Leukemia-da Lymphoblastic ee daran (B-ALL)-01

Waxaa lagu ogaaday cudurka 'B-cell lymphoblastic leukemia' Noofambar 28, 2017.

Daawaynta habka VDLP marka hore, iyadoo la gaarayo qayb ka mid ah cafinta dhuuxa lafta (faahfaahinta lama soo sheegin).

Febraayo 2018: Waxaa loo beddelay habka VLCAM. Cytometry-ga socodka dhuuxa lafta wuxuu muujiyay 60.13% unugyada B ee aan qaan gaarin ee malignant.

Maarso 2018: Waxaa lagu qoray tijaabada kiliinikada BiTE. Ka-saaridda qaab-dhismeedka lafaha, ma jiraan unugyo aan qaan-gaarin oo lagu ogaado socodka cytometry.

Maajo 8, 2018: Waxaa la siiyay nidaamka qaboojinta TBI/CY+VP16 oo ay ku xigto tallaalka unugyada asliga ah ee allogeneic oo laga keenay walaal si buuxda isugu habboon (deeq bixiyaha AB+ ilaa qaataha A+). Soo kabashada Neutrophil maalinta +11, soo kabashada megakaryocyte maalinta +12.

Diseembar 5, 2018: Ka-fiirinta dhammaystiran ee dhuuxa lafta, ma jiraan unugyo aan qaan-gaarin oo lagu ogaado socodka cytometry. Waxaa la siiyay faleebo lymphocyte deeq-bixiye ah (DLI) iyo daaweyn ka hortag ah oo lagu sameeyay dasatinib iyo imatinib si looga hortago soo noqoshada.

Febraayo 2, 2019: Qaab-dhismeedka ayaa muujiyay 6.5% unugyo aan qaan-gaarin, cytometry-ga socodka ayaa muujiyay 0.08% lymphoblasts B aan qaan-gaarin oo malignant ah. Waxaa la siiyay daaweynta DLI. Maarso 28, 2019: Cytometry-ga socodka ma muujin wax cillado ah.

Ogosto 11, 2019: Dib u soo noqoshada dhuuxa lafta, oo lagu daweeyay dasatinib.

Sebtembar 2, 2019: Qaab-dhismeedka jirka ayaa muujiyay 3% unugyo aan qaan-gaarin, cytometry-ga socodka ayaa muujiyay 0.04% unugyo aan qaan-gaarin oo malignant ah. Daaweynta joogtada ah ee dasatinib, oo ay ku xigto 2 wareeg oo kiimoterabiga methotrexate ah.

Maajo 11, 2020: Dib u soo noqoshada dhuuxa lafta mar kale.

Waxaan helay 2 daaweyn oo unugyada CD19-CAR-T ah oo iskiis u shaqeeya iyo 2 daaweyn oo unugyada CD19-CAR-T ah oo allogeneic ah sanadkii 2020, midkoodna ma helin cafis.

Oktoobar 26, 2020: Waxaa la dhigay isbitaalkayaga.

Natiijooyinka Shaybaadhka:

Jadwalka dhiigga: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Unugyada dhiigga ee aan qaan gaarin ee ku wareegsan: 63%

Qaab-dhismeedka dhuuxa lafta: Unugyada sare (heerka II), 96% lymphoblasts aan qaan gaarin.

Tijaabinta Difaaca Jirka: Unugyada waxay muujiyaan CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; muujinta qayb ka mid ah CD123. Waxaa loo aqoonsaday inay yihiin lymphoblasts B aan qaan gaarin oo halis ah.

Isbeddelka burooyinka dhiigga: Taban.

Hidde-sidayaasha isku-dhafka dhiigga ee leukemia: Hidde-sidayaasha isku-dhafka NUP214-ABL1 ee togan.

Falanqaynta koromosoomka: 46, XX, t(1;9)(p34;p24), ku dar(11)(q23)[4]/46, XX, t(1;9)(p34;p24), ku dar(11)(q23)x2 [2]/46, XX[3]

Jimicsiga: Unugyada ka soo jeeda deeq-bixiyayaashu waxay ka dhigan yihiin 7.71%.

Daaweynta:

- Dawooyinka kiimoterabiga ee VDS, DEX, LASP oo la bixiyo.

- Noofambar 20: Unugyada aan qaan gaarin ee dhiigga ku wareegsan 0%.

- Ururinta unugyada dhiigga ee isku-dhafan ee iswada ee loogu talagalay dhaqanka unugyada CAR-T ee CD19/22.

- Noofambar 29: Daaweynta kiimikada ee FC (Flu 50mg x 3, CTX 0.4gx 3).

- Diseembar 2 (kahor gelinta unugyada CAR-T):

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

- Qaab-dhismeedka dhuuxa lafta: Unugyada sare (heerka IV), 68% lymphoblasts aan qaan gaarin.

- Qiimaynta tirada ee hidda-wadaha isku-dhafka NUP214-ABL1: 24.542%.

- Cytometry-ga socodka: 46.31% unugyada ayaa muujiya CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, taasoo muujinaysa unugyada B ee aan qaan gaarin ee kansarka ah.

- Diseembar 4: Ku shubidda unugyada laba-geesoodka ah ee CD19/22 ee iswada (3 x 10^5/kg).

- Waxyeellooyinka la xiriira CAR-T: CRS heerka 1aad, qandho maalinta 6aad oo leh Tmax oo ah 40°C, qandhada oo la xakameeyey Maalinta 10aad. Ma jirin wax sun ah oo neerfaha ah oo la arkay.

- Diseembar 22 (Qiimaynta Maalinta 18): Ka-saaris dhammaystiran oo qaab-dhismeedka lafaha ah, ma jiraan unugyo aan qaan-gaarin oo lagu ogaado cytometry socodka. Qiimaynta tirada ee hidda-wadaha isku-dhafka NUP214-ABL1: 0%.