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Leukemia ikabije ya Lymphoblastic (T-ALL)-05

Umurwayi: Utazwi

Igitsina：Igitsina gabo

Imyaka: Imyaka 15

UbwenegihuguIgishinwa

IsuzumaLeukemia ikabije ya Lymphoblastic (T-ALL)

    Twandikire

    Umurwayi wa T-ALL wasubiye inyuma arwaye kanseri y'imitsi yo mu bwoko bwa Central Nevervous Syndrome nyuma yo kuvurwa na CAR-T


    Uru rubanza rureba umwana w'imyaka 16 ukomoka mu majyaruguru y'uburasirazuba bw'u Bushinwa, ufite ikibazo cy'indwara ya kanseri y'amaraso mu gihe cy'umwaka urenga ushize.


    Ku ya 8 Ugushyingo 2020, Dawei (izina ry'irihimbano) yasuye ibitaro byo muri ako gace kubera kwangirika mu maso, ibibyimba, n'umunwa ugoramye. Yasuzumwe indwara ya "leukemia y'urukerera rukabije (ubwoko bwa T-cell)." Nyuma yo guhabwa imiti ya kanseri inshuro imwe, MRD (indwara ntoya isigara) ntiyagaragaye ko ari mbi, hakurikiraho imiti isanzwe ya kanseri. Muri icyo gihe, gutobora amagufwa, gutobora amagufwa, no guterwa inshinge mu nda nta kibazo byagaragaje.


    Ku ya 6 Gicurasi 2021, hakozwe igikorwa cyo gutobora uruhu rw'umugongo hakoreshejwe inshinge zo mu bwonko, maze isesengura rya CSF ryemeza "leukemia yo mu bwonko bwo hagati." Ibi byakurikiwe n'uburyo bubiri bwo gukoresha imiti isanzwe ya chimiotherapie. Ku ya 1 Kamena, gutobora uruhu rw'umugongo hakoreshejwe isesengura rya CSF byagaragaje uturemangingo tutarakura. Hatanzwe izindi ntera eshatu zo gutobora uruhu rw'umugongo hakoreshejwe inshinge zo mu bwonko, aho ikizamini cya nyuma cya CSF kitagaragaje uturemangingo twa kanseri.


    Ku ya 7 Nyakanga, Dawei yatakaje icyerekezo cy'ijisho rye ry'iburyo, rigabanuka rigahinduka urumuri gusa. Nyuma yo guhabwa imiti ikomeye ya chimiotherapie, ijisho rye ry'iburyo ryongeye kubona neza.


    Ku ya 5 Kanama, ijisho rye ry'iburyo ryongeye kwangirika, bituma ahuma burundu, maze ijisho rye ry'ibumoso ritangira kuba ridasobanutse neza. Kuva ku ya 10 kugeza ku ya 13 Kanama, yakorewe ubuvuzi bwa radiyo mu bwonko bwose no mu ruti rw'umugongo (TBI), bwasubije ijisho rye ry'ibumoso, ariko ijisho ry'iburyo rikomeza kuba ridasobanutse. Ku ya 16 Kanama, MRI scan y'ubwonko yagaragaje ko imitsi y'iburyo y'amatwi n'urumuri byarushijeho kumera neza, ndetse byagaragaye ko byarushijeho kwiyongera. Nta bimenyetso bidasanzwe cyangwa kwiyongera byabonetse mu bwonko.


    Muri icyo gihe, umuryango wari witeguye guterwa umworera w’amagufwa, utegereje gusa igitanda mu cyumba cy’abatera umworera. Ikibabaje ni uko isuzuma risanzwe mbere yo guterwa umworera ryagaragaje ibibazo byatumye guterwa umworera bidashoboka.

    2219

    Ku ya 30 Kanama, hakozwe isuzuma ry’umusemburo w’amagufwa, hagaragazwa MRD y’umusemburo w’amagufwa ufite lymphocyte T zitari zisanzwe zigeze kuri 61.1%. Hakozwe kandi isuzuma ry’umusemburo w’uruti rw’umugongo hakoreshejwe inshinge zo mu nda, bigaragaza CSF MRD ifite uturemangingo 127 twose, muri two lymphocyte T zitari zisanzwe zigize 35.4%, bigaragaza ko kanseri y’amaraso yongeye kugaruka burundu.

    Ku ya 31 Kanama 2021, Dawei n'umuryango we bageze mu kigo cyacu cya CGT. Ibipimo by'amaraso byagaragaye ko: WBC 132.91×10^9/L; itandukaniro ry'amaraso yo mu mpande (imiterere): 76.0% by'ibisasu. Hatanzwe imiti igabanya ubukana bwa kanseri mu gihe kimwe.

    Nyuma yo gusuzuma uburyo Dawei yavuwe mbere, byaragaragaye ko T-ALL ye yari idafite ubushobozi bwo gusubira inyuma kandi ko uturemangingo twa kanseri twinjiye mu bwonko, bigira ingaruka ku mitsi y'amaso. Itsinda ry'abaganga ryemeje ko Dawei yujuje ibisabwa kugira ngo yinjizwe mu igerageza rya CD7 CAR-T.

    Ku ya 18 Nzeri, hakozwe ikindi kizamini: itandukaniro ry'amaraso yo mu mpande (imiterere) ryagaragaje ko amaraso yaturitse ku kigero cya 11.0%. Lymphocytes zo mu maraso yo mu mpande zakusanyijwe kugira ngo hamenyekane selile za CD7 CAR-T kuri uwo munsi, kandi inzira yagenze neza. Nyuma yo gufata, hatanzwe imiti ivura indwara ya CD7 CAR-T.

    Mu gihe cyo guhabwa imiti ya chimiotherapie, uturemangingo twa kanseri twariyongereye cyane. Ku ya 6 Ukwakira, itandukaniro ry'amaraso yo mu gice cy'umubiri (imiterere) ryagaragaje guturika kwa 54.0%, kandi uburyo bwo gutanga imiti ya chimiotherapie bwarahinduwe kugira ngo bigabanye umutwaro w'uturemangingo. Ku ya 8 Ukwakira, isesengura ry'imiterere y'uturemangingo tw'umusemburo w'amagufwa ryagaragaje guturika kwa 30.50%; MRD yagaragaje ko 17.66% by'uturemangingo ari lymphocytes T zitarakura.

    Ku ya 9 Ukwakira, uturemangingo twa CD7 CAR-T twongeye gushyirwamo. Nyuma yo kongera gushyirwamo, umurwayi yagize umuriro n'ububabare bw'ishinya. Nubwo yavuwe neza kugira ngo arwanye indwara, umuriro ntiwagenzuwe neza, nubwo ububabare bw'ishinya bwagiye bugabanuka buhoro buhoro.

    Ku munsi wa 11 nyuma yo kongera gushyirwamo amaraso, amaraso yo mu gice cyo ku ruhande rw'umubiri yiyongereyeho 54%; ku munsi wa 12, ikizamini cy'amaraso cyagaragaje ko uturemangingo tw'amaraso twera twazamutse tugera kuri 16 × 10 ^ 9 / L. Ku munsi wa 14 nyuma yo kongera gushyirwamo amaraso, umurwayi yagize CRS ikomeye, harimo kwangirika k'umutima, imikorere mibi y'umwijima n'impyiko, kubura amaraso menshi mu mubiri, kuva amaraso mu gifu kugabanuka, no kurwara imitsi. Uburyo bugaragaza ibimenyetso bikomeye n'uburyo bwo kuvura, hamwe no guhinduranya amaraso mu maraso, byagiye birushaho kunoza imikorere y'ingingo zagize ikibazo, bituma ibimenyetso by'ubuzima bw'umurwayi bihagarara neza.

    Ku ya 27 Ukwakira, umurwayi yari afite imbaraga z'imitsi zo hasi zo mu cyiciro cya 0. Ku ya 29 Ukwakira (iminsi 21 nyuma yo kongera gushyirwamo), ikizamini cya MRD cy'umusemburo w'amagufwa cyagaragaje ko ari kibi.

    Mu gihe yari amaze koroherwa byuzuye, Dawei yakomeje imikorere ye y’amaguru yo hasi abifashijwemo n’abaforomo n’umuryango we, buhoro buhoro yongera imbaraga z’imitsi kugeza ku byiciro 5. Ku ya 22 Ugushyingo, yimuriwe mu ishami rishinzwe gutera uturemangingo kugira ngo yitegure gutera uturemangingo tw’amaraso two mu bwoko bwa allogeneic hematopoietic.

    ibisobanuro2

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