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

Iimpawu zeklinikhi:

- Uxilongo: I-T-cell lymphoblastic lymphoma/leukemia

- Matshi 2020: Iboniswe ukukhohlela okubangelwa yi-paroxysmal kunye ne-mediastinal mass, i-T-cell lymphoblastic lymphoma eqinisekisiweyo nge-mediastinal mass puncture biopsy.

- Ndifumene imijikelo esi-8 ye-chemotherapy kunye neeseshoni ezingaphezu kwama-20 ze-radiotherapy, nto leyo ekhokelele ekunciphiseni okukhulu kwe-mediastinal mass.

- 16 kaJanuwari 2021: Ndafumana intlungu kwilungu elisezantsi lasekunene.

- Indlela yegazi: I-WBC 122.29 x 10^9/L, i-HGB 91 g/L, i-PLT 51 x 10^9/L

- Imo yethambo lomongo: 95.5% ii-lymphoblasts zamandulo.

- I-Bone marrow flow cytometry: 91.77% yeeseli yayizii-lymphoblasts ze-T-cell ezingavuthwanga.

- Ulandelelwano lwezakhi zofuzo: Utshintsho kwizakhi zofuzo ze-NOTCH1, IL7R, ASXL2 lufunyenwe.

- Ndifumene irejimeni yeHyper-CVAD/B, irejimeni ye-ESAP emva koko, zombini ezi zingasebenzi xa kukho umkhuhlane ongapheliyo.

- Nge-18 kaFebruwari 2021: Ungeniswe esibhedlele sethu.

- Evezwe ngumkhuhlane, i-CT yesifuba ibonise i-pneumonia.

- Indlela yegazi: I-WBC 2.89 x 10^9/L, i-HGB 57.7 g/L, i-PLT 14.9 x 10^9/L

- Iiseli ezingavuthwanga zegazi elisecaleni: 90%

- Imo yethambo lomongo: Ii-Hypercellular (ibanga le-IV), i-85% ye-lymphoblasts yamandulo.

- I-Immunophenotyping: 87.27% yeeseli yayizii-lymphoblasts ze-T-cell eziyingozi.

- Uhlalutyo lweChromosomal: 46,XX [24]; kubonwe ezinye iikaryotypes ezintathu ezingaqhelekanga.

- Izakhi zofuzo eziguqukileyo:

1. IL7R T244_I245insARCPL mutation positive

2. I-NOTCH1 E1583_Q1584dup mutation positive

3. I-ASXL2 Q602R iguqukile kwaye ine-HIV

- Ukuhlolwa kwe-leukemia fusion gene: Okubi

- Iziphumo zePET/CT: Akukho foci ibalulekileyo ye-hypermetabolic tumor kwi-skeleton yonke kunye ne-bone marrow cavity.

Unyango:

- Uqalise unyango lwe-VP regimen chemotherapy, oluchazwe ngolu hlobo lulandelayo: I-Vincristine (VDS) 3mg kanye, i-Dexamethasone (Dex) 7mg rhoqo emva kweeyure ezili-12 kangangeentsuku ezili-9, kunye nonyango lokulwa nosulelo.

- Matshi 1: Iiseli ezingavuthwanga zegazi ezingaphandle zinciphile zaya kwi-7%.

- Matshi 4: Kuqokelelwe ii-lymphocytes ze-autologous ukuze kukhuliswe iiseli ze-CD7-CAR T.

- Matshi 8: Uqalise inkqubo ye-VLP edityaniswe nonyango lwe-Sida benzamine.

- Matshi 14: Ndifumene i-FC regimen chemotherapy (i-Fludarabine 0.35g iintsuku ezi-3, i-Cyclophosphamide 45mg iintsuku ezi-3).

- Matshi 17 (ukufakwa kwangaphambi kokuba iiseli zifakwe):

- I-Bone marrow residual immunophenotyping: Iiseli ezili-15.14% ziveza ukukhanya kweCD7, i-CD3 dim, i-cytoplasmic CD3, i-T cell receptor restricted delta (TCRrd), ukubonakaliswa okungaphelelanga kwe-CD99, okubonisa iiseli ze-T ezinobungozi.

- Matshi 19: Iiseli ze-T ze-CD7-CAR ezifakwe kwi-autologous (1 x 10^6/kg).

- Iziphumo ebezingalindelekanga ezinxulumene ne-CAR-T: I-CRS yeBanga loku-1 (umkhuhlane), ayinabungozi kwimithambo-luvo.

- Ngomhla wesi-6 ku-Epreli (Usuku lwe-17): Imo ye-bone marrow ibonise ukuxolelwa, i-flow cytometry ayizange ibone iiseli ezinobungozi zokuqala.