Ho hasanya lymphoma e kholo ea lisele tsa B (DLBCL), mofuta oa setsi se seng sa kokoana-hloko, se amang nko le li-sinuses-02

Ka Hlakubele 2021, mokuli oa monna ea lilemo li 52 ea tsoang Leboea-bochabela la Chaena o ile a fumanoa a e-na le bothata ba nko bo ileng ba fumanoa nakong ea tlhahlobo ea kamehla. O ile a ba le matšoao a nko e thibaneng, hlooho e opang, pono e lerootho, le mofufutso oa bosiu, ntle le feberu kapa ho theola boima ba 'mele.

Litlhahlobo tsa pele li senotse boima bo boholo ba lisele tse bonolo tse kenyeletsang nko e nepahetseng le li-sinuse, tse amang meaho ea bohlokoa joalo ka orbit, motheo oa lehata la pele, sinus ea sphenoid, le sinus ea leqele la ethmoid ho MRI. Tlhahlobo ea pathological ea sinus e nepahetseng ea maxillary e bontšitse ho ata ha lymphoma e kholo ea B-cell (DLBCL), e leng mofuta oa setsi se seng sa germinal.

Immunohistochemistry (IHC) e bontshitse ho kenella ho hoholo ka tlhahiso e habeli ya Ki-67 (90%+), CD20 (+), c-Myc (>80%+), Bcl-2 (>90%), Bcl-6 (+), CD10 (-), Mum1 (+), CD79a (+), CD30 (-), le CyclinD1 (-), ntle le RNA e nyane (EBER) e ka lemohuwang ke vaerase ya Epstein-Barr.

Ho kopanya ha Fluorescence in situ (FISH) ho fumane phetisetso ea Bcl-6 le c-myc, empa ha ho phetisetso ea liphatsa tsa lefutso tsa Bcl-2. Sequencing ea moloko o latelang (NGS) e tiisitse liphetoho liphatseng tsa lefutso tsa MYD88, CD79B, IGH-MYC, BAP1, le TP53, e leng se bontšang lymphoma ea B-cell ea boemo bo holimo e nang le phetisetso ea MYC le BCL2 le/kapa BCL6.

Positron emission tomography-computed tomography (PET-CT) e bonts'itse lihlopha tse sa tloaelehang tsa lisele tse bonolo ka har'a nko e nepahetseng le sinus e phahameng, e ka bang 6.3x3.8cm ka boholo, e nang le meeli e sa hlakang. Seso se ile sa namela holimo ho ea sinus e nepahetseng ea ethmoid, ka ntle ho ea leboteng le bohareng la orbit le sebaka sa intraorbital, le ka morao ho ea sinus ea sphenoid le motheo oa lehata. Seso se bontšitse keketseho ea ho monya ha fluorodeoxyglucose (FDG) ka SUVmax ea 20. Ho teteana ha mucosal ho ile ha bonoa sinus e letšehali ea ethmoid le e superior, ka metabolism e tloaelehileng ea FDG.

Mokuli o ne a kile a fuoa R2-CHOP, R-ESHAP, BEAM+ASCT, le kalafo ea mahlaseli a sebakeng seo, 'me tsoelo-pele ea lefu e bonoa. Ka lebaka la ho hanyetsa chemotherapy le ho ameha ho hoholo ha litho tse ngata (ho kenyeletsoa matšoafo, sebete, spleen le masapo), mokuli o ile a fumanoa a e-na le DLBCL ea mantlha e sa sebetseng hantle. Lefu lena le ile la tsoela pele ka potlako ka ho kenella ho hoholo, maemo a phahameng a LDH, lintlha tse 5 tse fetotsoeng tsa International Prognostic Index (NCCN-IPI), phetoho ea TP53, le mofuta oa MCD, a boela a khutlela morao likhoeling tse 6 kamora ho kenngoa ha autologous.

Kamora kalafo e kopaneng, mokuli o ile a fumana kalafo ea steroid ka nakoana empa karabelo ea hae ea fokola. Kalafo ea morao e ne e kenyelletsa li-antibodies tsa monoclonal tsa CD79 tse kopantsoeng le bendamustine le mechlorethamine hydrochloride, e leng se ileng sa fella ka phokotso e kholo ea maemo a LDH le ho fokotseha ha hlahala ho bonahalang.

Kamora ho lokisetsa kalafo ea CAR-T ka katleho, mokuli o ile a fuoa chemotherapy ea ho fokotseha ha lymphocyte (lymphodepletion) ka mokhoa oa FC, a fihlela ho tlosoa ha lymphocyte ho neng ho reriloe le leukopenia e matla e latelang. Leha ho le joalo, matsatsi a mararo pele ho ente ea CAR-T, mokuli o ile a ba le feberu, herpes zoster sebakeng sa lumbar, le maemo a phahameng a serum lactate dehydrogenase (LDH) ho fihlela ho 25.74ng/ml, e leng se bontšang ketsahalo e mpe ea tšoaetso e sebetsang ea mofuta o tsoakiloeng (AE). Ha ho nahanoa ka kotsi e eketsehileng ea ente ea CAR-T ka lebaka la tšoaetso e sebetsang, e ka lebisang liphellong tse bolaeang, mokuli o ile a fuoa lithibela-mafu tse pharaletseng tse koahelang likokoana-hloko tse fapaneng.

Kamora ho kenngoa CAR-T, mokuli o ile a ba le feberu e phahameng letsatsing la ho kenngoa, a tsoela pele ho ba le ho ferekana, ho hemoptysis, le ho mpefatsa matšoao a matšoafo letsatsing la boraro. Angiography ea pulmonary venous CT letsatsing la bohlano e ile ea senola ho se bonahale ha khalase ea fatše le liphetoho tse pakeng tsa methapo ea mali, e tiisang ho tsoa mali matšoafong. Ho sa tsotellehe ho qoba li-steroid qalong ka lebaka la ho hatelloa ha CAR-T ho ka bang teng, le kalafo e tšehetsang e shebaneng le taolo ea ho thibela tšoaetso, boemo ba mokuli bo bontšitse ntlafatso e fokolang.

Letsatsing la bosupa, keketseho e kgolo ya palo ya kopi ya dijini tsa CAR e ile ya fumanwa mading a kantle, e leng se ileng sa etsa hore ho etswe phetoho ya kalafo ka methylprednisolone ya tekanyo e tlase (40mg-80mg). Matsatsi a mahlano hamorao, di-rale tsa matshwafo a mabedi di ile tsa fokotseha, mme matshwao a hemoptysis a ile a laolwa ka ho hlaka.

Letsatsing la borobeli, phekolo ea CAR-T e bontšitse katleho e ikhethang. Nakong ea khoeli e le 'ngoe feela ea phekolo ea CAR-T, mokuli o ile a fumana pholiso e felletseng (CR). Litlhahlobo tse latelang ho fihlela ka Phupu 2023 li tiisitse hore mokuli o ntse a le CR, e leng se bontšang karabelo e tebileng phekolong ea CAR-T le monyetla oa phekolo.