Leukemia ikabije ya Lymphoblastic (B-ALL)-01

Yasuzumwe afite kanseri y’amaraso ya B-cell lymphoblastic leukemia ku ya 28 Ugushyingo 2017.

Kuvurwa hakoreshejwe uburyo bwa VDLP mu ntangiriro, bigatuma habaho koroherwa kw'umusemburo w'amagufwa (ibisobanuro birambuye ntibiratangazwa).

Gashyantare 2018: Yimukiye kuri gahunda ya VLCAM. Uburyo bwo gupima imiterere y'umusemburo w'amagufwa bwagaragaje 60.13% by'uturemangingo twa B tutarakura neza.

Werurwe 2018: Yiyandikishije mu igerageza rya BiTE. Kugabanuka k'imiterere y'umubiri mu musokoro w'amagufwa, nta tunyangingo twanduye twabonetse hakoreshejwe uburyo bwo kuboneza urubyaro.

Ku ya 8 Gicurasi 2018: Yahawe uburyo bwo kuvura TBI/CY+VP16 hanyuma ahabwa uturemangingo tw’umubiri two mu bwoko bwa allogeneic tuvanywe mu muryango umwe (uwatanze AB+ kuri A+). Kugarura Neutrophil ku munsi wa +11, kongera gukira kwa megakaryocyte ku munsi wa +12.

Ku ya 5 Ukuboza 2018: Kugabanuka burundu kw'imiterere y'umubiri mu magufwa, nta tunyangingo twanduye twabonetse hakoreshejwe uburyo bwo kuvura indwara. Nahawe imiti ya donor lymphocyte (DLI) kandi nyifashishwa mu kuvura indwara hifashishijwe dasatinib na imatinib kugira ngo hirindwe ko indwara isubira inyuma.

Ku ya 2 Gashyantare 2019: Imiterere y'uturemangingo yagaragaje 6.5% by'uturemangingo tudakuze, flow cytometry yagaragaje 0.08% by'uturemangingo twa B tutakuze. Yahawe ubuvuzi bwa DLI. Ku ya 28 Werurwe 2019: Flow cytometry nta kibazo yagaragaje.

Ku ya 11 Kanama 2019: Umwongo wongera kugaruka, uvurwa na dasatinib.

Ku ya 2 Nzeri 2019: Inyigo y’imiterere y’umubiri yagaragaje 3% by’uturemangingo tudakuze, flow cytometry igaragaza 0.04% by’uturemangingo tudakuze. Gukomeza kuvurwa na dasatinib, hagakurikiraho uburyo bubiri bwo gukoresha imiti ya methotrexate.

11 Gicurasi 2020: Umworo wo mu magufwa wongeye kugaruka.

Nakiriye uburyo bubiri bwo kuvura CD19-CAR-T mu buryo bwa autologous n'ubundi bubiri bwo kuvura CD19-CAR-T mu buryo bwa allogeneic mu 2020, nta na bumwe bwagize ingaruka nziza.

Ku ya 26 Ukwakira 2020: Yakiriwe mu bitaro byacu.

Ibyavuye muri Laboratwari:

Gahunda y'amaraso: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Uturemangingo tw’amaraso yo mu mpande z’umurwayi tudakuze: 63%

Imiterere y'umusemburo w'amagufwa: Hypercellular (grade II), 96% by'uturemangingo tw'amagufwa tudakuze.

Ubushobozi bwo kwirinda indwara: Utunyangingo twerekana CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; igice cy'igaragara rya CD123. Bigaragazwa nk'utunyangingo tw'amaraso twa B tutarakura.

Impinduka mu maraso: Negative.

Ingirabuzimafatizo zo guhuza kanseri y'amaraso: Ingirabuzimafatizo zo guhuza NUP214-ABL1 zifite imiterere myiza.

Isesengura rya chromosome: 46, XX, t(1;9)(p34;p24), add(11)(q23)[4]/46, XX, t(1;9)(p34;p24), add(11)(q23)x2 [2]/46, XX[3]

Chimerism: Uturemangingo dukomoka ku batanga ubwishingizi bw'indwara dufata 7.71%.

Uburyo bwo kuvura:

- Gutanga imiti ya VDS, DEX, LASP.

- Ugushyingo 20: Uturemangingo tw’amaraso yo ku nkengero z’umugezi tudakuze ni 0%.

- Gukusanya lymphocytes zo mu maraso zikomoka ku maraso zigenewe ubwiyongere bw'uturemangingo twa CD19/22 dual CAR-T.

- Ugushyingo 29: Imiti ya chimiotherapie ya FC (ibicurane 50mg x 3, CTX 0.4gx 3).

- Ku ya 2 Ukuboza (mbere yo guteranya uturemangingo twa CAR-T):

- Gahunda y'amaraso: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- Imiterere y'umusemburo w'amagufwa: Hypercellular (grade IV), 68% by'uturemangingo tw'amagufwa tudakuze.

- Isuzuma ry'imibare rya gene ya NUP214-ABL1 fusion: 24.542%.

- Ingano y'amaraso mu mubiri: 46.31% by'uturemangingo tugaragaza CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, bigaragaza ko lymphoblaste B idakuze neza.

- Ku ya 4 Ukuboza: Gutera uturemangingo twa CD19/22 twinshi twa CAR-T (3 x 10^5/kg).

- Ingaruka mbi zijyanye na CAR-T: CRS yo mu cyiciro cya 1, umuriro ku munsi wa 6 hamwe na Tmax ya 40°C, umuriro ugenzurwa n'umunsi wa 10. Nta burozi bw'imitsi bwagaragaye.

- Ukuboza 22 (Isuzuma ry'umunsi wa 18): Kugabanuka burundu kw'imiterere y'umubiri mu musokoro w'amagufwa, nta turemangingo twanduye twabonetse hakoreshejwe uburyo bwo kuzenguruka kw'amagufwa. Isuzuma ry'ingano ya gene ya NUP214-ABL1 fusion: 0%.