I-Acute Lymphoblastic Leukemia (B-ALL)-02

Iimpawu zeTyala:

- Meyi 19, 2019: Ufunyaniswe ene-acute B-cell lymphoblastic leukemia (B-ALL)

- Iboniswa ziintlobo ngeentlobo zeentloko zentloko kunye ne-lymphadenopathy

- Indlela yegazi eqhelekileyo: I-WBC 13.3 x 10^9/L, i-HGB 94 g/L, i-PLT 333 x 10^9/L, ii-lymphocytes ezingaqhelekanga 4%

- Imo ye-bone marrow: 80.2% ii-lymphoblasts ezingavuthwanga (ii-blasts)

- I-Immunophenotyping: 74.19% yeeseli ziiseli ze-B-lineage precursor ezibangela i-CD45dim, i-CD19, i-CD9, i-CD22, i-CD81, i-CD58, i-cCD79a, i-CD38, i-HLA-DR, ezivelisa i-cIgM kancinci. Uxilongo: I-B-ALL (Isigaba sangaphambi kwe-B)

- I-Fusion gene: I-MLL-ENL positive, i-Philadelphia chromosome-like (Ph-like) screen negative

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

- I-VDLD regimen chemotherapy ekuqaleni ifumene ukuxolelwa kwe-immunological emva kwenyanga e-1, i-MLL-ENL quantitative PCR 0.026%

- I-chemotherapy eqhubekayo ngokwemigaqo yabantwana, i-MLL-ENL quantitative PCR 0 emva komjikelo wesi-4. I-chemotherapy eqhubekayo yaqhubeka.

- Matshi 2020: Isifo se-immunological residual disease yi-0.35%, i-MLL-ENL quantitative PCR yi-0.53%, nto leyo ebonisa ukuba kukho ukuphinda ubuye. Usapho lwala ukufakelwa. I-chemotherapy yaqhubeka imijikelo emi-3.

- Julayi 2020: Umongo wethambo uphinde wabuyela umva ngokupheleleyo.

- Nge-11 kaNovemba 2020: I-Intrathecal chemotherapy, i-CSF immunological residue disease 66%, ifunyaniswe ine-leukemia yenkqubo yemithambo-luvo ephakathi. I-Intrathecal chemotherapy iphindwe kabini, i-CSF yajika yaba ne-negative.

- Disemba 31, 2020: Ungeniswe esibhedlele sethu.

- Indlela yegazi: I-WBC 3.99 x 10^9/L, i-HGB 66 g/L, i-PLT 57 x 10^9/L

- Inani lokuqhuma kwegazi elijikeleze ulwandle: 69%

- Imo yethambo lomongo: 90% ii-lymphoblasts ezingavuthwanga (ii-blasts)

- I-Immunophenotyping: 84.07% yeeseli ziveza i-CD38, i-CD19, i-CD81dim, i-cCD79a, i-HLA-DR, i-cIgM, i-CD22, i-CD123, i-CD24, i-CD15dim evezwa kancinci, nto leyo ebonisa ii-lymphoblasts ze-B ezingavuthwanga kakuhle.

- I-Fusion gene: I-MLL-ENL fusion gene positive, i-quantitative PCR 44.419%

- Uguquko lwemfuza: Uguquko lwe-KMT2D oluvela kwi-gene (imvelaphi ye-germline)

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

- I-PET-CT: Ukwanda kwe-metabolism kuwo wonke umngxuma wamathambo kunye nomongo wethambo, ukurhanelwa okuphezulu kokubuyela kwe-leukemia; i-splenomegaly kunye ne-metabolism eyonyukileyo, mhlawumbi ebandakanya i-leukemia.

- Ndenze ukubhobozwa kwe-lumbar kunye ne-intrathecal chemotherapy kanye, akukho ziphazamiso zifunyenweyo kuvavanyo olunxulumene ne-CSF.

Unyango:

- Iiveki ezimbini ze-VLP chemotherapy, igazi elisecaleni liqhuma nge-5% ngoJanuwari 18.

- Januwari 25: Igazi eliphuma emzileni liqhuma ngama-91%, linyangwa nge-CTX, Ara-C, i-chemotherapy ye-6-MP.

- Nge-3 kaFebruwari: Ukuqhuma kwegazi elingaphandle kwengingqi ngama-22%.

- Nge-4 kaFebruwari: Ukuqokelelwa kwegazi eliyi-50ml elisecaleni le-autologous ukuze kukhuliswe iiseli ze-CD19-CART.

- MTX 1g, i-FC chemotherapy (Umkhuhlane yi-15mg imihla ngemihla x iintsuku ezi-3, i-CTX yi-0.12g imihla ngemihla x iintsuku ezi-3).

- Nge-13 kaFebruwari (ngaphambi kokufakwa): Imo ye-bone marrow ibonisa ukuqhuma okungama-87.5%, i-flow cytometry ibonisa ukuqhuma okungama-79.4% okubangela iintlungu.

- Uhlalutyo lobungakanani be-MLL-ENL fusion gene: 42.639%.

- Februwari 14: Ukufakwa kweeseli zeCART ngedosi ye-5 x 10^5/kg.

- Iziphumo ezimbi ezinxulumene ne-CAR-T: I-CRS yeBanga loku-1 (umkhuhlane), akukho tyhefu kwimithambo-luvo.

- Usuku lwama-20 emva kokufakwa: I-blood smear ibonisa ukwanda kwethumba, umlinganiselo weseli yeCART yi-0.07%.

- Unyango lwe-CART cell olungasebenziyo.

- Matshi 8, 2021: Inkqubo yegazi: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- Ukuqhuma kwegazi elingaphandle: 83%. Igazi elingaphandle elizenzekelayo liqokelelwe i-60ml ukuze kukhuliswe iiseli zeCD19/CD22 ezimbini zeCART.

- Inyangwa nge-cytarabine kunye ne-dexamethasone ukulawula umthwalo we-tumor.

- Matshi 18: I-FC chemotherapy (Umkhuhlane yi-15mg imihla ngemihla x iintsuku ezi-3, i-CTX yi-0.12g imihla ngemihla x iintsuku ezi-3).

- Matshi 22 (ngaphambi kokumnika): Indlela yokusebenzisa igazi: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Imo yegazi ejikeleze igazi: 6% ukuqhuma.

- Imo yomongo wethambo: 91% ukuqhuma. Intsalela kwimongo wethambo: 88.61% iiseli ezivelisa iCD38, CD19, cCD79a, CD81, CD22, nto leyo ebonisa ii-lymphoblasts ze-B ezingavuthwanga kakuhle.

- Uhlalutyo lobungakanani be-MLL-ENL fusion gene: 62.894%.

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

- Matshi 23: Ukufakwa kweeseli zeCART ngedosi ye-3 x 10^5/kg.

- Ngomhla wama-26 kuMatshi ukuya phambili: Umkhuhlane ongapheliyo kwaye kamva waba nokudumba komzimba.

- Matshi 29: Imo yegazi ejikeleze igazi: 92% ukuqhuma; ii-transaminases eziphezulu kunye ne-bilirubin.

- Epreli 2: Ukuqala kokuxhuzula, kunyangwa nge-diazepam.

- Ngomhla wesi-2 ku-Epreli (Usuku lwe-10): Uqalise unyango lwe-methylprednisolone kangangeentsuku ezi-3.

- Impendulo ye-CRS: Ibanga lesi-3, ii-CRES: Ibanga lesi-3.

- Ngomhla wesi-8 ku-Epreli (Usuku lwe-16): Uvavanyo lomongo wethambo lubonisa ukuxolelwa okupheleleyo kwesimo somzimba, i-flow cytometry negative kwi-malignant blasts; Uhlalutyo lobungakanani be-MLL-ENL fusion gene: 0.