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

Izici Zomtholampilo:

- Ukuxilongwa: I-Acute T-cell lymphoblastic leukemia

- Ukuqala: Ekupheleni kukaMashi 2018

- Izimpawu zokuqala: Ukwanda kwama-lymph node amaningi angaphezulu emzimbeni wonke

- Umkhuba wokuqala wegazi: I-WBC: 39.46*10^9/L, I-Hb: 129g/L, I-PLT: 77*10^9/L

- Ukwakheka komnkantsha wamathambo: 92% ukuqhuma

-I-Flow cytometry: 95.3% amaseli angajwayelekile aveza

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

- Izakhi zofuzo ze-Fusion: Ezimbi

- Ukuguquka kwezakhi zofuzo: Kutholwe ukuguqulwa kwezakhi zofuzo kwe-NOTCH1

- Ukuhlaziywa kwe-Chromosome: Uhlobo olujwayelekile lwe-karyotype

Umlando Wokwelashwa:

- Ephreli 3, 2018: Ukwelashwa ngokungenisa nge-VDCP

- Ephreli 18, 2018: Ukuqhuma komnkantsha kwakha u-96%

- Ephreli 20, 2018: Ngithole ukuxolelwa ngemva kohlelo lwe-CAG

- 18 Meyi 2018: Ukwelashwa okuhlanganisiwe ngohlelo lwe-CMG+VP

- Juni 22, 2018: Ukuqhuma komnkantsha kwanda kwafika ku-40%, kwaphinde kwaba nomdlavuza wegazi

- Julayi 25, 2018: Uhlelo lwe-CLAM (i-clarithromycin+cyclophosphamide+amikacin)

- Ukufakelwa kweseli le-stem le-hematopoietic kusuka ku-HLA-matched sibling kusetshenziswa i-FLU+BU conditioning ngo-Agasti 14

- Ukuqapha ngemva kokufakelwa: Ukususwa kokwakheka komnkantsha enyangeni eyi-1, izinyanga ezi-3, izinyanga ezi-6, izinyanga eziyi-9, kanye nezinyanga eziyi-11

- Ukwakheka komnkantsha wethambo kubonise ukuphulukiswa ezinyangeni ezingu-16 ngemva kokufakelwa, kanti i-flow cytometry iveza ama-lymphocyte angakavuthwa angama-0.02%

- Novemba 13, 2020: I-peripheral blood chimerism evela emthonjeni wabanikeli yayingu-97.9%

- Amaseli egazi angaphandle: 20%

- Disemba 18, 2020: Ukwakheka komnkantsha wamathambo: ukuqhuma okungu-60.6%

- I-Flow cytometry: ama-lymphocyte e-T angakavuthwa angama-30.85%

- Ukuhlaziywa kwe-Chromosome: 46, XY (20)

- Wathola ukwelashwa ngamakhemikhali kwe-DA ngomhlaka-19 Januwari 2021

- Ukwakheka komnkantsha wamathambo ngoJanuwari 19, 2021: I-Grade III hyperplasia, ukuqhuma okungu-16%

- Ukuhlaziywa kwe-karyotype ye-chromosome: 46, XY (20)

- I-Flow cytometry: 7.27% wamaseli (phakathi kwamaseli enuzi) aveze i-CD99bri, i-CD13, i-CD38, i-cbcl-2, i-cCD3, i-HLA-ABC bri, i-CD7bri, kanye ne-CD5dim eveze ingxenye, okubonisa ama-lymphocyte e-T angakavuthwa kahle.

- Ukuhlolwa kwezakhi zofuzo zokuhlanganiswa kwe-leukemia: Okubi

- Ukuhlaziywa kokuguquka kwesimila segazi (izinhlobo ezingu-86):

1. PHF6 K299Efs*13 ine-mutation positive

2. I-RUNX1 S322* ine-mutation positive

3. Ukuguqulwa kwe-FBXW7 E471G okuhle

4. Ukuguqulwa kwe-JAK3 M511I okune-positive

5. I-NOTCH1 Q2393* i-mutation positive

Ukwelashwa:

- Januwari 22: Ukuqoqwa kanye nokukhuliswa kwama-lymphocyte egazi angaphandle kwe-autologous ukuze kutholakale i-CD7-CART

- Ngaphambi kokufakwa kwe-CD7-CART, isiguli sathola i-VLP (i-vincristine, i-l-asparaginase, i-prednisone) kanye ne-bortezomib chemotherapy.

- 3 Nhlolanja: I-FC regimen chemotherapy (Umkhuhlane 50mg izinsuku ezi-3 + i-CTX 0.45g izinsuku ezi-3)

- 5 Nhlolanja (ngaphambi kokumuncwa): Ukwakheka komnkantsha wethambo kubonise ukuqhuma okungu-23%.

- I-Flow cytometry iveze amaseli angu-4.05% aveza i-CD99bri, i-CD5dim, i-CD7bri, i-TDT, i-cCD3, okubonisa ama-lymphocyte e-T angakavuthwa abulalayo.

- Ukuhlaziywa kwe-Chromosome: 46, XY (20)

- Ukuhlaziywa kwe-Chimerism (ngemuva kwe-HSCT): Amaseli atholakala kubanikeli abalelwa ku-52.19%.

- 7 kuNhlolanja: Ukufakwa kwamaseli e-CD7-CART e-autologous ngesilinganiso esingu-5*10^5/kg.

- 15 Nhlolanja: Amaseli egazi angavuthiwe angaphansi kwemingcele yezwe ancishisiwe abe ngu-2%.

- 19 kuNhlolanja (Usuku lwe-12 ngemuva kokumuncwa): Isiguli saba nomkhuhlane, owahlala izinsuku ezi-5 ngaphambi kokuba kufezwe ukulawulwa kokushisa.

- Mashi 2: Ukuhlolwa komnkantsha kubonise ukuxolelwa okuphelele kokwakheka, kanye ne-flow cytometry engatholi amangqamuzana anobungozi angakavuthwa.