Leukemia e matla ea Lymphoblastic (B-ALL)-03

Likarolo tsa Nyeoe:

- E fumanoe e na le leukemia e matla ea lisele tsa B tsa lymphoblastic qetellong ea Mots'eanong 2020.

- Mokhoa oa ho sebelisa mali: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- Sebopeho sa moko oa masapo: Hypocellular e nang le 67% ea li-lymphocyte tsa khale.

- Phallo ea mali: 82.28% ea lisele li hlahisa CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, CD9 e hlahisang karolo e itseng, CD13 e hlahisang ka mokhoa o fokolang.

- Tlhahlobo ea liphatsa tsa lefutso tsa Fusion e negative; WT1 57.3%; ha ho na liphatsa tsa lefutso tsa fusion tse amanang le ALL tse kang PH tse fumanoeng.

- TLHAPI: Phetoho ea TP53 e ntle.

- Li-chromosome: 63-58, XXY, +Y, +1, +del(1)(q41q42), -2, -3, +6, -7, +8, -9, +10, -12, -13, +14, +15, -17, +18, -20, +22(cp16)/46, XY[4].

- Ke fumane mokhoa oa VCDLP bakeng sa lithuto tse 2 ntle le pholiso.

- Mokhoa oa phekolo oa CAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) ka la 22 Phupu, 2020, o ntse o se na pholiso.

- Cytometry ea phallo ea moko oa masapo ka la 25 Loetse, 2020: 7.35% ea lisele li hlahisa CD81, CD19, CD10, CD38, CD33, li hlahisa CD20, CD45 ka mokhoa o fokolang.

- Tlhahlobo ea phetoho ea hlahala ea mali: phetoho ea TP53.

- Li-chromosome: 46, XY[20].

- O qalile kalafo ea CD19-CART.

- Phekolo ea chemotherapy ea FC (FLU 62.7mg x matsatsi a 4, CTX 1045mg x matsatsi a 2).

- La 1 Mphalane, 2020: Ho kenngoa ha sele ea Autologous CD19-CART ka 4.7x10^7/kg.

- CRS ea sehlopha sa 2 e nang le chefo ea methapo ea kutlo ea sehlopha sa 1, e ntlafalitsoe ka mor'a phekolo e tšehetsang.

- Mphalane 29, 2020: Phomolo e felletseng sebopehong sa moko oa masapo, ha ho na lisele tse mpe tsa pele tse kotsi ho cytometry ea phallo.

- La 31 Tšitoe 2020: Khohlela e ommeng, ho nyekeloa ke pelo, ho hlatsa, bofokoli bo akaretsang.

- Mokhoa oa ho sebelisa mali: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- Ho lapa ha moko oa masapo ho bontšang ho khutlela morao.

- La 2 Pherekhong 2021: Ke ile sepetlele sa rona.

- Mokhoa oa ho sebelisa mali: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

- Creatinine 134umol/L, kgato ya 3 ya kgatelelo e phahameng ya madi, nalane ya bongaka ya dilemo tse 4.

- Sehlopha sa mali a ka thoko: 62% ea lisele tsa khale.

- Immunophenotyping: 28.48% ea lisele (lisele tse nang le nucleotide) li hlahisa CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, li hlahisa CD123 ka karolo e itseng, TDT, ha li hlahise CD34, CD19, MPO, CD117, CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, e bontšang malignant primitive B lymphocytes.

- Tlhahlobo ea phetoho ea hlahala ea mali: phetoho ea TP53 R196P e ntle.

Kalafo:

- Ke fumane VLP chemotherapy, hammoho le kalafo ea khatello e phahameng ea mali, phokotso ea creatinine, le alkalinization ea metsi 'meleng.

- La 19 Pherekhong: Mokhoa oa ho sebelisa mali o bontšitse WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Sehlopha sa mali a ka thoko: Ha ho na li-lymphocyte tsa pele.

- Sebopeho sa moko oa masapo: Hypercellularity (sehlopha sa V), libaka tse shebaneng tsa sehlopha sa IV, ka 42% ea li-lymphocyte tsa pele.

- Phallo ea potoloho: 13.91% ea lisele li hlahisa CD10, cCD79a, CD38, CD81, CD22, ha li hlahise CD20, CD34, CD19, e leng se bontšang lisele tsa B tsa khale tse kotsi.

- Karyotype ea chromosome:

- 35,XY,-2,-3,-4,-5,-7,-9,-12,-13,-16,-17,-20[8]/35,XY,+X,-2,-3,-4,-5,-7,-9,-10,-12,-13,-16,-17,-20[1]/36,XY, eketsa(1)(q42),-2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].

- La 20 Pherekhong: Li-lymphocyte li bokelloa bakeng sa setso sa lisele tsa CD22-CART.

- La 21 Pherekhong: Ho entsoe ho phunya mokokotlo, ho fanoa ka chemotherapy ka hare ho methapo ho thibela leukemia ea tsamaiso ea methapo e bohareng; tlhahlobo ea mokelikeli oa boko e bontšitse ho se be le lintho tse sa tloaelehang.

- La 22 Pherekhong: Ke fumane Arac, 6MP, L-ASP chemotherapy, le FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.

- La 7 Hlakola (pele ho ts'ebeliso): Sebopeho sa moko oa masapo se bontšitse 93% ea li-lymphocyte tsa khale.

- Phallo ea potoloho: 76.42% ea lisele li hlahisa CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, ha li hlahise CD4, CD3, CD13+33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), e leng se bontšang lisele tsa B tsa khale tse kotsi.

- Ho ba le tšoaetso ea letlalo le lisele tse bonolo tse bakang feberu; e ntlafetse ka mor'a kalafo ea lithibela-mafu.

- La 9 Hlakola: Ho kenngoa ha sele ea Autologous CD22-CART (5x10^5/kg).

- Litlamorao tse amanang le CAR-T: CRS grade 1, feberu ka Letsatsi la 6 le Tmax 40°C, mocheso o laoloang ka Letsatsi la 10; ha ho na chefo ea methapo.

- La 11 Tlhakubele: Tlhahlobo ea moko oa masapo e bontšitse phokotso e felletseng ea sebopeho, cytometry ea phallo ha ea ka ea bontša lisele tse kotsi tsa pele.