Umfana olwa ne-acute lymphoblastic leukemia

Ulwazi Oluyisisekelo Lwesiguli

Indoda eneminyaka engu-16 ubudala etholakale ine-acute lymphoblastic leukemia (B-ALL), eyathola ukwelashwa ngamakhemikhali kokuqala, ukwelashwa ngamaseli e-CD19/22 CAR-T, ukwelashwa ngamakhemikhali okusindisa, kanye nokufakelwa kwamaseli e-hematopoietic stem cell (allo-HSCT) ngemva kwalokho okuvela kumnikeli wabazali.

Isimo Sesiguli Sangaphambi Kokwelashwa

Ngaphambi kwe-allo-HSCT, isiguli sathola ukwanda okusheshayo kwamangqamuzana amhlophe egazi kanye nesifo esiqhubekayo naphezu kokungenelela okuningi. Ngemva kokufakwa kwe-CD19/22 CAR-T ngo-Ephreli 21, 2025 (amangqamuzana e-CAR-T esewonke: 6.5×10^7), inani lamangqamuzana e-CAR-T ekuqaleni landa laya ku-3.95×10^6/L ngosuku lwesi-7 kodwa lehla laya ku-0.82×10^6/L ngosuku lwesi-14, lapho amangqamuzana okuqhuma kwegazi angaphandle ekhuphuka esuka ku-28.6% aya ku-87.1%. Ukuhlolwa komnkantsha ngoMeyi 15, 2025, kwembule ukwehla okukhulu kokwanda ngama-lymphoblast e-B angajwayelekile angu-37.42% (aveza i-CD34, i-CD38/CD22 engaphelele, i-CD81/CD19/CD33 ebuthakathaka, ayikho i-CD10/CD20/CD79b), okuqinisekisa ukuthi akukho ukuxolelwa. Uketshezi lwe-cerebrospinal alubonisanga amangqamuzana angajwayelekile, kodwa isifo sonke asizange siphumule.

Isimo Sesiguli Ngemva Kokwelashwa

Ngemva kwe-allo-HSCT ngoMeyi 29-30, 2025 (amaseli e-CD34+: 8.6×10^6/kg; amaseli e-mononuclear: 8×10^8/kg), isiguli sathola i-neutrophil engraftment ngosuku lwe-11 kanye ne-platelet engraftment ngosuku lwe-18. Ngosuku lwama-28 (Juni 27, 2025), ukubalwa kwegazi kwathuthuka kakhulu: i-hemoglobin 99 g/L (kusukela emazingeni aphansi angaphambilini), amaseli amhlophe egazi 11.73×10^9/L, ama-neutrophil 9.81×10^9/L, kanye nama-platelet 79×10^9/L. Ukwakheka komnkantsha wethambo kubonise ukwanda okusebenzayo ngaphandle kwamaseli okuqala angajwayelekile, i-flow cytometry yaqinisekisa ukuthi akukho okungahambi kahle, i-biopsy yabonisa ukwanda okuphansi kodwa amaseli e-trilineage abonakalayo angenawo ama-lymphocyte angakavuthwa, kanye ne-STR chimerism yafinyelela ku-100%, yafinyelela ukuxolelwa okuphelele (CR) ngesifo esincane esisele (MRD-). Ngosuku lwama-49 (Julayi 18, 2025), umongo wamathambo wawulokhu usebenza ngaphandle kwamaseli angajwayelekile, okugcina i-CR kanye ne-MRD-. Isifo esingesihle samathumbu esilingana nesigaba 1 sokufakelwa kwamathumbu ngokumelene nomnikazi waso savela kodwa saphathwa ngemithi, okubonisa ukulawulwa kwesifo okuphumelelayo kanye nokululama uma kuqhathaniswa nokuqhuma okuqhubekayo kwangaphambi kokufakelwa (kusuka ku-37.42% kuya ku-0%) kanye nokuntuleka kokukhululwa.