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

Izici zezokwelapha:

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

- Mashi 2020: Wethulwe nokukhwehlela okubangelwa yi-paroxysmal kanye ne-mediastinal mass, kwaqinisekiswa i-T-cell lymphoblastic lymphoma nge-biopsy ye-mediastinal mass puncture.

- Ngithole imijikelezo engu-8 ye-chemotherapy kanye nezikhathi ezingaphezu kuka-20 ze-radiotherapy, okwaholela ekunciphiseni okukhulu kwe-mediastinal mass.

- Januwari 16, 2021: Kwaba nobuhlungu esithweni esingezansi kwesokudla.

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

- Ukwakheka komnkantsha wamathambo: 95.5% ama-lymphoblast asendulo.

- I-Bone marrow flow cytometry: amaseli angu-91.77% ayengama-lymphoblast e-T-cell angakavuthwa.

- Ukulandelana kwezakhi zofuzo: Ukuguqulwa kwezakhi zofuzo kutholakale ku-NOTCH1, IL7R, ASXL2.

- Uthole uhlelo lwe-Hyper-CVAD/B, uhlelo lwe-ESAP kamuva, kokubili akuphumelelanga uma kunomkhuhlane oqhubekayo.

- 18 Nhlolanja 2021: Wangeniswa esibhedlela sethu.

- Evezwe umkhuhlane, i-CT yesifuba yabonisa i-pneumonia.

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

- Amaseli angakavuthwa egazini angaphandle: 90%

- Ukwakheka komnkantsha wethambo: Ama-Hypercellular (ibanga le-IV), ama-lymphoblast asendulo angu-85%.

- I-Immunophenotyping: 87.27% wamaseli ayengama-lymphoblast e-T-cell ayingozi asendulo.

- Ukuhlaziywa kwe-Chromosomal: 46,XX [24]; kubonwe ezinye izinhlobo ezintathu ezingavamile ze-karyotypes.

- Izakhi zofuzo eziguquliwe:

1. IL7R T244_I245insARCPL mutation positive

2. I-NOTCH1 E1583_Q1584dup mutation positive

3. Ukuguqulwa kwe-ASXL2 Q602R okune-positive

- Ukuhlolwa kwezakhi zofuzo zokuhlanganiswa kwe-leukemia: Okubi

- Imiphumela ye-PET/CT: Akukho foci ebalulekile ye-hypermetabolic tumor kuwo wonke umgogodla wamathambo kanye nomnkantsha wamathambo.

Ukwelashwa:

- Uqale ukwelashwa ngamakhemikhali e-VP, okuchazwe kanje: I-Vincristine (VDS) 3mg kanye, i-Dexamethasone (Dex) 7mg njalo emahoreni ayi-12 izinsuku ezingu-9, kanye nokwelashwa okulwa nokutheleleka.

- Mashi 1: Amaseli egazi angavuthiwe angaphansi kwemingcele ancishisiwe abe ngu-7%.

- Mashi 4: Kuqoqwe ama-lymphocyte e-autologous ukuze kukhuliswe amaseli e-CD7-CAR T.

- Mashi 8: Kwaqala uhlelo lwe-VLP oluhlanganiswe nokwelashwa kwe-Sida benzamine.

- Mashi 14: Ngithole i-FC regimen chemotherapy (i-Fludarabine 0.35g izinsuku ezi-3, i-Cyclophosphamide 45mg izinsuku ezi-3).

- Mashi 17 (ukufakwa kwangaphambi kweseli):

- I-Bone marrow residual immunophenotyping: Amaseli angu-15.14% aveza ukukhanya kwe-CD7, i-CD3 dim, i-cytoplasmic CD3, i-T cell receptor restricted delta (TCRrd), ukubonakaliswa kwe-CD99 okungaphelele, okubonisa amaseli e-T asendulo anonya.

- Mashi 19: Amaseli e-T e-CD7-CAR afakwe ngaphakathi (1 x 10^6/kg).

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

- Ephreli 6 (Usuku lwe-17): Ukwakheka komnkantsha wethambo kwabonisa ukuxolelwa, i-flow cytometry ayizange ithole amangqamuzana ayingozi asendulo.