Leukemia ikabije ya Lymphoblastic (T-ALL)-01

Ibiranga ubuvuzi:

- Isuzuma: T-cell lymphoblastic lymphoma/leukemia

- Werurwe 2020: Yafashwe n'inkorora ya paroxysmal n'uburemere bw'imitsi ya mediastinal, byemejwe ko T-cell lymphoblastic lymphoblastic lymphoblastic lymphoblastic lymphoblastic lymphoblastic lymphoblastic lymphoid biopsy.

- Nahawe imiti igabanya ubukana inshuro 8 ndetse n’imiti irenga 20, bituma ubukana bw’imiti igabanya cyane.

- 16 Mutarama 2021: Nagize ububabare mu gice cyo hasi cy'iburyo.

- Gahunda y'amaraso: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- Imiterere y'umusemburo w'amagufwa: 95.5% by'udukoko tw'imyuka y'umwimerere.

- Uburyo bwo kuzenguruka kw'umusemburo w'amagufwa: 91.77% by'uturemangingo twari lymphoblasts z'uturemangingo twa T tutaragera.

- Gukurikirana imiterere y'uturemangingo: Impinduka mu turemangingo twa NOTCH1, IL7R, ASXL2 zabonetse.

- Yahawe uburyo bwa Hyper-CVAD/B, hanyuma uburyo bwa ESAP, byombi ntacyo bitanga iyo habayeho umuriro udashira.

- Ku ya 18 Gashyantare 2021: Yakiriwe mu bitaro byacu.

- Yarwaye umuriro, CT yo mu gituza yagaragaje umusonga.

- Gahunda y'amaraso: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Uturemangingo tw'amaraso yo mu mpande tudakuze: 90%

- Imiterere y'umusemburo w'amagufwa: Hypercellular (IV grade), 85% by'uturemangingo tw'ibanze twa lymphoblasts.

- Ukwifashishwa mu bushobozi bwo kwirinda indwara: 87.27% by'uturemangingo twari lymphoblasts y'uturemangingo twa T tw’umwimerere twari tumeze nk'uturemangingo tw’umubiri.

- Isesengura rya chromosome: 46,XX [24]; hagaragaye izindi karyotype eshatu zidasanzwe.

- Ingirabuzimafatizo zahinduwe:

1. IL7R T244_I245insARCPL mutation positive

2. NOTCH1 E1583_Q1584dup mutation positive

3. Impinduka za ASXL2 Q602R zagaragaye ko zifite ihinduka ry’umubiri

- Gusuzuma imiterere y'uturemangingo twa kanseri y'amaraso: Negative

- Ibisubizo bya PET/CT: Nta tumori twinshi dufite mu mubiri mu gice cyose cy'amagufwa no mu mwongo.

Uburyo bwo kuvura:

- Gutangira imiti ya VP chemotherapy, irambuye ku buryo bukurikira: Vincristine (VDS) 3mg rimwe, Dexamethasone (Dex) 7mg buri masaha 12 mu gihe cy'iminsi 9, hamwe n'imiti igabanya ubwandu.

- 1 Werurwe: Uturemangingo tw’amaraso yo mu mpande two mu maraso tudakuze twagabanutseho 7%.

- Werurwe 4: Hakusanyijwe lymphocytes zo mu bwoko bwa autologous kugira ngo haboneke selile za CD7-CAR T.

- Ku ya 8 Werurwe: Tangije gahunda ya VLP ivanze n'ubuvuzi bwa Sida benzamine.

- 14 Werurwe: Yahawe imiti ya FC regimen chemotherapy (Fludarabine 0.35g mu minsi 3, Cyclophosphamide 45mg mu minsi 3).

- Werurwe 17 (gutera uturemangingo mbere yo gutera uturemangingo):

- Gupima ubukana bw'umubiri mu maraso: 15.14% by'uturemangingo bigaragaza ko CD7 igaragara cyane, CD3 idakora neza, CD3 ya cytoplasmic, delta ya T cell restricted receptor (TCRrd), kugaragaza igice cya CD99, bigaragaza ko uturemangingo twa T tw’umwimerere ari tubi.

- Werurwe 19: Uturemangingo twa CD7-CAR T twashyizwemo (1 x 10^6/kg).

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

- Ku ya 6 Mata (Umunsi wa 17): Imiterere y'umusemburo w'amagufwa yagaragaje ko umwororoke, imikorere y'uturemangingo ntabwo yasanze uturemangingo tw’umwimerere twa kanseri.