I-Multiple Myeloma(MM)-01

Ukululama Okuhle Kwesiguli Sasekhaya Esine-Multiple Myeloma Ngokwelashwa Kwe-CAR-T Naphezu Kokuntuleka Kokubonakaliswa Kwe-BCMA

Isiguli sesifazane esatholakala sine-stage IIIA IgD-λ type multiple myeloma ngo-2018 sathola ukwelashwa kokuqala nge-bortezomib. Ngemva kwemijikelezo emi-3, sathola ukuxolelwa okuphelele (CR). Ngo-Okthoba 2018, sathola ukufakelwa kwe-autologous hematopoietic stem cell njengokwelashwa kokuhlanganiswa, kwalandela ukwelashwa kokugcina nge-lenalidomide. Ngo-Ephreli 2020, lesi sifo saphinde sabuya, futhi sathola imijikelezo engu-7 yokwelashwa kwe-second line, okwaveza ukungasebenzi kahle. Kusukela ngoDisemba 2020 kuya ku-Ephreli 2021, sathola i-chemotherapy ikakhulukazi nge-daratumumab, kodwa i-bone marrow biopsy yabonisa amaseli e-plasma angama-malignant angu-21.763%, ane-serum free light chain λ ku-1470 mg/L kanye ne-urine free light chain λ ku-5330 mg/L. Ngalesi sikhathi, wayeseqede ukwelashwa okujwayelekile nokusha okutholakalayo ekhaya, okuhlanganisa nokufakelwa kwe-autologous stem cell, kanye nokungena esivivinyweni somtholampilo se-CAR-T kube yindlela engcono kakhulu esele.

Ethunyelwe odokotela bendawo, wafika eSibhedlela iLudaopei ngoMeyi 10, 2021, enethemba lokubhalisa esivivinyweni sabo sezokwelapha sokwelashwa kwe-BCMA CAR-T ku-multiple myeloma (MM). Lapho engeniswa esibhedlela, wayesesimweni esibuthakathaka ngenxa yobuhlungu obujwayelekile kanye nomkhuhlane ophindaphindayo. Ukuhlolwa okuphelele kuqinisekisile "i-multiple myeloma, uhlobo lwe-λ light chain, i-ISS stage III, i-R-ISS stage III, i-mSMART high-risk group."

Ukuskena kwe-PET-CT kwembule ukwanda komsebenzi we-metabolic ekubunjweni kwezicubu ezithambile ngaphakathi kwemigodi yomnkantsha wethambo we-femurs kanye ne-tibias, okubonisa ukubandakanyeka kwesimila. Ukuhlolwa komnkantsha wethambo kubonise amaseli e-plasma angama-malignant angu-60.13% angenakho ukubonakaliswa kwe-BCMA.

Isikhungo sethu se-CGT sazise isiguli nomndeni waso ngokusebenza kahle kokwelashwa kwamanje kwe-BCMA-negative multiple myeloma, nakuba kungenzeka ukuthi kuyasebenza ngokwezincwadi ezithile, kodwa akunawo idatha eqondile. Ngemva kokucabangisisa kahle, isiguli nomndeni waso bakhetha ukuqhubeka nohlelo lokwelashwa.

Ngemva kokulungiswa kusengaphambili ngohlelo lwe-FC, amaseli e-BCMA CAR-T afakwa ngomhlaka-1 Juni 2021, eSibhedlela iLudaopei. Isiguli sathola umkhuhlane ngemuva kokufakwa, okwalawulwa kancane kancane ngokwelashwa okunamandla okulwa nokutheleleka kanye nokusekela izimpawu. Ezinsukwini eziyishumi nane ngemuva kokufakwa, i-bone marrow biopsy ayizange ibonise amaseli e-plasma e-monoclonal asele. Ezinsukwini ezingamashumi amathathu nanye ngemuva kokufakwa, i-bone marrow biopsy yahlala ingenayo. I-Serum immunofixation yayingenayo, i-serum free light chain λ yayingaphakathi kwebanga elijwayelekile, kanti i-serum M protein yayingenayo, okubonisa ukuphulukiswa okuphelele kwalesi sifo.

Njengamanje, ngemva kwezinyanga ezingaphezu kwezingu-8 zithole ukumnika i-BCMA CAR-T cell, isiguli sihlala sikhululekile ngokuphelele futhi selulame kahle futhi sanelisekile kakhulu ngomphumela wokwelashwa.