Leukemia e matla ea Lymphoblastic (B-ALL)-01

O fumanoe a e-na le leukemia e matla ea B-cell lymphoblastic ka la 28 Pulungoana 2017.

Kalafo ka mokhoa oa VDLP qalong, ho fihlella phokotso ea moko oa masapo ka karolo (lintlha ha lia tlalehoa).

Hlakola 2018: E fetohetse ho mokhoa oa VLCAM. Cytometry ea phallo ea moko oa masapo e bontšitse lisele tsa B tse sa holang tse 60.13%.

Hlakubele 2018: Ke ngolisitsoe tekong ea bongaka ea BiTE. Phomolo ea 'mele mokong oa masapo, ha ho lisele tse sa holang tse kotsi tse fumanoeng ke flow cytometry.

La 8 Mots'eanong, 2018: Ke fumane mokhoa oa ho lokisa TBI/CY+VP16 o lateloang ke ho kenngoa ha sele ea stem ea allogeneic ho tsoa ho ngoana oa ka ea tšoanang ka botlalo (mofani oa AB+ ho ea ho moamoheli oa A+). Pholoso ea neutrophil ka letsatsi la +11, pholoso ea megakaryocyte ka letsatsi la +12.

La 5 Tšitoe 2018: Phomolo e felletseng ea sebopeho mokong oa masapo, ha ho na lisele tse sa holang tse mpe tse fumanoeng ke flow cytometry. Ke fumane infusion ea donor lymphocyte (DLI) le kalafo ea thibelo ka dasatinib le imatinib ho thibela ho khutlela morao.

La 2 Hlakola 2019: Sebopeho sa mmele se bontshitse 6.5% ya disele tse sa holang, cytometry ya phallo e bontshitse 0.08% ya di-lymphoblast tse sa holang tse kotsi. Ba fumane kalafo ya DLI. La 28 Tlhakubele 2019: Cytometry ya phallo ha e a ka ya bontsha diphoso.

La 11 Phato, 2019: Ho kgutlela ha moko wa masapo morao, ho phekolwa ka dasatinib.

La 2 Loetse 2019: Sebopeho se bontshitse 3% ya disele tse sa holang, cytometry ya phallo e bontshitse 0.04% ya disele tse sa holang tse kotsi. Kalafo e tswelang pele ka dasatinib, e latelwa ke medikoloho e 2 ya chemotherapy ya methotrexate.

La 11 Mots'eanong, 2020: Moko oa masapo o boela o kgutlela morao hape.

Ka 2020 ke fumane mekhoa e 'meli ea phekolo ea lisele tsa CD19-CAR-T ea autologous le mekhoa e 'meli ea phekolo ea lisele tsa CD19-CAR-T ea allogeneic, empa ha ho le e 'ngoe ea tsona e ileng ea fumana phomolo.

La 26 Mphalane, 2020: Ke amohetsoe sepetlele sa rona.

Liphetho tsa Laboratori:

Mokhoa oa ho sebelisa mali: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Lisele tse sa holang maling a ka ntle: 63%

Sebopeho sa moko oa masapo: Hypercellular (sehlopha sa II), 96% ea li-lymphoblast tse sa butsoang.

Ho Immunophenotyping: Disele di hlahisa CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; polelo e sa fellang ya CD123. E hlwauwa e le di-lymphoblast tse sa holang tse kotsi.

Phetoho ea hlahala ea mali: Hase 'nete.

Leukemia fusion Gene: NUP214-ABL1 fusion gene e ntle.

Tlhahlobo ea chromosome: 46, XX, t(1;9)(p34;p24), eketsa(11)(q23)[4]/46, XX, t(1;9)(p34;p24), eketsa(11)(q23)x2 [2]/46, XX[3]

Chimerism: Lisele tse nkiloeng ho bafani li etsa 7.71%.

Kalafo:

- Ho fanoa ka mokhoa oa chemotherapy oa VDS, DEX, LASP.

- Pudungwana 20: Disele tse sa holang maling a ka thoko ke 0%.

- Pokello ea li-lymphocyte tsa mali tse ka hare ho 'mele bakeng sa setso sa lisele tse peli tsa CAR-T tsa CD19/22.

- La 29 Pudungwana: Phekolo ya chemotherapy ya regimen ya FC (Flu 50mg x 3, CTX 0.4gx 3).

- La 2 Tšitoe (pele ho ho kenngoa ha sele ea CAR-T):

- Mokhoa oa ho sebelisa mali: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- Sebopeho sa moko oa masapo: Hypercellular (sehlopha sa IV), 68% ea li-lymphoblast tse sa butsoang.

- Tlhahlobo ea bongata ba liphatsa tsa lefutso tsa NUP214-ABL1 fusion: 24.542%.

- Phallo ea mali: 46.31% ea lisele li hlahisa CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, e leng se bontšang li-lymphoblast tsa B tse sa holang hantle.

- La 4 Tšitoe: Ho kenngoa ha lisele tse peli tsa CAR-T tsa autologous CD19/22 (3 x 10^5/kg).

- Litlamorao tse amanang le CAR-T: CRS ea Sehlopha sa 1, feberu ka Letsatsi la 6 ka Tmax ea 40°C, feberu e laoloang ke Letsatsi la 10. Ha ho na chefo ea methapo e bonoeng.

- La 22 Tšitoe (Tlhahlobo ea Letsatsi la 18): Phomolo e felletseng ea 'mele mokong oa masapo, ha ho na lisele tse sa holang tse kotsi tse fumanoeng ke flow cytometry. Tlhahlobo ea bongata ba liphatsa tsa lefutso tsa NUP214-ABL1 fusion: 0%.