Chirwere cheAcute Lymphoblastic Leukemia (B-ALL)-01

Akaonekwa aine chirwere cheB-cell lymphoblastic leukemia musi wa28 Mbudzi, 2017.

Kurapa neVDLP regimen pakutanga, zvichiita kuti pave nekurerukirwa kwechikamu chemapfupa emubofu (ruzivo haruna kutaurwa).

Kukadzi 2018: Yakachinjwa kuenda kuVLCAM regimen. Kuyerera kwemubofu kwakaratidza 60.13% masero eB asina kukura ane malignant.

Kurume 2018: Ndakanyoresa muBiTE clinical trial. Kuregeredzwa kwemuviri mubhonzo, hapana masero asina kukura akaonekwa neflow cytometry.

Chivabvu 8, 2018: Ndakawana mushonga wekugadzirisa chirwere cheTBI/CY+VP16 zvichiteverwa nekuisirwa masero emuviri akabatana neallogenic kubva kumunin'ina wangu (AB+ donor to A+ receiver). Kupora kwemasero eropa pazuva re +11, kupora kwemegakaryocyte pazuva re +12.

Zvita 5, 2018: Kuregererwa kwakakwana kwemuviri mumongo wemapfupa, hapana masero asina kukura akaonekwa ne flow cytometry. Ndakawana donor lymphocyte infusion (DLI) uye kurapwa kwekudzivirira ne dasatinib ne imatinib kudzivirira kudzokera shure.

Kukadzi 2, 2019: Maumbirwo emasero akaratidza 6.5% masero asina kukura, flow cytometry yakaratidza 0.08% malignant immature B lymphoblasts. Yakapihwa DLI therapy. Kurume 28, 2019: Flow cytometry haina kuratidza kusagadzikana.

Nyamavhuvhu 11, 2019: Kudzoka kwemubofu, kwakarapwa nedasatinib.

Gunyana 2, 2019: Maumbirwo emuviri akaratidza 3% yemasero asina kukura, flow cytometry yakaratidza 0.04% yemasero asina kukura ane malignant. Kurapwa kwakaramba kuchiitwa nedasatinib, kuchiteverwa nemethotrexate chemotherapy kaviri.

Chivabvu 11, 2020: Kudzoka kwemubofu zvakare.

Ndakawana mishonga miviri yeCD19-CAR-T cell therapy kaviri uye miviri yeCD19-CAR-T cell therapy mbiri muna 2020, hapana yakawana kuregererwa.

Gumiguru 26, 2020: Ndakapinda muchipatara chedu.

Zvakawanikwa muLaboratory:

Ropa remuropa: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Masero asina kusimba eropa rekunze: 63%

Maumbirwo emapfupa emubofu: Hypercellular (giredhi rechipiri), 96% lymphoblasts dzisina kukura.

Kugadzira ma immunophenotyping: Masero ane CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; kuratidzwa kweCD123 zvishoma. Inozivikanwa sema lymphoblast eB asina kukura.

Kuchinja kwegomarara reropa: Negative.

Jini reLeukemia fusion: gene reNUP214-ABL1 fusion rakanaka.

Kuongororwa kwechromosome: 46, XX, t(1;9)(p34;p24), wedzera(11)(q23)[4]/46, XX, t(1;9)(p34;p24), wedzera(11)(q23)x2 [2]/46, XX[3]

Chimerism: Masero anobva kune vanopa anokwana 7.71%.

Kurapa:

- VDS, DEX, LASP chemotherapy regimen inopihwa.

- Mbudzi 20: Masero asina kukura eropa ari panze 0%.

- Kuunganidzwa kwemasero eropa ega ega eCD19/22 ane CAR-T culture.

- Mbudzi 29: Kurapwa kweFC regimen chemotherapy (Flu 50mg x 3, CTX 0.4gx 3).

- Zvita 2 (usati waiswa CAR-T cell):

- Ropa remuropa: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- Maumbirwo emapfupa emubofu: Hypercellular (giredhi IV), 68% lymphoblasts dzisina kukura.

- Kuongororwa kwehuwandu hwejini reNUP214-ABL1 fusion: 24.542%.

- Flow cytometry: 46.31% yemasero anoratidza CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, zvichiratidza kuti maB lymphoblasts asina kukura zvakanaka.

- Zvita 4: Kuiswa kwemasero maviri eCAR-T eCD19/22 (3 x 10^5/kg).

- Migumisiro ine chekuita neCAR-T: CRS yeGiredhi 1, fivha pazuva rechitanhatu ine Tmax ye40°C, fivha inodzorwa neZuva rechi10. Hapana chepfu yetsinga yakaonekwa.

- Zvita 22 (Kuongororwa kwezuva rechi18): Kuregererwa kwakakwana kwemuviri mumongo wemapfupa, hapana masero asina kukura akaonekwa ne flow cytometry. Kuongororwa kwehuwandu hweNUP214-ABL1 fusion gene: 0%.