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

Kutholakale ukuthi une-acute B-cell lymphoblastic leukemia ngoNovemba 28, 2017.

Ukwelashwa ngohlelo lwe-VDLP ekuqaleni, kufezwe ukuxolelwa komnkantsha okungaphelele (imininingwane ayibikwanga).

NgoFebhuwari 2018: Kushintshelwe ohlelweni lwe-VLCAM. I-Bone marrow flow cytometry ibonise amaseli e-B angakavuthwa angama-60.13%.

Mashi 2018: Wabhalisa esivivinyweni sezokwelapha se-BiTE. Ukukhululwa kwesimo somzimba emnkantsheni wethambo, akukho maseli angakavuthwa atholakala yi-flow cytometry.

Meyi 8, 2018: Ngithole uhlelo lokulungisa i-TBI/CY+VP16 olulandelwe ukufakelwa kweseli le-stem le-allogeneic kusuka kumuntu ozalwa naye ofanelana ngokuphelele (umnikeli we-AB+ kumuntu othola i-A+). Ukululama kwe-neutrophil ngosuku lwe-+11, ukululama kwe-megakaryocyte ngosuku lwe-+12.

5 Disemba 2018: Ukukhululwa okuphelele kwesimo somzimba emnkantsheni wethambo, awekho amangqamuzana angakavuthwa atholakala yi-flow cytometry. Ngithole i-donor lymphocyte infusion (DLI) kanye nokwelashwa kokuvimbela nge-dasatinib kanye ne-imatinib ukuvimbela ukubuyela emuva.

2 Nhlolanja 2019: I-Mofology ibonise amaseli angavuthiwe angu-6.5%, i-flow cytometry ibonise ama-lymphoblast e-B angavuthiwe angu-0.08% abulalayo. Yathola ukwelashwa kwe-DLI. 28 Nhlolanja 2019: I-Flow cytometry ayibonisanga ukuphazamiseka.

Agasti 11, 2019: Ukubuyela emuva komnkantsha, welashwa nge-dasatinib.

2 Septhemba 2019: Ukwakheka kwesimo somzimba kubonise amaseli angavuthiwe angu-3%, i-flow cytometry ibonise amaseli angavuthiwe angu-0.04%. Ukwelashwa okuqhubekayo nge-dasatinib, kulandelwe imijikelezo emibili ye-methotrexate chemotherapy.

Meyi 11, 2020: Ukulimala kwethambo kuphinda kubuye.

Ngithole izindlela zokwelapha ezimbili zamaseli e-CD19-CAR-T ezizimele kanye nezindlela ezimbili zokwelapha zamaseli e-CD19-CAR-T ezi-allogeneic ngo-2020, akukho noyedwa owathola ukuthethelelwa.

Okthoba 26, 2020: Wangeniswa esibhedlela sethu.

Okutholakele Kwelebhu:

Isimiso segazi: I-WBC 22.75 x 10^9/L, i-HGB 132 g/L, i-PLT 36 x 10^9/L

Amaseli angavuthiwe egazi angaphandle: 63%

Ukwakheka komnkantsha wethambo: Ama-hypercellular (ibanga lesi-2), ama-lymphoblast angavuthiwe angama-96%.

Ukuhlolwa kwe-Immunophenotyping: Amaseli aveza i-CD19, i-cCD79a, i-CD38dim, i-CD10bri, i-CD34, i-CD81dim, i-CD24, i-HLA-DR, i-TDT, i-CD22, i-CD72; ukubonakaliswa okuyingxenye kwe-CD123. Kuhlonzwa njenge-malignant immature B lymphoblasts.

Ukuguquka kwesimila segazi: Okubi.

I-gene ye-fusion ye-leukemia: I-gene ye-fusion ye-NUP214-ABL1 ilungile.

Ukuhlaziywa kwe-Chromosome: 46, XX, t(1;9)(p34;p24), add(11)(q23)[4]/46, XX, t(1;9)(p34;p24), add(11)(q23)x2 [2]/46, XX[3]

I-Chimerism: Amaseli atholakala kubanikeli alinganiselwa ku-7.71%.

Ukwelashwa:

- Kunikezwa ukwelashwa ngamakhemikhali i-VDS, DEX, LASP.

- Novemba 20: Amaseli angakavuthwa egazini angaphandle angu-0%.

- Ukuqoqwa kwama-lymphocyte egazi angaphandle kwe-autologous ukuze kukhiqizwe amaseli amabili e-CD19/22 e-CAR-T.

- Novemba 29: Ukwelashwa ngamakhemikhali kwe-FC (Umkhuhlane 50mg x 3, CTX 0.4gx 3).

- Disemba 2 (ngaphambi kokufakwa kwamaseli e-CAR-T):

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

- Ukwakheka komnkantsha wethambo: Ama-hypercellular (ibanga lesi-IV), ama-lymphoblast angakavuthwa angu-68%.

- Ukuhlolwa kobuningi be-NUP214-ABL1 fusion gene: 24.542%.

- I-Flow cytometry: 46.31% wamaseli aveza i-CD38dim, i-CD22, i-BCL-2, i-CD19, i-CD10bri, i-CD34, i-CD81dim, i-CD24, i-cCD79a, okubonisa ama-lymphoblast e-B angakavuthwa.

- Disemba 4: Ukufakwa kwamaseli amabili e-CAR-T e-autologous CD19/22 (3 x 10^5/kg).

- Imiphumela emibi ehlobene ne-CAR-T: I-CRS yebanga loku-1, umkhuhlane ngosuku lwesi-6 kanye ne-Tmax engu-40°C, umkhuhlane olawulwa ngosuku lwe-10. Akukho ubuthi obubonakalayo obukhona.

- Disemba 22 (Ukuhlolwa kosuku lwe-18): Ukukhululwa okuphelele kwesimo somzimba emnkantsheni wethambo, akukho maseli angakavuthwa atholakala yi-flow cytometry. Ukuhlolwa kobuningi be-NUP214-ABL1 fusion gene: 0%.