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

Astaamaha caafimaad:

- Baadhista: Lymphoma/leukemia-da unugyada T-cell lymphoblastic

- Maarso 2020: Waxaa lagu soo bandhigay qufac paroxysmal ah iyo cufnaan dhexdhexaad ah, lymphoma-ka T-cell lymphoblastic oo la xaqiijiyay iyadoo la adeegsanayo biopsy-ga daloolinta cufnaanta dhexdhexaadka ah.

- Waxaan helay 8 wareeg oo kiimoterabi ah iyo in ka badan 20 kalfadhi oo shucaac ah, taasoo keentay hoos u dhac weyn oo ku yimaada cufka dhexe.

- Janaayo 16, 2021: Xanuun ayaa ka soo baxay qaybta hoose ee midig.

- Jadwalka dhiigga: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- Qaab-dhismeedka dhuuxa lafta: 95.5% lymphoblasts-ka asalka ah.

- Cytometry socodka dhuuxa lafta: 91.77% unugyada waxay ahaayeen lymphoblasts aan qaan gaarin.

- Taxanaha hidde-sideyaasha: Isbeddellada ku yimaada hiddo-sidayaasha NOTCH1, IL7R, ASXL2 ayaa la ogaaday.

- Markii dambe waxaa la siiyay daawada Hyper-CVAD/B, ESHAP, labaduba wax natiijo ah kama soo bixin qandhada joogtada ah awgeed.

- Febraayo 18, 2021: Waxaa la dhigay isbitaalkayaga.

- Markay qandho la kulantay, CT-ga laabta ayaa muujiyay oof-wareen.

- Jadwalka dhiigga: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Unugyada dhiigga ee aan qaan gaarin ee ku wareegsan: 90%

- Qaab-dhismeedka dhuuxa lafaha: Unugyada sare (heerka IV), 85% lymphoblasts-ka asalka ah.

- Immunophenotyping: 87.27% unugyadu waxay ahaayeen lymphoblasts-ka unugyada T-cell ee asalka ah ee malignant.

- Falanqaynta koromosoomka: 46,XX [24]; saddex nooc oo karyotypes oo aan caadi ahayn oo dheeraad ah ayaa la arkay.

- Hiddo-sidayaasha isbeddelay:

1. Isbeddelka IL7R T244_I245insARCPL ee togan

2. NOTCH1 E1583_Q1584dup isbeddel togan

3. Isbeddelka ASXL2 Q602R ee togan

- Baaritaanka hidda-wadaha isku-dhafka leukemia: Taban

- Natiijooyinka PET/CT: Ma jiraan wax muhiim ah oo ah burooyinka hypermetabolic ee ku jira qalfoofka oo dhan iyo godka dhuuxa lafaha.

Daaweynta:

- Kiimikada daaweynta VP-ga oo la bilaabay, oo faahfaahsan sida soo socota: Vincristine (VDS) 3mg hal mar, Dexamethasone (Dex) 7mg 12kii saacadoodba mar muddo 9 maalmood ah, oo ay weheliso daawaynta ka hortagga caabuqa.

- Maarso 1: Unugyada dhiigga ee aan qaan gaarin ee ku wareegsan ayaa hoos u dhacay 7%.

- Maarso 4: Waxaa la ururiyay unugyada unugyada ee iswada ee loo yaqaan 'autologous lymphocytes' si loogu sameeyo unugyada T ee CD7-CAR.

- Maarso 8: Waxaa la bilaabay daawada VLP oo lagu daray daaweynta Sida benzamine.

- Maarso 14: Waxaa la siiyay daaweynta kiimikada ee FC regimen (Fludarabine 0.35g muddo 3 maalmood ah, Cyclophosphamide 45mg muddo 3 maalmood ah).

- Maarso 17 (faleebo ka hor unugyada):

- Habka difaaca jirka ee haraaga dhuuxa: 15.14% unugyadu waxay muujiyaan CD7 dhalaalaya, CD3 mugdi ah, cytoplasmic CD3, T cell receptor reseptor delta (TCRrd), muujinta qayb ahaan ee CD99, taasoo muujinaysa unugyada T ee asalka ah ee halista ah.

- Maarso 19: Unugyada T ee CD7-CAR ee iswada ee la isku daray (1 x 10^6/kg).

- Waxyeellooyinka la xiriira CAR-T: CRS heerka 1aad (qandho), ma laha sunta neerfaha.

- Abriil 6 (Maalinta 17): Qaab-dhismeedka dhuuxa lafta ayaa muujiyay cafis, socodka cytometry-gu ma uusan ogaan unugyada asalka ah ee halista ah.