M cutar sankarar bargo ta Lymphoblastic (B-ALL) -03

Siffofin Harka:

- An gano cutar sankarar bargo ta B-cell a ƙarshen Mayu 2020.

- Tsarin jini: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- Halin kasusuwa na kasusuwa: Hypocellular with 67% primitive lymphocytes.

- cytometry na gudana: 82.28% na sel suna bayyana CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, CD9 a wani bangare, bayyana CD13 mai rauni.

- Fusion gene screening mara kyau; WT1 57.3%; babu PH-kamar DUK kwayoyin halittar hadewar da aka gano.

- KIFI: TP53 maye gurbi tabbatacce.

- Chromosomes: 63-58, XXY, +Y, +1, +del(1)(q41q42), -2, -3, +6, -7, +8, -9, +10, -12, -13 , +14, +15, -17, +18, -20, +22(cp16)/46, XY[4].

- An karɓi tsarin VCDLP na darussa 2 ba tare da gafara ba.

- Tsarin CAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) akan Yuli 22, 2020, har yanzu ba tare da gafara ba.

- Sitometry kwararar kasusuwa a ranar 25 ga Satumba, 2020: 7.35% na sel suna bayyana CD81, CD19, CD10, CD38, CD33, CD20 mai rauni, CD45.

- Binciken maye gurbi na jini: maye gurbin TP53.

- Chromosomes: 46, XY[20].

- An fara maganin CD19-CART.

- Tsarin FC (FLU 62.7mg x 4 days, CTX 1045mg x 2 days) chemotherapy.

- Oktoba 1, 2020: CD19-CART jiko tantanin halitta ta atomatik a 4.7x10^7/kg.

- CRS 2 tare da neurotoxicity na 1, ingantawa bayan jiyya na tallafi.

- Oktoba 29, 2020: Cikakkiyar gafara a cikin ilimin halittar kasusuwan kasusuwan kasusuwa, babu wani mummunan sel na farko akan sitometry mai gudana.

- Disamba 31, 2020: bushewar tari, tashin zuciya, amai, raunin gaba ɗaya.

- Tsarin jini: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- Burin marrow na kashi yana nuna koma baya.

- Janairu 2, 2021: An kwantar da shi a asibitin mu.

- Tsarin jini: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

Creatinine 134umol/L, mataki na 3 hauhawar jini, tarihin likita na shekaru 4.

- Rarrabawar jini na gefe: 62% sel na farko.

- Immunophenotyping: 28.48% na sel (kwayoyin halitta) suna bayyana CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, wani bangare na bayyana CD123, TTT, kar a bayyana CD10,7 MP1, CD19 , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, yana nuna m primitive B lymphocytes.

- Binciken maye gurbi na jini: TP53 R196P maye gurbi tabbatacce.

Jiyya:

- An karɓi VLP chemotherapy, tare da jiyya don hauhawar jini, raguwar creatinine, da hydration alkalinization.

- Janairu 19: Tsarin jini ya nuna WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Rarraba jini na gefe: Babu ƙwayoyin lymphocytes na farko.

- Halin kasusuwa na kasusuwa: Hypercellularity (V grade), wurare masu mahimmanci na darajar IV, tare da 42% lymphocytes na farko.

- cytometry na gudana: 13.91% na sel suna bayyana CD10, cCD79a, CD38, CD81, CD22, ba sa bayyana CD20, CD34, CD19, mai nuni da ƙwayoyin sel B masu cutarwa.

- Chromosomal karyotype:

- 35,XY,-2,-3,-4,-5,-7,-9,-12,-13,-16,-17,-20[8]/35,XY+X,-2 ,-3,-4,-5,-7,-9,-10,-12,-13,-16,-17,-20[1]/36,XY, add(1)(q42),- 2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].

- Janairu 20: Lymphocytes tattara don CD22-CART al'adar cell.

- Janairu 21: Lumbar huda da aka yi, intrathecal chemotherapy da aka gudanar don hana cutar sankarar bargo ta tsakiya; Binciken ruwa na cerebrospinal bai nuna rashin daidaituwa ba.

- Janairu 22: An karɓi Arac, 6MP, L-ASP chemotherapy, da FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.

- Fabrairu 7 (kafin jiko): ilimin halittar jiki na kasusuwa ya nuna 93% na farko na lymphocytes.

- cytometry na gudana: 76.42% na sel suna bayyana CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, kar a bayyana CD4, CD3, CD13+33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), mai nuni ga ƙwayoyin B masu cutarwa.

- Ci gaban fata da ƙwayar cuta mai laushi tare da zazzabi; inganta bayan maganin rigakafi.

- Fabrairu 9: Autologous CD22-CART jiko cell (5x10^5/kg).

- Abubuwan da ke da alaƙa da CAR-T: CRS 1, zazzabi a ranar 6 tare da Tmax 40 ° C, zazzabi mai sarrafawa a ranar 10; babu neurotoxicity.

- Maris 11: Ƙimar kasusuwan kasusuwa ya nuna cikakkiyar gafarar halittar jiki, cytometry mai gudana ya nuna babu ƙwayoyin cuta na farko.