Leukemia ikabije ya Lymphoblastic (B-ALL)-02

Ibiranga urubanza:

- 19 Gicurasi 2019: Yasuzumwe afite kanseri y'amaraso ya B-cell lymphoblastic (B-ALL) ikabije

- Igaragaza ubwoko bwinshi bw'imitsi yo mu mutwe hamwe n'indwara ya lymphadenopathy

- Gahunda y'amaraso: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, limfozeti zidasanzwe 4%

- Imiterere y'umusemburo w'amagufwa: 80.2% by'uturemangingo tw'amagufwa tudakuze (uturemangingo)

- Gupima indwara ziterwa n'imyuka mibi: 74.19% by'uturemangingo ni uturemangingo tw’ibanze tw’uruhererekane rwa B tugaragaza CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, dutanga cIgM igice. Isuzuma: B-ALL (Icyiciro cya mbere ya B)

- Ingirabuzimafatizo za Fusion: MLL-ENL positive, Philadelphia chromosome-like (Ph-like) ecran negative

- Chromosome: 46, XX, t(11;19)(q23;p13), del(20)(q12) [3]/46, XX [7]

- Imiti ya VDLD ya chemotherapy yatangiye kugabanya ubudahangarwa bw'umubiri nyuma y'ukwezi kumwe, MLL-ENL quantitative PCR 0.026%

- Gukomeza guhabwa imiti igabanya ubukana nk'uko biteganywa n'amabwiriza y'abana, MLL-ENL quantitative PCR 0 nyuma y'ikizamini cya 4. Imiti igabanya ubukana yakomeje.

- Werurwe 2020: Indwara y'ubudahangarwa bw'umubiri isigara mu magufwa 0.35%, MLL-ENL quantitative PCR 0.53%, bigaragaza ko hari icyerekezo cyo kongera kurwara. Umuryango wanze guterwa inshinge. Bakomeje guhabwa imiti igabanya ubukana mu gihe cy'ingendo eshatu.

- Nyakanga 2020: Umwobo w'amagufwa wongeye kugaruka burundu.

- 11 Ugushyingo 2020: Chimiotherapie yo mu nda, indwara ya CSF isigaranye 66%, yagaragayemo kanseri y'imitsi yo mu mutwe. Chimiotherapie yo mu nda yasubiwemo kabiri, CSF ihinduka ntayo ifite.

- Ku ya 31 Ukuboza 2020: Yakiriwe mu bitaro byacu.

- Gahunda y'amaraso: WBC 3.99 x 10^9/L, HGB 66 g/L, PLT 57 x 10^9/L

- Umubare w'amaraso yo mu nkengero z'umuyoboro: 69%

- Imiterere y'umusemburo w'amagufwa: 90% by'uturemangingo tw'amagufwa tudakuze (uturemangingo)

- Ubushobozi bwo gupima imiterere y'umubiri: 84.07% by'uturemangingo twerekana CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, CD24, CD15dim, bigaragaza ko lymphoblaste B idakuze neza.

- Ingirabuzimafatizo ya Fusion: MLL-ENL fusion gene positive, PCR 44.419%

- Impinduka mu ngirabuzimafatizo: Impinduka mu ngirabuzimafatizo ya KMT2D (inkomoko y'imimero)

- Karyotype ya chromosome: 46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3), ongeraho(14)(q34), -17, +mar [7]/46, idem, t(3;16)(p21;p13.3) [1]/46, XX [13]

- PET-CT: Kwiyongera k'uburyo umubiri ukoresha mu gukwirakwiza imikorere y'umubiri mu gice cyose cy'amagufwa n'umusemburo, bikekwa ko kanseri y'amaraso ishobora kugaruka; splenomegaly hamwe n'imikorere y'umubiri yiyongera, bishobora kuba bifitanye isano na kanseri y'amaraso.

- Nakoreye amenyo yo mu kibuno na mediotherapie yo mu nda rimwe, nta kibazo cyabonetse mu bizamini bifitanye isano na CSF.

Uburyo bwo kuvura:

- Ibyumweru bibiri byo gukoresha imiti ya VLP, amaraso yo mu miyoboro y'amaraso yazamutseho 5% ku ya 18 Mutarama.

- 25 Mutarama: Amaraso yo mu nkengero z'umugezi yaturikaga 91%, avurwa na CTX, Ara-C, na 6-MP chemotherapy.

- Ku ya 3 Gashyantare: Amaraso yo mu nkengero z'umugezi yaturikanye 22%.

- Ku ya 4 Gashyantare: Gukusanya amaraso ya 50ml yo mu gice cy'amaraso cya autologous kugira ngo haboneke selile za CD19-CART.

- MTX 1g, FC chemotherapy (Ibicurane 15mg ku munsi x iminsi 3, CTX 0.12g ku munsi x iminsi 3).

- 13 Gashyantare (mbere yo guterwa): Imiterere y'umusemburo w'amagufwa igaragaza 87.5% by'ibisebe, flow cytometry igaragaza 79.4% by'ibisebe bibi.

- Isesengura ry'ingano y'uturemangingo twa MLL-ENL: 42.639%.

- Ku ya 14 Gashyantare: Gutera utunyangingo twa CART ku gipimo cya 5 x 10^5/kg.

- Ingaruka mbi ziterwa na CAR-T: CRS yo mu cyiciro cya 1 (umuriro), nta burozi bw'ubwonko.

- Umunsi wa 20 nyuma yo guterwa: Amaso apima indwara agaragaza ko ikibyimba cyiyongera, igipimo cy'uturemangingo twa CART ni 0.07%.

- Ubuvuzi budatanga umusaruro ku ngirabuzimafatizo za CART.

- Werurwe 8, 2021: Gahunda yo gukoresha amaraso: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- Amaraso yo mu mpande: 83%. Amaraso yo mu mpande yakusanyijwe na 60ml kugira ngo haboneke selile za CD19/CD22 ebyiri za CART.

- Ivurwa na cytarabine na dexamethasone kugira ngo igabanye uburemere bw'ikibyimba.

- Werurwe 18: Imiti ya kanseri ya FC (ibicurane 15mg ku munsi x iminsi 3, CTX 0.12g ku munsi x iminsi 3).

- Werurwe 22 (mbere yo guterwa): Gahunda y'amaraso: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Imiterere y'amaraso yo ku nkengero: 6% by'ibiturika.

- Imiterere y'umusemburo w'amagufwa: 91% by'uturemangingo. Ibisigaye mu musemburo w'amagufwa: 88.61% by'uturemangingo tugaragaza CD38, CD19, cCD79a, CD81, CD22, bigaragaza lymphoblasts za B zitarakura neza.

- Isesengura ry'ingano y'uturemangingo twa MLL-ENL: 62.894%.

- Isesengura rya karyotype ya chromosome: 46, XX, del(1)(p36.1), del(11)(q13), t(11;19)(q23;p13.3), add(14)(q34), -17, +mar [2]/46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3), add(14)(q34).

- Werurwe 23: Gutera uturemangingo twa CART ku gipimo cya 3 x 10^5/kg.

- Ku ya 26 Werurwe gukomeza: Umuriro mwinshi udashira ndetse nyuma yaho nkagira indwara yo kubyimba umubiri wose.

- Werurwe 29: Imiterere y'amaraso yo mu gice cy'imbere: 92% by'ibiturika; transaminase nyinshi na bilirubin.

- Ku ya 2 Mata: Gutangira gukubita ibisebe, bivurwa na diazepam.

- Ku ya 2 Mata (Umunsi wa 10): Batangiye kuvura methylprednisolone mu gihe cy'iminsi 3.

- Uburyo CRS ikora: Icyiciro cya 3, CRES: Icyiciro cya 3.

- Ku ya 8 Mata (Umunsi wa 16): Isuzuma ry'umusemburo w'amagufwa rigaragaza ko habayeho kugabanuka k'imiterere y'umubiri, kandi ko nta mikorere y'umubiri igaragara mu maraso; Isesengura ry'ingano ya MLL-ENL fusion gene: 0.