Leukemia-da Lymphoblastic ee daran (B-ALL)-02

Astaamaha Kiisaska:

- Maajo 19, 2019: Waxaa lagu ogaaday cudurka 'B-cell lymphoblastic leukemia' (B-ALL)

- Waxay leedahay tiro badan oo buro madaxa ah iyo lymphadenopathy

- Jadwalka dhiigga: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, lymphocytes aan caadi ahayn 4%

- Qaab-dhismeedka dhuuxa lafta: 80.2% lymphoblasts aan qaan gaarin (qaraxyo)

- Tijaabinta Difaaca Jirka: 74.19% unugyadu waa unugyo horudhac ah oo B-lineage ah oo malignant ah oo muujiya CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, oo qayb ahaan muujiya cIgM. Baadhista: B-ALL (Marxaladda Kahor B)

- Hiddo-sidayaasha isku-dhafka ah: MLL-ENL togan, shaashadda u eg koromosoomka Philadelphia (sida Ph-like) taban

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

- Kiimikada daaweynta VDLD waxay markii hore gaartay cafis difaac kadib 1 bil, MLL-ENL quantitative PCR 0.026%

- Kiimikada oo la sii wado sida waafaqsan hab-maamuuska carruurta, MLL-ENL quantitative PCR 0 ka dib wareegga 4aad. Kiimikada oo dheeraad ah ayaa sii socotay.

- Maarso 2020: Cudurka haraadiga difaaca jirka ee dhuuxa lafta 0.35%, MLL-ENL quantitative PCR 0.53%, taasoo muujinaysa isbeddel ku yimaada dib u soo noqoshada. Qoyska ayaa diiday tallaalka. Kiimikada oo sii socota muddo 3 wareeg ah.

- Luulyo 2020: Lafaha ayaa si buuxda dib ugu soo laabtay.

- Noofambar 11, 2020: Kiimikada gudaha, cudurka difaaca jirka ee CSF 66%, oo laga helay cudurka leukemia ee habdhiska neerfaha dhexe. Kiimikada gudaha ee laba jeer lagu celceliyay, CSF waxay noqotay mid taban.

- Diseembar 31, 2020: Waxaa la dhigay isbitaalkayaga.

- Jadwalka dhiigga: WBC 3.99 x 10^9/L, HGB 66 g/L, PLT 57 x 10^9/L

- Tirada qaraxyada dhiigga ee hareeraha: 69%

- Qaab-dhismeedka dhuuxa lafta: 90% lymphoblasts aan qaan gaarin (qaraxyo)

- Tijaabinta Difaaca Jirka: 84.07% unugyada ayaa muujiya CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, oo qayb ahaan muujiya CD24, CD15dim, taasoo muujinaysa unugyada B ee aan qaan gaarin ee malignant.

- Hidde-sidayaasha isku-dhafka ah: Hidde-sidayaasha isku-dhafka ah ee MLL-ENL, PCR tiro ahaan 44.419%

- Isbeddelka hidde-sidaha: Isbeddelka KMT2D ee togan (asalka jeermiska)

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

- PET-CT: Kordhinta dheef-shiid kiimikaadka ee ku baahsan godka lafaha iyo lafaha oo dhan, shaki badan oo ku saabsan soo noqoshada leukemia; splenomegaly oo leh dheef-shiid kiimikaad oo kordhay, oo u badan tahay inay ku lug leedahay leukemia.

- Waxaan sameeyay dalool dhabarka ah iyo kiimoterabiga gudaha, wax cillado ah lagama helin baaritaannada la xiriira CSF.

Daaweynta:

- Laba toddobaad oo kiimoterabiga VLP ah, dhiigga ku dhaca meelaha durugsan ayaa 5% ku dhacaya Janaayo 18.

- Janaayo 25: Dhiigga ku dhaca hareeraha ayaa qarxay 91%, waxaana lagu daaweeyay kiimoterabiga CTX, Ara-C, iyo 6-MP.

- Febraayo 3: Dhiigga hareeraha ayaa qarxay 22%.

- Febraayo 4: Uruurinta 50ml oo dhiig ah oo isku-dhafan oo loogu talagalay abuurista unugyada CD19-CART.

- MTX 1g, kiimoterabiga FC (Hargabka 15mg maalin kasta x 3 maalmood, CTX 0.12g maalin kasta x 3 maalmood).

- Febraayo 13 (kahor gelinta): Qaab-dhismeedka dhuuxa lafta wuxuu muujinayaa 87.5% qaraxyo, socodka cytometry wuxuu muujinayaa 79.4% qaraxyo halis ah.

- Falanqaynta tirada hidda-wadaha isku-dhafka MLL-ENL: 42.639%.

- Febraayo 14: Ku shubidda unugyada CART qiyaas dhan 5 x 10^5/kg.

- Saameyn xun oo la xiriirta CAR-T: CRS heerka 1aad (qandho), ma laha sunta neerfaha.

- Maalinta 20aad ee galinta kadib: Dhiigga baaritaanka ayaa muujinaya faafitaanka burooyinka, saamiga unugyada CART waa 0.07%.

- Daaweynta unugyada CART oo aan waxtar lahayn.

- Maarso 8, 2021: Jadwalka dhiigga: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- Dhiigga ku dhaca hareeraha: 83%. Dhiigga ku dhaca agagaarka ayaa la ururiyay 60ml si loogu sameeyo unugyada CART ee CD19/CD22 ee laba-jibbaaran.

- Waxaa lagu daaweeyaa cytarabine iyo dexamethasone si loo xakameeyo culeyska burooyinka.

- Maarso 18: Daaweynta kiimikada FC (Hargabka 15mg maalin kasta x 3 maalmood, CTX 0.12g maalin kasta x 3 maalmood).

- Maarso 22 (kahor-gelinta): Jadwalka dhiigga: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Qaab-dhismeedka dhiigga ee agagaarka: 6% qaraxyo.

- Qaab-dhismeedka dhuuxa lafta: 91% qaraxyo. Haraaga dhuuxa lafta: 88.61% unugyo muujinaya CD38, CD19, cCD79a, CD81, CD22, oo tilmaamaya unugyada B ee aan qaan gaarin ee kansarka ah.

- Falanqaynta tirada hidda-wadaha isku-dhafka MLL-ENL: 62.894%.

- Falanqaynta karyotype-ka koromosoomka: 46, XX, del(1)(p36.1), del(11)(q13), t(11;19)(q23;p13.3), ku dar(14)(q34), -17, +mar [2]/46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3), ku dar(14)(q34).

- Maarso 23: Ku shubidda unugyada CART qiyaas dhan 3 x 10^5/kg.

- Maarso 26 wixii ka dambeeya: Qandho sare oo joogto ah iyo barar nidaamsan oo soo ifbaxay.

- Maarso 29: Qaab-dhismeedka dhiigga ee hareeraha: 92% qaraxyo; transaminases oo sarreeya iyo bilirubin.

- Abriil 2: Bilawga suuxdinta, oo lagu daweeyay diazepam.

- Abriil 2 (Maalinta 10): Waxaa la bilaabay daawaynta methylprednisolone muddo 3 maalmood ah.

- Falcelinta CRS: Fasalka 3, CRES: Fasalka 3.

- Abriil 8 (Maalinta 16): Qiimaynta dhuuxa lafta waxay muujinaysaa cafis dhammaystiran oo qaab-dhismeedka ah, cytometry socodka oo taban oo loogu talagalay qaraxyada halista ah; Falanqaynta tirada hidda-wadaha isku-dhafka MLL-ENL: 0.