Leukemia e matla ea Lymphoblastic (B-ALL)-02

Litšobotsi tsa Nyeoe:

- Mots'eanong 19, 2019: E fumanoe e na le leukemia e matla ea B-cell lymphoblastic (B-ALL)

- E hlahisoa ka bongata ba letlalo la hlooho le lymphadenopathy

- Mokhoa oa mali: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, li-lymphocyte tse sa tloaelehang 4%

- Sebopeho sa moko oa masapo: 80.2% ea li-lymphoblast tse sa butsoang (li-blast)

- Immunophenotyping: 74.19% ea lisele ke lisele tse ka pele ho B-lineage tse kotsi tse hlahisang CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, tse hlahisang cIgM ka karolo e itseng. Tlhahlobo: B-ALL (Mokhahlelo oa Pele ho B)

- Fusion gene: MLL-ENL positive, skrine e kang chromosome ea Philadelphia (e kang Ph) e negative

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

- Phekolo ea VDLD chemotherapy qalong e fihletse phokotso ea sesole sa 'mele kamora khoeli e le' ngoe, MLL-ENL quantitative PCR 0.026%

- Kalafo e tswelang pele ho latela protocol ya bana, MLL-ENL quantitative PCR 0 kamora potoloho ya bone. Kalafo e tswelang pele ya chemotherapy e tswela pele.

- Hlakubele 2020: Lefu la ho se phele ha mmele la moko oa masapo ke 0.35%, MLL-ENL quantitative PCR 0.53%, e leng se bontšang tšekamelo ea ho khutlela morao. Lelapa le hanne ho kenngoa ha setho. Ho tsoela pele ka chemotherapy bakeng sa lipotoloho tse 3.

- Phupu 2020: Moko oa masapo o ile oa khutla ka botlalo.

- La 11 Pudungwana, 2020: Kalafo ya intrathecal, lefu la immunological residual la CSF 66%, le fumanwe le na le leukemia ya tsamaiso ya methapo e bohareng. Kalafo ya intrathecal e phetilwe habeli, CSF e ile ya fetoha e mpe.

- La 31 Tšitoe 2020: Ke amohetsoe sepetlele sa rona.

- Mokhoa oa ho sebelisa mali: WBC 3.99 x 10^9/L, HGB 66 g/L, PLT 57 x 10^9/L

- Palo ea ho phatloha ha mali ka ntle ho naha: 69%

- Sebopeho sa moko oa masapo: 90% ea li-lymphoblast tse sa butsoang (li-blast)

- Immunophenotyping: 84.07% ea lisele li hlahisa CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, li hlahisa CD24, CD15dim ka karolo e itseng, e leng se bontšang li-lymphoblast tsa B tse sa holang hantle.

- Fusion Gene: MLL-ENL fusion gene e ntle, PCR e nang le bongata 44.419%

- Phetoho ea liphatsa tsa lefutso: Phetoho ea KMT2D e ntle (tšimoloho ea kokoana-hloko)

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

- PET-CT: Keketseho e pharalletseng ea metabolism ka har'a lesapo lohle le ka har'a moko oa masapo, ho belaelloa ho hoholo ha leukemia hape; splenomegaly e nang le metabolism e eketsehileng, mohlomong e kenyeletsang leukemia.

- Ke entse ho phunya lumbar le intrathecal chemotherapy hang, ha ho na diphoso tse fumanweng ditekong tse amanang le CSF.

Kalafo:

- Libeke tse peli tsa chemotherapy ea VLP, mali a tsoang ka ntle a phahama ka 5% ka la 18 Pherekhong.

- La 25 Pherekhong: Mali a tsoang ka ntle a phatloha ka 91%, a phekoloa ka CTX, Ara-C, chemotherapy ea 6-MP.

- La 3 Hlakola: Ho phatloha ha mali a ka ntle ho naha ka 22%.

- La 4 Hlakola: Pokello ea mali a 50ml a tsoang ka ntle ho 'mele bakeng sa setso sa lisele tsa CD19-CART.

- MTX 1g, chemotherapy ea FC (Flu 15mg letsatsi le letsatsi x matsatsi a 3, CTX 0.12g letsatsi le letsatsi x matsatsi a 3).

- La 13 Hlakola (pele ho kenngoa): Sebopeho sa moko oa masapo se bontša ho phatloha ha 87.5%, cytometry ea phallo e bontša ho phatloha ha malignant ha 79.4%.

- Tlhahlobo ea bongata ba liphatsa tsa lefutso tsa motsoako oa MLL-ENL: 42.639%.

- La 14 Hlakola: Ho kenngoa ha lisele tsa CART ka tekanyo ea 5 x 10^5/kg.

- Litlamorao tse mpe tse amanang le CAR-T: CRS ea Sehlopha sa 1 (feberu), ha e na chefo ea methapo.

- Letsatsi la 20 kamora ho kenngwa: Smear ea mali e bontša ho ata ha hlahala, karolo ea sele ea CART ke 0.07%.

- Kalafo e sa sebetseng hantle ea sele ea CART.

- La 8 Tlhakubele, 2021: Mokhoa oa ho sebelisa mali: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- Ho phatloha ha mali a ka ntle ho tšitiso: 83%. Mali a ka ntle ho tšitiso a bokelletsoeng 60ml bakeng sa tlhahiso ea lisele tse peli tsa CD19/CD22 CART.

- E phekoloa ka cytarabine le dexamethasone ho laola moroalo oa hlahala.

- La 18 Tlhakubele: Kalafo ea chemotherapy ea FC (Flu 15mg letsatsi le letsatsi x matsatsi a 3, CTX 0.12g letsatsi le letsatsi x matsatsi a 3).

- La 22 Tlhakubele (pele ho enteloa): Mokhoa oa ho sebelisa mali: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Sebopeho sa mali a ka thoko: 6% ea ho phatloha.

- Sebopeho sa moko oa masapo: 91% ea ho phatloha. Masalla mokong oa masapo: 88.61% ea lisele tse hlahisang CD38, CD19, cCD79a, CD81, CD22, tse bontšang li-lymphoblast tsa B tse sa holang hantle.

- Tlhahlobo ea bongata ba liphatsa tsa lefutso tsa motsoako oa MLL-ENL: 62.894%.

- Tlhahlobo ea karyotype ea chromosome: 46, XX, del(1)(p36.1), del(11)(q13), t(11;19)(q23;p13.3), eketsa(14)(q34), -17, +mar [2]/46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3), eketsa(14)(q34).

- La 23 Tlhakubele: Ho kenngoa ha lisele tsa CART ka tekanyo ea 3 x 10^5/kg.

- La 26 Hlakubele ho ea pele: Ho ba le feberu e phahameng e sa feleng mme hamorao ho ile ha hlaha ho ruruha ha mmele.

- La 29 Tlhakubele: Sebopeho sa mali a ka thoko: 92% ea ho phatloha ha mali; li-transaminase tse phahameng le bilirubin.

- La 2 Mmesa: Ho qala ho tšoaroa ke sethoathoa, se phekoloang ka diazepam.

- La 2 Mmesa (Letsatsi la 10): Ho qadilwe kalafo ya methylprednisolone ka matsatsi a 3.

- Karabelo ea CRS: Kereiti ea 3, CRES: Kereiti ea 3.

- La 8 Mmesa (Letsatsi la 16): Tlhahlobo ea moko oa masapo e bontša phokotso e felletseng ea sebopeho, cytometry ea phallo e mpe bakeng sa ho phatloha ho kotsi; Tlhahlobo ea bongata ba liphatsa tsa lefutso tsa motsoako oa MLL-ENL: 0.