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

Izici Zecala:

- Kutholakale ukuthi une-acute B-cell lymphoblastic leukemia ekupheleni kukaMeyi 2020.

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

- Ukwakheka komnkantsha wethambo: I-Hypocellular enama-lymphocyte ayisisekelo angu-67%.

- I-Flow cytometry: 82.28% wamaseli aveza i-CD38, i-HLA-DR, i-CD19, i-CD10, i-CD105, i-TDT, i-CD22, i-cCD79a, i-CD9 eveza kancane, i-CD13 eveza kancane.

- Ukuhlolwa kwezakhi zofuzo ze-fusion ku-negative; i-WT1 57.3%; azikho izakhi zofuzo ze-fusion ezihlobene ne-PH ezifana ne-ALL ezitholiwe.

- INHLANZI: Ukuguquka kwe-TP53 okuhle.

- Ama-chromosome: 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].

- Ngithole uhlelo lwe-VCDLP lwezifundo ezimbili ngaphandle kokuxolelwa.

- Uhlelo lwe-CAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) ngomhlaka-22 Julayi 2020, lungakaqedwa.

- I-Bone marrow flow cytometry ngoSepthemba 25, 2020: 7.35% wamaseli aveza i-CD81, i-CD19, i-CD10, i-CD38, i-CD33, iveza i-CD20, i-CD45 kancane kancane.

- Ukuhlaziywa kokuguquka kwesimila segazi: ukuguqulwa kwe-TP53.

- Ama-chromosome: 46, XY[20].

- Uqale ukwelashwa kwe-CD19-CART.

- Ukwelashwa ngamakhemikhali kwe-FC (i-FLU 62.7mg x izinsuku ezi-4, i-CTX 1045mg x izinsuku ezi-2).

- Okthoba 1, 2020: Ukufakwa kweseli le-Autologous CD19-CART ku-4.7x10^7/kg.

- I-CRS yebanga lesi-2 enobuthi be-neurological bebanga loku-1, ithuthukisiwe ngemva kokwelashwa okusekelayo.

- Okthoba 29, 2020: Ukukhululwa okuphelele ekubunjweni komnkantsha wamathambo, ukungabikho kwamangqamuzana ayingozi asendulo ku-flow cytometry.

- Disemba 31, 2020: Ukukhwehlela okomile, isicanucanu, ukuhlanza, ubuthakathaka obujwayelekile.

- Inqubo yegazi: I-WBC 15.53x10^9/L, i-HGB 134g/L, i-PLT 71x10^9/L.

- Ukufuthwa komnkantsha okubonisa ukubuyela emuva.

- Januwari 2, 2021: Wangeniswa esibhedlela sethu.

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

- I-Creatinine 134umol/L, umfutho wegazi ophakeme wesigaba sesi-3, umlando wezokwelapha weminyaka emi-4.

- Ukuhlukaniswa kwegazi okungaphandle: amaseli ayisisekelo angu-62%.

- I-Immunophenotyping: 28.48% wamaseli (amaseli ane-nucleated) aveza i-CD10, i-CD38dim, i-HLA-DR, i-CD20dim, i-CD24, i-CD81, i-cCD79a, i-CD22, i-CD268dim, i-CD58, aveza i-CD123 kancane, i-TDT, awavezi 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, okubonisa ama-lymphocyte e-B angewona awemvelo.

- Ukuhlaziywa kokuguquka kwesimila segazi: Ukuguqulwa kwe-TP53 R196P okuhle.

Ukwelashwa:

- Ngithole i-VLP chemotherapy, kanye nokwelashwa komfutho wegazi ophakeme, ukunciphisa i-creatinine, kanye nokufakwa kwe-hydration alkaline.

- Januwari 19: Uhlelo lwegazi lubonise i-WBC 1.77x10^9/L, i-HGB 71g/L, i-PLT 29.8x10^9/L.

- Ukuhlukaniswa kwegazi okungaphandle: Azikho ama-lymphocyte ayisisekelo.

- Ukwakheka komnkantsha wethambo: Ukuqina kwamangqamuzana (ibanga le-V), izindawo ezigxile zebanga le-IV, ezinama-lymphocyte ayisisekelo angu-42%.

- I-Flow cytometry: 13.91% wamaseli aveza i-CD10, i-cCD79a, i-CD38, i-CD81, i-CD22, awavezi i-CD20, i-CD34, i-CD19, okubonisa amaseli e-B angewona awemvelo.

- I-karyotype ye-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,engeza(1)(q42),-2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].

- Januwari 20: Ama-lymphocyte aqoqwe ukuze kuthuthukiswe amangqamuzana e-CD22-CART.

- Januwari 21: Kwenziwe ukubhoboza i-lumbar, kwenziwa i-chemotherapy yangaphakathi ukuze kuvinjelwe i-leukemia yesistimu yezinzwa ephakathi; ukuhlolwa koketshezi lwe-cerebrospinal akubonisanga ukuphazamiseka.

- Januwari 22: Ngithole i-Arac, i-6MP, i-L-ASP chemotherapy, kanye ne-FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.

- 7 kuNhlolanja (ngaphambi kokufakwa): Ukwakheka komnkantsha wethambo kubonise ama-lymphocyte ayisisekelo angu-93%.

- I-Flow cytometry: 76.42% wamaseli aveza i-CD38, i-cCD79a, i-CD22, i-cbcl-2, i-CD123, i-CD10bri, i-CD24, i-CD81, awavezi i-CD4, i-CD3, i-CD13+33, i-CD34, i-CD20, i-CD19, i-CD279 (PD1), i-CD274 (PDL1), okubonisa amaseli e-B angewona awemvelo.

- Kwaba nokutheleleka kwesikhumba nezicubu ezithambile okubangelwa umkhuhlane; kwaba ngcono ngemva kokwelashwa ngama-antibiotic.

- 9 kuNhlolanja: Ukufakwa kwamaseli e-Autologous CD22-CART (5x10^5/kg).

- Imiphumela emibi ehlobene ne-CAR-T: Ibanga loku-1 le-CRS, umkhuhlane ngosuku lwesi-6 kanye ne-Tmax 40°C, izinga lokushisa elilawulwayo ngosuku lwe-10; akukho ubuthi be-neurological.

- Mashi 11: Ukuhlolwa komnkantsha kwabonisa ukuxolelwa okuphelele kokwakheka, i-flow cytometry ayizange ibonise amangqamuzana ayingozi asendulo.