imagwira ntchito bwino pakati pa anthu osiyanasiyana komanso kukonza njira zothetsera mavuto, monga omwe ali ndi T-ALL yosagwira ntchito.