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

Astaamaha Caafimaadka:

- Baadhista: Cudurka 'pneum T-cell lymphoblastic leukemia' ee daran

- Bilowgii: Dabayaaqadii Maarso 2018

- Calaamadaha ugu horreeya: Ballaarinta qanjidhada limfa ee dusha sare oo badan oo jirka oo dhan ah

- Jadwalka dhiigga ee bilowga ah: WBC: 39.46*10^9/L, Hb: 129g/L, PLT: 77*10^9/L

- Qaab-dhismeedka dhuuxa lafta: 92% qaraxyo

- Cytometry socodka: 95.3% unugyo aan caadi ahayn oo muujiya

TdT+CD99+CyCD3+CD7stCd5DdimCD4-CD8-mCD3-CD45dim

- Hiddo-sidayaasha isku-dhafka ah: Taban

- Isbeddelka hidda-wadaha: Isbeddelka hidda-wadaha NOCH1 ayaa la ogaaday

- Falanqaynta koromosoomka: Karyotype caadi ah

Taariikhda Daaweynta:

- Abriil 3, 2018: Daaweynta kicinta oo leh nidaamka VDCP

- Abriil 18, 2018: Qaraxyada dhuuxa lafta waxay ka koobnaayeen 96%

- Abriil 20, 2018: Waxaa la gaaray cafis ka dib markii la sameeyay nidaamka CAG

- Maajo 18, 2018: Daaweynta isku-dhafka ah ee leh nidaamka CMG+VP

- Juun 22, 2018: Qaraxyada dhuuxa lafta ayaa kor u kacay ilaa 40%, taasoo dib u soo noqotay cudurka leukemia

- Luulyo 25, 2018: Daawada CLAM (clarithromycin+cyclophosphamide+amikacin)

- Tallaalka unugyada asliga ah ee dhiigga laga tallaalo oo ka yimaada walaalka HLA-la jaanqaadaya iyadoo la isticmaalayo xaalad FLU+BU ah Agoosto 14

- La socodka tallaalka kadib: Ka-saaridda qaab-dhismeedka dhuuxa lafaha 1 bil, 3 bilood, 6 bilood, 9 bilood, iyo 11 bilood

- Qaab-dhismeedka dhuuxa lafta ayaa muujiyay cafis 16 bilood kadib tallaalka, iyadoo cytometry-ga socodka uu muujinayo 0.02% lymphocytes-ka aan qaan gaarin ee malignant-ka ah.

- Noofambar 13, 2020: Dhiig-kicinta ku-meel-gaarka ah ee ka timid ilo deeq-bixiye waxay ahayd 97.9%

- Unugyada aasaasiga ah ee dhiigga ee ku wareegsan: 20%

- Diseembar 18, 2020: Qaab-dhismeedka dhuuxa lafta: 60.6% qaraxyo

- Cytometry socodka: 30.85% unugyada T ee aan qaan gaarin ee malignant

- Falanqaynta koromosoomka: 46, XY (20)

- Waxaan qaatay daawaynta kiimoterabiga ee DA bishii Janaayo 19, 2021

- Qaab-dhismeedka dhuuxa lafta Janaayo 19, 2021: Heerka saddexaad ee hyperplasia, 16% qaraxyo

- Falanqaynta karyotype-ka koromosoomka: 46, XY (20)

- Cytometry socodka: 7.27% unugyada (unugyada nukliyeerka dhexdooda) ayaa lagu muujiyey CD99bri, CD13, CD38, cbcl-2, cCD3, HLA-ABC bri, CD7bri, iyo qayb ahaan lagu muujiyey CD5dim, taasoo muujinaysa lymphocytes-ka aan qaan-gaarin ee T

- Baaritaanka hidda-wadaha isku-dhafka leukemia: Taban

- Falanqaynta isbeddelka burooyinka dhiigga (86 nooc):

1. Isbeddellada PHF6 K299Efs*13 ee togan

2. RUNX1 S322* isbeddel togan

3. Isbeddelka FBXW7 E471G ee togan

4. Isbeddelka JAK3 M511I ee togan

5. Isbeddelka NOCH1 Q2393* ee togan

Daaweynta:

- Janaayo 22: Ururinta iyo kobcinta unugyada dhiigga ee isku-dhafan ee loogu talagalay CD7-CART

- Kahor inta aan la gelin CD7-CART, bukaanku wuxuu qaatay VLP (vincristine, l-asparaginase, prednisone) iyo kiimoterabiga bortezomib.

- Febraayo 3: Daaweynta kiimikada ee FC (Hargabka 50mg muddo 3 maalmood ah + CTX 0.45g muddo 3 maalmood ah)

- Febraayo 5 (kahor gelinta): Qaab-dhismeedka dhuuxa lafta ayaa muujiyay 23% qaraxyo.

- Cytometry-ga socodka ayaa shaaca ka qaaday 4.05% unugyo muujinaya CD99bri, CD5dim, CD7bri, TDT, cCD3, taasoo muujinaysa unugyada T ee aan qaan gaarin ee malignant.

- Falanqaynta koromosoomka: 46, XY (20)

- Falanqaynta Chimerism (ka dib HSCT): Unugyada ka soo jeeda deeq-bixiyayaashu waxay ahaayeen 52.19%.

- Febraayo 7: Ku shubidda unugyada CD7-CART ee iswada oo leh qiyaas dhan 5*10^5/kg.

- Febraayo 15: Unugyada dhiigga ee aan qaan gaarin ee ku wareegsan ayaa hoos u dhacay 2%.

- Febraayo 19 (Maalinta 12aad kadib markii la siiyay): Bukaanku wuxuu yeeshay qandho, taasoo socotay 5 maalmood ka hor inta aan la gaarin xakamaynta heerkulka.

- Maarso 2: Qiimaynta dhuuxa lafta waxay muujisay cafis dhammaystiran oo qaab-dhismeedka ah, iyadoo cytometry-ga socodka aan la ogaan karin unugyada aan qaan-gaarin ee halista ah.