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

Iimpawu zeKliniki:

- Uxilongo: I-Acute T-cell lymphoblastic leukemia

- Ukuqala: Ekupheleni kukaMatshi 2018

- Iimpawu zokuqala: Ukwanda kwee-lymph nodes ezininzi ezingaphezulu komzimba wonke

- Inkqubo yokuqala yegazi: I-WBC: 39.46*10^9/L, I-Hb: 129g/L, I-PLT: 77*10^9/L

- Imo yethambo lomongo: 92% ukuqhuma

-I-Flow cytometry: 95.3% iiseli ezingaqhelekanga eziveza

I-TdT+CD99+CyCD3+CD7stCd5DdimCD4-CD8-mCD3-CD45dim

- Izakhi zofuzo ze-Fusion: Ezingalunganga

- Utshintsho kwizakhi zofuzo: Utshintsho kwizakhi zofuzo lwe-NOTCH1 lufunyenwe

- Uhlalutyo lweChromosome: Uhlobo oluqhelekileyo lwekaryotype

Imbali Yonyango:

- Epreli 3, 2018: Unyango lokungenisa nge-VDCP regimen

- Nge-18 ka-Epreli, 2018: Ukuqhuma kwe-bone marrow kwakungu-96%

- Epreli 20, 2018: Ndafumana uxolelo emva kwenkqubo ye-CAG

- Meyi 18, 2018: Unyango lokudibanisa kunye ne-CMG+VP regimen

- Juni 22, 2018: Ukuqhuma kwethambo lomongo kunyuke ukuya kuma-40%, ukuphinda kwesifo segazi esibizwa ngokuba yi-leukemia

- Julayi 25, 2018: Inkqubo ye-CLAM (i-clarithromycin+cyclophosphamide+amikacin)

- Ukufakelwa kweeseli ze-Hematopoietic stem cell ezivela kwi-HLA-matched sibling ngokusebenzisa i-FLU+BU conditioning nge-14 ka-Agasti

- Ukubeka esweni emva kokufakelwa: Ukususwa komongo wethambo kwinyanga e-1, iinyanga ezi-3, iinyanga ezi-6, iinyanga ezi-9, kunye neenyanga ezili-11

- Imo ye-bone marrow ibonise ukuxolelwa kwiinyanga ezili-16 emva kokufakelwa, apho i-flow cytometry ityhila i-0.02% ye-lymphocytes ezingalunganga ezingavuthwanga.

- Novemba 13, 2020: I-peripheral blood chimerism evela kumthombo wabaxhasi yayiyi-97.9%

- Iiseli zegazi ezingaphandle: 20%

- Disemba 18, 2020: Ukwakheka komongo wethambo: 60.6% ukuqhuma

- I-Flow cytometry: 30.85% ii-lymphocytes ze-T ezingavuthwanga ezinobungozi

- Uhlalutyo lweChromosome: 46, XY (20)

- Ndifumene i-DA regimen chemotherapy ngoJanuwari 19, 2021

- Imo yeBone Marrow ngoJanuwari 19, 2021: I-Grade III hyperplasia, i-16% yokuqhuma

- Uhlalutyo lwe-karyotype ye-chromosome: 46, XY (20)

- I-Flow cytometry: 7.27% yeeseli (phakathi kweeseli zenyukliya) ezivezwe yi-CD99bri, i-CD13, i-CD38, i-cbcl-2, i-cCD3, i-HLA-ABC bri, i-CD7bri, kunye ne-CD5dim evezwe kancinci, nto leyo ebonisa ii-lymphocytes ze-T ezingavuthwanga kakuhle.

- Ukuhlolwa kwe-leukemia fusion gene: Okubi

- Uhlalutyo lokuguquka kwesisu egazini (iintlobo ezingama-86):

1. PHF6 K299Efs*13 utshintsho oluhle

2. I-RUNX1 S322* iguqukile

3. I-FBXW7 E471G yenguqu ephilayo

4. I-JAK3 M511I mutation positive

5. I-NOTCH1 Q2393* itshintshile ibe positive

Unyango:

- Januwari 22: Ukuqokelelwa kunye nokuphuhliswa kwee-lymphocytes zegazi eziphuma emzimbeni ze-CD7-CART

- Ngaphambi kokufakwa kwe-CD7-CART, isigulane safumana i-VLP (vincristine, l-asparaginase, prednisone) kunye ne-bortezomib chemotherapy.

- Nge-3 kaFebruwari: I-FC regimen chemotherapy (iFlu 50mg iintsuku ezi-3 + i-CTX 0.45g iintsuku ezi-3)

- Ngomhla wesi-5 kuFebruwari (ngaphambi kokufakwa): Imo yethambo lomongo ibonise ukuqhuma kwe-23%.

- I-Flow cytometry ityhile iiseli eziyi-4.05% eziveza i-CD99bri, i-CD5dim, i-CD7bri, i-TDT, i-cCD3, nto leyo ebonisa ii-lymphocytes ze-T ezingavuthwanga kakuhle.

- Uhlalutyo lweChromosome: 46, XY (20)

- Uhlalutyo lweChimerism (emva kweHSCT): Iiseli ezifunyenwe ngabanikeli zibalwa kwi-52.19%.

- 7 kaFebruwari: Ukufakwa kweeseli ze-CD7-CART ezizii-autologous ngedosi ye-5*10^5/kg.

- Nge-15 kaFebruwari: Iiseli ezingavuthwanga zegazi ezingaphandle zinciphile zaya kwi-2%.

- Ngomhla we-19 kuFebruwari (Usuku lwe-12 emva kokumnika): Isigulana saba nomkhuhlane, owahlala iintsuku ezi-5 ngaphambi kokuba kufezekiswe ulawulo lobushushu.

- Matshi 2: Uvavanyo lwe-bone marrow lubonise ukuxolelwa okupheleleyo kwe-morphological, kunye ne-flow cytometry engaziboni iiseli ezinobungozi ezingavuthwanga.