Matenda a systemic lupus erythematosus (SLE)-05

Mayi C ndi mkazi wazaka 32 yemwe adapezeka ndi matenda a systemic lupus erythematosus (SLE) zaka ziwiri zapitazo. Zizindikiro zake zazikulu zinali nephritis yayikulu, nyamakazi, ndi ziphuphu. Ngakhale adalandira chithandizo chamankhwala chopondereza chitetezo cha mthupi (kuphatikizapo glucocorticoids, hydroxychloroquine, ndi rituximab), vuto lake silinathe kulamuliridwa.

Mkhalidwe Wosalandira chithandizo:

Zizindikiro: Kupweteka kwambiri kwa mafupa ndi kutupa, ziphuphu zosalekeza, kutopa kwambiri, ndi kuphulika kwa nephritis mobwerezabwereza.

Zomwe Zapezeka mu Laboratory:

Chiwerengero cha # SLEDAI-2K: 16

# Milingo ya ma antibodies a DNA otsutsana ndi ma stranded awiri m'magazi: Okwera pamwamba pa mulingo wabwinobwino

# Kuonjezera milingo ya C3 ndi C4: Pansi pa mulingo wabwinobwino

Njira Yothandizira:

1. Kusankha Wodwala: Popeza chithandizo chachikhalidwe sichinagwire ntchito bwino komanso kuopsa kwa vuto lake, Mayi C adalembetsedwa mu mayeso azachipatala a chithandizo cha maselo a CAR-T.

2. Kukonzekera: Asanalandire chithandizo cha maselo a CAR-T, Mayi C adapatsidwa chithandizo chamankhwala cha chemotherapy kuti achepetse ma lymphocyte omwe alipo ndikukonzekera kuyambitsa maselo a CAR-T.

3. Kukonzekera kwa Maselo:

Ma cell a #T adachotsedwa m'magazi a Ms. C.

# Maselo a T awa adapangidwa majini mu labu kuti azitha kuwonetsa ma chimeric antigen receptors (CAR) omwe amalunjika ku ma CD19 ndi ma BCMA antigen.

4. Kulowetsedwa kwa Maselo: Pambuyo pokulitsa ndi kuyesa kwabwino, maselo a CAR-T opangidwa ndi akatswiri adalowetsedwanso m'thupi la Ms. C.

5. Kuyang'anira odwala omwe ali m'chipatala: Mayi C adayang'aniridwa kuchipatala kwa masiku 25 atalandira mankhwala kuti aone ngati pali zotsatirapo zoyipa komanso kuti awone ngati mankhwalawa ndi othandiza.

Zotsatira za Chithandizo:

1. Yankho la Nthawi Yaifupi:

# Kuwongolera Zizindikiro: Mkati mwa milungu itatu atatha kumwa mankhwalawa, Ms. C adachepetsa kwambiri ululu ndi kutupa kwa mafupa, ndipo ziphuphu zake zinachepa pang'onopang'ono.

# Zotsatira za Laboratory: Patatha masiku awiri kuchokera pamene anapatsidwa mankhwala, maselo a B m'magazi a Ms. C anachotsedwa kwathunthu, zomwe zikusonyeza kuti maselo a CAR-T anali kulunjika bwino.

2. Kuwunika kwa Pakati pa Nthawi (miyezi itatu):

Chiwerengero cha # SLEDAI-2K: Chachepetsedwa kufika pa 2, zomwe zikusonyeza kuti matenda achepa kwambiri.

# Ntchito ya Impso: Kuchepa kwakukulu kwa proteinuria, ndipo nephritis ikuchepetsedwa.

# Zizindikiro za Chitetezo cha Mthupi: Kuchepa kwa ma antibodies a DNA otsutsana ndi ma stranded awiri, ndi kuchuluka kwa C3 ndi C4 komwe kumabwereranso mwakale.

3. Zotsatira za Nthawi Yaitali (miyezi 12):

# Kukhululukidwa Kosatha: Mayi C adapitirizabe kuchira popanda mankhwala kwa chaka chimodzi popanda zizindikiro za kubwereranso kwa SLE.

# Chitetezo: Kupatula pa mild cytokine release syndrome (CRS), Mayi C sanakumane ndi zotsatirapo zoyipa zilizonse. Chitetezo cha mthupi lake chinayamba kuchira pang'onopang'ono atalandira chithandizo, ndipo maselo a B omwe anabwereranso sanawonetse matenda.

Ponseponse, vuto la a Ms. C linawonetsa kusintha kwakukulu komanso kuchira kosalekeza pambuyo pa chithandizo cha maselo a CAR-T, zomwe zikusonyeza kuthekera kwa chithandizochi pa matenda a SLE ovuta komanso osachiritsika.

Lipoti loyesa maselo a CART: