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

Izici Zecala:

- Meyi 19, 2019: Kutholakale ukuthi une-acute B-cell lymphoblastic leukemia (B-ALL)

- Kwethulwa ngenqwaba yesikhumba sekhanda kanye ne-lymphadenopathy

- Inqubo yegazi: I-WBC 13.3 x 10^9/L, i-HGB 94 g/L, i-PLT 333 x 10^9/L, ama-lymphocyte angajwayelekile angu-4%

- Ukwakheka komnkantsha wamathambo: 80.2% ama-lymphoblast angakavuthwa (ukuqhuma)

- I-Immunophenotyping: 74.19% wamaseli angamaseli angaphambi komugqa we-B abangela i-CD45dim, i-CD19, i-CD9, i-CD22, i-CD81, i-CD58, i-cCD79a, i-CD38, i-HLA-DR, aveza i-cIgM ngokwengxenye. Ukuxilongwa: I-B-ALL (Isigaba sangaphambi kwe-B)

- I-Fusion gene: I-MLL-ENL positive, isikrini esifana ne-Philadelphia chromosome (Ph-like) negative

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

- I-chemotherapy ye-VDLD ekuqaleni yathola ukuphulukiswa kwe-immunological ngemuva kwenyanga eyi-1, i-MLL-ENL quantitative PCR 0.026%

- Ukwelashwa ngamakhemikhali okuqhubekayo ngokwenqubo yezingane, i-MLL-ENL quantitative PCR 0 ngemuva komjikelezo wesine. Ukwelashwa ngamakhemikhali okuqhubekayo kwaqhubeka.

- Mashi 2020: Isifo se-immunological residual immunological 0.35%, i-MLL-ENL quantitative PCR 0.53%, okubonisa ukuthambekela kokubuyela emuva. Umndeni wenqaba ukufakelwa. Kuqhutshekwe nokwelashwa ngamakhemikhali imijikelezo emi-3.

- Julayi 2020: Umnkantsha wamathambo wabuyela emuva ngokuphelele.

- Novemba 11, 2020: I-Intrathecal chemotherapy, i-CSF immunological residual disease 66%, kutholakale ukuthi ine-leukemia yesistimu yezinzwa ephakathi. I-Intrathecal chemotherapy iphindwe kabili, i-CSF yaba negative.

- 31 Disemba 2020: Ungeniswe esibhedlela sethu.

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

- Inani lokuqhuma kwegazi elingaphandle: 69%

- Ukwakheka komnkantsha wamathambo: 90% ama-lymphoblast angakavuthwa (ukuqhuma)

- I-Immunophenotyping: 84.07% wamaseli aveza i-CD38, i-CD19, i-CD81dim, i-cCD79a, i-HLA-DR, i-cIgM, i-CD22, i-CD123, eveza i-CD24, i-CD15dim ngokwengxenye, okubonisa ama-lymphoblast e-B angakavuthwa.

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

- Ukuguquka kwezakhi zofuzo: Ukuguquka kwezakhi zofuzo kwe-KMT2D okuhle (imvelaphi yezakhi zofuzo)

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

- I-PET-CT: Ukwanda kwe-metabolic okusabalele kuwo wonke umgodi wamathambo kanye nomnkantsha, izinsolo eziphezulu zokuphindeka kwe-leukemia; i-splenomegaly kanye nokwanda kwe-metabolism, okungenzeka ukuthi kuhilela i-leukemia.

- Ngenze ukubhoboza i-lumbar kanye ne-intrathecal chemotherapy kanye, akukho ukuphazamiseka okutholakale ekuhlolweni okuhlobene ne-CSF.

Ukwelashwa:

- Amasonto amabili e-VLP chemotherapy, igazi elingaphandle likhuphuke ngo-5% ngoJanuwari 18.

- Januwari 25: Igazi eliphuma ngaphandle liqhuma ngo-91%, lelashwa nge-CTX, Ara-C, 6-MP chemotherapy.

- 3 Nhlolanja: Ukuqhuma kwegazi okungaphandle kwemingcele kukhuphuke ngo-22%.

- 4 Nhlolanja: Ukuqoqwa kwegazi elingaphandle elingu-50ml le-autologous ukuze kukhiqizwe amaseli e-CD19-CART.

- I-MTX 1g, i-FC chemotherapy (Umkhuhlane 15mg nsuku zonke x izinsuku ezi-3, i-CTX 0.12g nsuku zonke x izinsuku ezi-3).

- 13 Nhlolanja (ngaphambi kokufakwa): Ukwakheka komnkantsha wethambo kubonisa ukuqhuma okungu-87.5%, i-flow cytometry ibonisa ukuqhuma okunonya okungu-79.4%.

- Ukuhlaziywa kobuningi be-gene fusion ye-MLL-ENL: 42.639%.

- 14 Nhlolanja: Ukufakwa kwamaseli e-CART ngesilinganiso esingu-5 x 10^5/kg.

- Imiphumela emibi ehlobene ne-CAR-T: I-CRS yebanga loku-1 (umkhuhlane), ayinabo ubuthi bemizwa.

- Usuku lwama-20 ngemuva kokufakwa: I-smear yegazi ikhombisa ukwanda kwesimila, isilinganiso samaseli e-CART singu-0.07%.

- Ukwelashwa kwamaseli e-CART okungasebenzi kahle.

- Mashi 8, 2021: Umkhuba wegazi: I-WBC 38.55 x 10^9/L, i-HGB 65g/L, i-PLT 71.60 x 10^9/L.

- Ukuqhuma kwegazi okuseceleni: 83%. Igazi eliseceleni elizimele liqoqwe ngama-60ml ukuze kukhiqizwe amaseli amabili e-CD19/CD22 CART.

- Yelashwa nge-cytarabine kanye ne-dexamethasone ukulawula umthwalo wesimila.

- Mashi 18: I-FC chemotherapy (Umkhuhlane 15mg nsuku zonke x izinsuku ezi-3, i-CTX 0.12g nsuku zonke x izinsuku ezi-3).

- Mashi 22 (ngaphambi kokumnika): Inqubo yegazi: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Ukwakheka kwegazi okuzungezile: 6% ukuqhuma.

- Ukwakheka komnkantsha wamathambo: 91% ukuqhuma. Okusele kumnkantsha wamathambo: 88.61% amaseli aveza i-CD38, i-CD19, i-cCD79a, i-CD81, i-CD22, okubonisa ama-lymphoblast e-B angakavuthwa.

- Ukuhlaziywa kobuningi be-gene fusion ye-MLL-ENL: 62.894%.

- Ukuhlaziywa kwe-karyotype ye-Chromosome: 46, XX, del(1)(p36.1), del(11)(q13), t(11;19)(q23;p13.3), add(14)(q34), -17, +mar [2]/46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3), add(14)(q34).

- Mashi 23: Ukufakwa kwamaseli e-CART ngesilinganiso esingu-3 x 10^5/kg.

- Mashi 26 kuqhubeke: Umkhuhlane ophakeme oqhubekayo futhi kamuva waba nokuvuvukala komzimba.

- Mashi 29: Ukwakheka kwegazi elingaphandle: ukuqhuma okungu-92%; ama-transaminase aphezulu kanye ne-bilirubin.

- Ephreli 2: Ukuqala kokuxhuzula, kwelashwa nge-diazepam.

- Ephreli 2 (Usuku lwe-10): Kwaqalwa ukwelashwa nge-methylprednisolone izinsuku ezi-3.

- Ukusabela kwe-CRS: Ibanga lesi-3, i-CRES: Ibanga lesi-3.

- Ephreli 8 (Usuku lwe-16): Ukuhlolwa komnkantsha wethambo kukhombisa ukuxolelwa okuphelele kwesimo somzimba, i-flow cytometry negative yokuqhuma okubi; Ukuhlaziywa kwe-MLL-ENL fusion gene quantitative: 0.