I-Acute Lymphoblastic Leukemia (B-ALL)-01

Ufunyaniswe ene-acute B-cell lymphoblastic leukemia ngoNovemba 28, 2017.

Unyango nge-VDLP regimen ekuqaleni, ukufikelela ekuxolelweni komongo wethambo okungaphelelanga (iinkcukacha azixelwanga).

NgoFebruwari 2018: Itshintshelwe kwi-VLCAM regimen. I-Bone marrow flow cytometry ibonise ii-60.13% zeeseli ze-B ezingalunganga.

NgoMatshi 2018: Ubhalisele uvavanyo lweklinikhi lweBiTE. Ukukhululwa kwesimo somzimba kwi-bone mongo, akukho ziseli zingavuthwanga ezifunyenwe yi-flow cytometry.

Ngomhla wesi-8 kuCanzibe, ngo-2018: Ndifumene i-TBI/CY+VP16 conditioning regimen elandelwa kukufakelwa i-allogeneic stem cell transplant evela kumntakwabo ohambelana ngokupheleleyo (umxhasi we-AB+ ukuya kumkeli we-A+). Ukubuyiselwa kwe-neutrophil ngomhla we-+11, ukubuyiselwa kwe-megakaryocyte ngomhla we-+12.

Ngomhla wesi-5 kweyoMnga, ngo-2018: Ukukhululwa okupheleleyo kwesimo somzimba kwi-bone marrow, akukho ziseli zingavuthwanga ezifunyenwe yi-flow cytometry. Ndifumene i-donor lymphocyte infusion (DLI) kunye nonyango lokuthintela ukuphinda kubuye isifo.

Ngomhla wesi-2 kuFebruwari 2019: I-Morphology ibonise iiseli ezingavuthwanga eziyi-6.5%, i-flow cytometry ibonise ii-lymphoblasts ze-B ezingavuthwanga eziyi-0.08%. Ifumene unyango lwe-DLI. Ngomhla wama-28 kuMatshi 2019: I-flow cytometry ayibonisanga zizinto ezingaqhelekanga.

Nge-11 ka-Agasti 2019: Ukubuyela komongo wethambo, unyangwa nge-dasatinib.

Ngomhla wesi-2 kweyoMsintsi ngo-2019: I-Mofology ibonise iiseli ezingavuthwanga eziyi-3%, i-flow cytometry ibonise iiseli ezingavuthwanga eziyi-0.04%. Unyango oluqhubekayo nge-dasatinib, lulandelwa yimijikelo emibini ye-methotrexate chemotherapy.

Ngomhla we-11 kuCanzibe, ngo-2020: Umongo wethambo uphinde ubuye kwakhona.

Ndifumene iindlela ezimbini zonyango lweeseli ze-CD19-CAR-T ezizenzekelayo kunye nezinye ezimbini zonyango lweeseli ze-CD19-CAR-T ezi-allogeneic ngo-2020, akukho nanye eyafumana uxolelo.

Ngomhla wama-26 kweyeDwarha, ngo-2020: Wangeniswa esibhedlele sethu.

Iziphumo zeLebhu:

Indlela yegazi eqhelekileyo: I-WBC 22.75 x 10^9/L, i-HGB 132 g/L, i-PLT 36 x 10^9/L

Iiseli ezingavuthwanga zegazi elisecaleni: 63%

Imo yomongo wethambo: Ii-hypercellular (grade II), i-96% yee-lymphoblasts ezingavuthwanga.

I-Immunophenotyping: Iiseli ziveza i-CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; ukubonakaliswa okungaphelelanga kwe-CD123. Ichongwa njenge-malignant immature B lymphoblasts.

Utshintsho kwi-tumor yegazi: Olubi.

Ijini yokuhlanganisa i-leukemia: Ijini yokuhlanganisa i-NUP214-ABL1 ilungile.

Uhlalutyo lweChromosome: 46, XX, t(1;9)(p34;p24), dibanisa(11)(q23)[4]/46, XX, t(1;9)(p34;p24), dibanisa(11)(q23)x2 [2]/46, XX[3]

I-Chimerism: Iiseli ezifunyenwe ngabanikeli zithatha i-7.71%.

Unyango:

- Kunikezelwa unyango lwe-chemotherapy lwe-VDS, DEX, LASP.

- Novemba 20: Iiseli ezingavuthwanga zegazi elingaphandle ziyi-0%.

- Ukuqokelelwa kwee-lymphocyte zegazi eziphuma emzimbeni ezibizwa ngokuba yi-autologous peripheral blood culture zeCD19/22 dual CAR-T cells.

- Novemba 29: I-FC regimen chemotherapy (iFlu 50mg x 3, CTX 0.4gx 3).

- Disemba 2 (ngaphambi kokufakwa kweeseli ze-CAR-T):

- Indlela yegazi eqhelekileyo: I-WBC 0.44 x 10^9/L, i-HGB 66 g/L, i-PLT 33 x 10^9/L.

- Umongo wethambo: Iiseli ezixineneyo (ibanga lesi-IV), ii-lymphoblasts ezingavuthwanga ezingama-68%.

- Uvavanyo lobungakanani be-NUP214-ABL1 fusion gene: 24.542%.

- I-Flow cytometry: 46.31% yeeseli ziveza i-CD38dim, i-CD22, i-BCL-2, i-CD19, i-CD10bri, i-CD34, i-CD81dim, i-CD24, i-cCD79a, nto leyo ebonisa ii-lymphoblasts ze-B ezingavuthwanga kakuhle.

- Disemba 4: Ukufakwa kweeseli ezimbini ze-CAR-T ze-autologous CD19/22 (3 x 10^5/kg).

- Iziphumo ebezingalindelekanga ezinxulumene ne-CAR-T: I-CRS yeBanga loku-1, umkhuhlane ngosuku lwesi-6 kunye ne-Tmax engama-40°C, umkhuhlane olawulwa luSuku lwe-10. Akukho tyhefu ye-neurological eboniweyo.

- Disemba 22 (Uvavanyo lweSuku le-18): Ukukhululwa okupheleleyo kwesimo somzimba kwi-bone mongo, akukho ziseli zingavuthwanga ezifunyenwe yi-flow cytometry. Uvavanyo lobungakanani be-NUP214-ABL1 fusion gene: 0%.