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

Likarolo tsa kliniki:

- Tlhahlobo: T-cell lymphoblastic lymphoma/leukemia

- Hlakubele 2020: E hlahisitsoe ka khohlela e sa foleng le boima ba mediastinal, e tiisitsoeng ke lymphoma ea T-cell lymphoblastic ka biopsy ea mediastinal mass puncture.

- Ke fumane medikoloho e 8 ya chemotherapy le dithuto tse fetang 20 tsa radiotherapy, e leng se ileng sa fella ka phokotso e kgolo ya boima ba mediastinal.

- La 16 Pherekhong 2021: Ho bile le bohloko leotong le ka tlase le letona.

- Mokhoa oa ho sebelisa mali: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- Sebopeho sa moko oa masapo: 95.5% ea li-lymphoblast tsa khale.

- Cytometry ea phallo ea moko oa masapo: 91.77% ea lisele e ne e le li-lymphoblast tsa sele ea T tse sa holang.

- Tatellano ea liphatsa tsa lefutso: Liphetoho tse fumanoeng liphatseng tsa lefutso tsa NOTCH1, IL7R, ASXL2.

- E fumane mokhoa oa Hyper-CVAD/B, mokhoa oa ESHAP ka mor'a moo, ka bobeli ha o sebetse ka feberu e sa feleng.

- La 18 Hlakola 2021: Ke amohetsoe sepetlele sa rona.

- A hlasetsoe ke feberu, sefuba sa CT se bontšitse pneumonia.

- Mokhoa oa ho sebelisa mali: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Lisele tse sa holang maling a ka ntle: 90%

- Sebopeho sa moko oa masapo: Hypercellular (sehlopha sa IV), 85% ea li-lymphoblast tsa khale.

- Immunophenotyping: 87.27% ea lisele e ne e le li-lymphoblast tsa T-cell tsa khale tse kotsi.

- Tlhahlobo ea chromosome: 46,XX [24]; ho bonoe mefuta e meraro e sa tloaelehang ea karyotype.

- Liphatsa tsa lefutso tse fetotsoeng:

1. IL7R T244_I245insARCPL phetoho e ntle

2. NOTCH1 E1583_Q1584phetoho e positive

3. Phetoho ea ASXL2 Q602R e na le phello e ntle

- Tlhahlobo ea liphatsa tsa lefutso tsa leukemia: Hase 'nete

- Liphetho tsa PET/CT: Ha ho na foci e kholo ea hlahala e nang le metabolism e ngata masapong 'ohle le mokong oa masapo.

Kalafo:

- Ho qadilwe kalafo ya VP chemotherapy, e hlalositsweng ka tsela e latelang: Vincristine (VDS) 3mg hanngoe, Dexamethasone (Dex) 7mg dihoreng tse ding le tse ding tse 12 ka matsatsi a 9, hammoho le kalafo e thibelang tshwaetso.

- La 1 Tlhakubele: Lisele tse sa holang maling a ka thoko li fokotsehile ho fihlela ho 7%.

- La 4 Tlhakubele: Ho bokelletsoe li-lymphocyte tsa autologous bakeng sa setso sa lisele tsa CD7-CAR T.

- La 8 Tlhakubele: Ho qadilwe mokhoa oa VLP o kopantsoeng le kalafo ea Sida benzamine.

- La 14 Tlhakubele: Ke fumane kalafo ea chemotherapy ea FC (Fludarabine 0.35g ka matsatsi a 3, Cyclophosphamide 45mg ka matsatsi a 3).

- La 17 Tlhakubele (tlhahiso ea pele ho lisele):

- Ho ntsha immunophenotyping e setseng ya moko wa masapo: Disele tse 15.14% di hlahisa CD7 e kganyang, CD3 e fifetse, cytoplasmic CD3, T cell receptor restricted delta (TCRrd), tlhahiso e sa fellang ya CD99, e bontshang disele tsa T tsa kgale tse kotsi.

- La 19 Tlhakubele: Lisele tsa T tsa CD7-CAR tse kentsweng ka hara mmele (1 x 10^6/kg).

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

- La 6 Mmesa (Letsatsi la 17): Sebopeho sa moko oa masapo se bontšitse pholiso, cytometry ea phallo ha ea ka ea lemoha lisele tse kotsi tsa pele.