I-Acute Lymphoblastic Leukemia (B-ALL)-03

Iimpawu zeTyala:

- Uxilongwe nge-acute B-cell lymphoblastic leukemia ekupheleni kukaMeyi 2020.

- Indlela yegazi: I-WBC 5.14x10^9/L, i-HGB 101.60g/L, i-PLT 6x10^9/L.

- Umongo wethambo: I-Hypocellular ene-67% ye-lymphocytes zamandulo.

- I-Flow cytometry: 82.28% yeeseli ziveza i-CD38, i-HLA-DR, i-CD19, i-CD10, i-CD105, i-TDT, i-CD22, i-cCD79a, i-CD9 evezwa kancinci, i-CD13 evezwa kancinci.

- Ukuhlolwa kwe-Fusion gene akukho ziphumo zimbi; i-WT1 57.3%; akukho ziphumo zimbi ezifana ne-PH ezinxulumene nazo zonke.

- INTLIZI: Utshintsho lwe-TP53 lulungile.

- Iikhromosomu: 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].

- Ndifumene irejimeni ye-VCDLP yezifundo ezi-2 ngaphandle kokukhululwa.

- Inkqubo ye-CAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) nge-22 kaJulayi 2020, ingekaxolelwa.

- I-Bone marrow flow cytometry nge-25 kaSeptemba 2020: i-7.35% yeeseli ziveza i-CD81, i-CD19, i-CD10, i-CD38, i-CD33, i-CD20, i-CD45 engabonakaliyo.

- Uhlalutyo lokuguquka kwethumba legazi: utshintsho lwe-TP53.

- Iikhromosomu: 46, XY[20].

- Uqalise unyango lwe-CD19-CART.

- I-FC regimen (i-FLU 62.7mg x iintsuku ezi-4, i-CTX 1045mg x iintsuku ezi-2) i-chemotherapy.

- Okthobha 1, 2020: Ukufakwa kweeseli ze-Autologous CD19-CART kwi-4.7x10^7/kg.

- I-CRS yebanga lesi-2 enobuthi be-neurological bebanga loku-1, iphucukile emva konyango oluxhasayo.

- Okthobha 29, 2020: Ukukhululwa ngokupheleleyo kwimo yethambo lomongo, akukho ziseli zokuqala ezinobungozi kwi-flow cytometry.

- Disemba 31, 2020: Ukukhohlela okomileyo, isicaphucaphu, ukuhlanza, ubuthathaka obuqhelekileyo.

- Indlela yokusebenzisa igazi: I-WBC 15.53x10^9/L, i-HGB 134g/L, i-PLT 71x10^9/L.

- Ukufunxwa komongo wethambo okubonisa ukuphinda kubuye.

- 2 kaJanuwari 2021: Ungeniswe esibhedlele sethu.

- Indlela yegazi: I-WBC 20.87x10^9/L, i-HGB 118.30g/L, i-PLT 58.60x10^9/L.

- I-Creatinine 134umol/L, inqanaba lesi-3 loxinzelelo lwegazi, imbali yezonyango yeminyaka emi-4.

- Udidi lwegazi olusecaleni: iiseli zokuqala ezingama-62%.

- I-Immunophenotyping: 28.48% yeeseli (iiseli ezinee-nucleated) ziveza i-CD10, i-CD38dim, i-HLA-DR, i-CD20dim, i-CD24, i-CD81, i-cCD79a, i-CD22, i-CD268dim, i-CD58, iveza i-CD123 kancinci, i-TDT, azivezi i-CD34, i-CD19, i-MPO, i-CD117, i-CD13, i-CD33, i-CD11b, i-clgM, i-CD79b, i-CD7, i-cCD3, i-kappa, i-lambda, ebonisa ii-lymphocytes ze-B eziyingozi.

- Uhlalutyo lokuguquka kwesisu segazi: Utshintsho lwe-TP53 R196P luchanekile.

Unyango:

- Ndifumene i-VLP chemotherapy, kunye nonyango lwe-hypertension, ukunciphisa i-creatinine, kunye ne-hydration alkalinization.

- NgoJanuwari 19: Inkqubo yegazi ibonise i-WBC 1.77x10^9/L, i-HGB 71g/L, i-PLT 29.8x10^9/L.

- Udidi lwegazi olusecaleni: Akukho lymphocytes zamandulo.

- Imo yethambo lomongo: I-Hypercellularity (ibanga le-V), iindawo ezigxile kwibanga le-IV, kunye ne-42% ye-lymphocytes zamandulo.

- I-Flow cytometry: 13.91% yeeseli ziveza i-CD10, i-cCD79a, i-CD38, i-CD81, i-CD22, azivezi i-CD20, i-CD34, i-CD19, nto leyo ebonisa iiseli ze-B ezinobungozi.

- Uhlobo lwe-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,yongeza(1)(q42),-2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].

- 20 kaJanuwari: Iilymphocytes ziqokelelwe ukukhuliswa kweeseli zeCD22-CART.

- 21 kaJanuwari: Kwenziwe ukubhobozwa kwe-lumbar, kwenziwa i-chemotherapy yangaphakathi ukuze kuthintelwe i-leukemia yenkqubo ye-nervous system; uvavanyo lwe-cerebrospinal fluid alubonisanga zizinto ezingaqhelekanga.

- Nge-22 kaJanuwari: Ndifumene i-Arac, i-6MP, i-L-ASP chemotherapy, kunye ne-FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.

- Nge-7 kaFebruwari (ngaphambi kokufakwa): Imo ye-bone marrow ibonise i-93% ye-lymphocytes zamandulo.

- I-Flow cytometry: 76.42% yeeseli ziveza i-CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, azivezi i-CD4, CD3, CD13+33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), nto leyo ebonisa iiseli ze-B ezinobungozi.

- Usulelo lwesikhumba kunye nezicubu ezithambileyo lubangelwa ngumkhuhlane; luphucukile emva konyango lwee-antibiotics.

- 9 kweyoMdumba: Ukufakwa kweeseli ze-Autologous CD22-CART (5x10^5/kg).

- Iziphumo ebezingalindelekanga ezinxulumene ne-CAR-T: i-CRS grade 1, umkhuhlane ngosuku lwesi-6 kunye ne-Tmax 40°C, ubushushu obulawulwayo ngosuku lwe-10; akukho tyhefu kwimithambo-luvo.

- Matshi 11: Uvavanyo lomongo wethambo lubonise ukuxolelwa okupheleleyo kwesimo somzimba, i-flow cytometry ayibonisanga ziseli zokuqala ezinobungozi.