M cutar sankarar bargo ta Lymphoblastic (B-ALL) -01

Mai haƙuri: mutum XX

Jinsi: Namiji

Shekaru: shekara 24

Ƙasa: Sinanci

BincikeCutar sankarar bargo ta Lymphoblastic (B-ALL)

Tuntube mu

An gano shi tare da cutar sankarar bargo ta B-cell a ranar 28 ga Nuwamba, 2017.

Jiyya tare da tsarin VDLP da farko, samun nasarar kawar da bargon kashi (ba a ba da rahoto ba).

Fabrairu 2018: Canja zuwa tsarin VLCAM. Sitometry kwararar kasusuwan kasusuwa sun nuna 60.13% m sel B marasa girma.

Maris 2018: Shiga cikin gwajin asibiti na BiTE. Rarraba ilimin dabi'a a cikin kasusuwa, babu sel marasa girma da aka gano ta hanyar cytometry kwarara.

Mayu 8, 2018: An karɓi tsarin kwantar da TBI/CY+VP16 wanda ke biye da allogeneic stem cell dashi daga cikakken ɗan'uwan da suka dace (mai ba da gudummawa AB+ ga mai karɓar A+). Neutrophil farfadowa a rana +11, megakaryocyte farfadowa a rana +12.

Disamba 5, 2018: Cikakkar gafarar halittar jiki a cikin bargo, babu sel marasa girma da aka gano ta hanyar cytometry kwarara. An karɓi jiko na lymphocyte mai bayarwa (DLI) da maganin rigakafi tare da dasatinib da imatinib don hana sake dawowa.

Fabrairu 2, 2019: Ilimin halitta ya nuna 6.5% sel marasa girma, cytometry kwarara ya nuna 0.08% m rashin balaga B lymphoblasts. An karɓi maganin DLI. Maris 28, 2019: Sitometry mai gudana bai nuna rashin daidaituwa ba.

Agusta 11, 2019: Marrow na kashi ya koma baya, ana yi masa maganin dasatinib.

Satumba 2, 2019: Ilimin halitta ya nuna 3% sel marasa girma, cytometry kwarara ya nuna 0.04% m sel marasa girma. Ci gaba da jiyya tare da dasatinib, biye da 2 hawan keke na methotrexate chemotherapy.

Mayu 11, 2020: Maƙarƙashiyar ƙashi ta sake komawa.

An karɓi maganin tantanin halitta CD19-CAR-T guda 2 na autologous da 2 allogeneic CD19-CAR-T therapy a cikin 2020, babu wanda ya sami gafara.

Oktoba 26, 2020: An kwantar da shi a asibitin mu.

Abubuwan da aka gano na dakin gwaje-gwaje:

Tsarin jini: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Kwayoyin jini marasa girma: 63%

Kwayoyin halittar kasusuwa: Hypercellular (grade II), 96% lymphoblasts marasa girma.

Immunophenotyping: Sel suna bayyana CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; Bayani na bangare na CD123. An gano shi azaman m rashin balaga B lymphoblasts.

Mutuwar jini: Korau.

Kwayoyin cutar sankarar bargo: NUP214-ABL1 fusion gene tabbatacce.

Binciken Chromosome: 46, XX, t (1;9) (p34; p24), ƙara (11) (q23) [4]/46, XX, t (1;9) (p34; p24), ƙara (11) (q23) x2 [2]/46, XX[3]

Chimerism: Kwayoyin da aka samu masu bayarwa suna lissafin 7.71%.

Jiyya:

- VDS, DEX, LASP tsarin chemotherapy ana gudanarwa.

- Nuwamba 20: Kwayoyin jini marasa girma 0%.

- Tarin ƙwayoyin lymphocytes na jini na autologous don CD19/22 dual CAR-T cell al'ada.

- Nuwamba 29: FC tsarin chemotherapy (Flu 50mg x 3, CTX 0.4gx 3).

- Disamba 2 (kafin jiko tantanin halitta CAR-T):

- Tsarin jini: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- Kwayoyin halittar kasusuwa: Hypercellular (aji IV), 68% lymphoblasts marasa girma.

- Ƙimar ƙima na NUP214-ABL1 fusion gene: 24.542%.

- cytometry na gudana: 46.31% na sel suna bayyana CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, yana nuna m rashin balaga B lymphoblasts.

- Disamba 4: Jiko na autologous CD19/22 Kwayoyin CAR-T dual (3 x 10^5/kg).

- Abubuwan da ke da alaƙa da CAR-T: Grade 1 CRS, zazzabi a ranar 6 tare da Tmax na 40 ° C, zazzabi da aka sarrafa ta ranar 10. Babu neurotoxicity da aka lura.

- Disamba 22 (Kimanin Ranar 18): Cikakkiyar gafarar dabi'a a cikin bargo na kasusuwa, babu sel marasa girma da aka gano ta hanyar cytometry kwarara. Ƙimar ƙima na NUP214-ABL1 fusion gene: 0%.