M cutar sankarar bargo ta Lymphoblastic (B-ALL) -02

Halayen Harka:

- Mayu 19, 2019: An gano shi tare da cutar sankarar bargo ta B-cell lymphoblastic (B-ALL)

- An gabatar da shi tare da yawan fatar kan mutum da kuma lymphadenopathy

- Tsarin jini: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, ƙananan lymphocytes 4%

- Ilimin halittar kasusuwa na kasusuwa: 80.2% lymphoblasts marasa girma (fashewa)

- Immunophenotyping: 74.19% na sel su ne m B-lineage precursor sel masu bayyana CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, wani bangare na bayyana cIgM. Bincike: B-ALL (Pre-B matakin)

- Fusion gene: MLL-ENL tabbatacce, Philadelphia chromosome-like (Ph-like) allon mara kyau

- Chromosome: 46, XX, t(11;19)(q23;p13), del (20) (q12) [3]/46, XX [7]

- VDLD tsarin chemotherapy da farko an sami gafarar rigakafi bayan wata 1, ƙimar MLL-ENL PCR 0.026%

- Ci gaba da chemotherapy kamar yadda ka'idodin yara, MLL-ENL ƙididdiga PCR 0 bayan zagayowar 4th. An ci gaba da ci gaba da maganin chemotherapy.

- Maris 2020: Ciwon ƙwayar kasusuwa na ƙashi 0.35%, MLL-ENL PCR mai ƙididdigewa 0.53%, yana nuna yanayin komawa. Iyali sun ƙi dasawa. Ci gaba da chemotherapy don hawan keke 3.

- Yuli 2020: Bargon ƙashi ya sake komawa gabaɗaya.

- Nuwamba 11, 2020: Intrathecal chemotherapy, CSF ragowar cututtukan rigakafi 66%, an gano shi da cutar sankarar bargo ta tsakiya. Intrathecal chemotherapy maimaita sau biyu, CSF ya juya mara kyau.

- Disamba 31, 2020: An kwantar da shi a asibitin mu.

- Tsarin jini: WBC 3.99 x 10^9/L, HGB 66 g/L, PLT 57 x 10^9/L

- Ƙididdigar fashewar jini: 69%

- Kwayoyin halittar kasusuwa: 90% lymphoblasts da ba su balaga ba (blasts)

- Immunophenotyping: 84.07% na sel suna bayyana CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, CD24, CD15dim, wanda ke nuna rashin girma B lymphoblasts.

Halin Fusion: MLL-ENL fusion gene tabbatacce, PCR mai ƙididdigewa 44.419%

- maye gurbin kwayoyin halitta: KMT2D maye gurbi mai inganci (asalin kwayoyin cuta)

- Chromosome karyotype: 46, XX, del (1) (p36.1), del (1) (q31q42), del (11) (q13), t (11;19) (q23; p13.3), add() 14) (q34), -17, +mar [7]/46, idem, t(3;16)(p21;p13.3) [1]/46, XX [13]

- PET-CT: Yaɗa haɓakar haɓakar rayuwa a cikin duka kwarangwal da ɓarna na kasusuwa, babban zato game da sake dawowar cutar sankarar bargo; splenomegaly tare da haɓaka metabolism, mai yiwuwa ya haɗa da cutar sankarar bargo.

- An yi huda lumbar da intrathecal chemotherapy sau ɗaya, ba a sami rashin daidaituwa a cikin gwaje-gwaje masu alaƙa da CSF ba.

Jiyya:

- Makonni biyu na VLP chemotherapy, jini na gefe yana fashewa 5% akan Janairu 18.

- Janairu 25: Jini na gefe yana fashewa 91%, an yi masa magani tare da CTX, Ara-C, 6-MP chemotherapy.

- Fabrairu 3: Jini na gefe yana fashewa da kashi 22%.

- Fabrairu 4: Tarin 50ml na gefen jini mai sarrafa kansa don al'adar tantanin halitta CD19-CART.

- MTX 1g, FC chemotherapy (Flu 15mg kullum x 3 days, CTX 0.12g kullum x 3 days).

- Fabrairu 13 (pre-jiko): Kwayoyin halittar kasusuwa na kasusuwa yana nuna fashewar 87.5%, cytometry kwarara yana nuna fashewar 79.4% m.

- MLL-ENL fusion na ƙididdigar ƙididdiga na gene: 42.639%.

- Fabrairu 14: Jiko na CART Kwayoyin a kashi na 5 x 10 ^ 5 / kg.

- Abubuwan da ke da alaƙa da CAR-T: Grade 1 CRS (zazzabi), babu neurotoxicity.

- Rana ta 20 bayan jiko: Gwargwadon jini yana nuna haɓakar ƙwayar cuta, adadin ƙwayoyin CART 0.07%.

- Maganin kwayar halitta CART mara inganci.

- Maris 8, 2021: Tsarin jini: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- fashewar jini na gefe: 83%. Jini na gefe na atomatik ya tattara 60ml don CD19/CD22 al'adar tantanin halitta biyu CART.

- Ana yin maganin cytarabine da dexamethasone don sarrafa nauyin ƙari.

- Maris 18: FC chemotherapy (Flu 15mg kullum x 3 days, CTX 0.12g kullum x 3 days).

- Maris 22 (kafin-jiko): Tsarin jini: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Halin halittar jini na gefe: 6% fashewa.

- Kwayoyin halittar kasusuwa: 91% fashewa. Ragowa a cikin kasusuwa: 88.61% Kwayoyin bayyana CD38, CD19, cCD79a, CD81, CD22, yana nuna m rashin balaga B lymphoblasts.

- MLL-ENL fusion na ƙididdigar ƙididdiga ta asali: 62.894%.

- Binciken karyotype na Chromosome: 46, XX, del (1) (p36.1), del (11) (q13), t (11;19) (q23; p13.3), ƙara (14) (q34), - 17, +mar [2]/46, XX, del (1) (p36.1), del (1) (q31q42), del (11) (q13), t (11;19) (q23; p13.3) ), ƙara (14) (q34).

- Maris 23: Jiko na ƙwayoyin CART a kashi 3 x 10 ^ 5 / kg.

- Maris 26 zuwa gaba: Zazzaɓi mai tsayi kuma daga baya ya haɓaka edema na tsarin.

- Maris 29: Halin halittar jini na gefe: 92% fashewa; karuwa a transaminases da bilirubin.

- Afrilu 2: Farkon kamewa, ana yi da diazepam.

- Afrilu 2 (Ranar 10): Fara maganin methylprednisolone na kwanaki 3.

- Halin CRS: Mataki na 3, CRES: Darasi na 3.

- Afrilu 8 (Ranar 16): Ƙididdigar ƙasusuwan kasusuwa yana nuna cikakkiyar gafarar yanayin halitta, cytometry mai gudana mara kyau ga fashewar mummunan; MLL-ENL fusion na ƙididdigar ƙididdiga ta asali: 0.