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

Siffofin asibiti:

- Ganewa: T-cell lymphoblastic lymphoma/ cutar sankarar bargo

- Maris 2020: An gabatar da shi tare da tari na paroxysmal da taro na mediastinal, an tabbatar da lymphoma na lymphoblastic T-cell ta hanyar biopsy na tsakiya.

- An karɓi kewayon 8 na chemotherapy da sama da zaman 20 na radiotherapy, wanda ya haifar da raguwa mai yawa na matsakaicin matsakaici.

- Janairu 16, 2021: Raɗaɗɗen ciwo a ƙananan ƙafar dama.

- Tsarin jini: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- Kwayoyin halittar kasusuwa: 95.5% na farko na lymphoblast.

- cytometry kwararar kasusuwa: 91.77% na sel sun kasance marasa girma T-cell lymphoblasts.

- Tsarin kwayoyin halitta: An gano maye gurbi a cikin kwayoyin NOTCH1, IL7R, ASXL2.

- An karɓi tsarin Hyper-CVAD/B, tsarin ESHAP daga baya, duka ba su da tasiri tare da zazzabi mai tsayi.

- Fabrairu 18, 2021: An kwantar da shi a asibitin mu.

- An gabatar da zazzabi, CT kirji ya nuna ciwon huhu.

- Tsarin jini: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Kwayoyin jini marasa girma: 90%

- Kwayoyin halittar kasusuwa: Hypercellular (IV grade), 85% na farko na lymphoblast.

- Immunophenotyping: 87.27% na sel sun kasance m primitive T-cell lymphoblasts.

- Binciken Chromosomal: 46,XX [24]; ƙarin nau'ikan karyotypes mara kyau guda uku da aka lura.

- Halittu masu canzawa:

1. IL7R T244_I245insARCPL maye gurbi tabbatacce

2. NOTCH1 E1583_Q1584 maye gurbi tabbatacce

3. ASXL2 Q602R maye gurbi tabbatacce

- Binciken kwayar cutar sankarar bargo: Rarrabe

- Sakamako na PET/CT: Babu wani mahimmancin ƙwayar ƙwayar cuta ta hypermetabolic a cikin duka kwarangwal da kasusuwan kasusuwa.

Jiyya:

- An fara maganin chemotherapy na VP, dalla-dalla kamar haka: Vincristine (VDS) 3mg sau ɗaya, Dexamethasone (Dex) 7mg kowane awanni 12 na kwanaki 9, tare da maganin rigakafi.

- Maris 1: Kwayoyin da ba su girma na jini sun ragu zuwa 7%.

- Maris 4: Tattara ƙwayoyin lymphocytes masu ƙarfi don al'adar tantanin halitta CD7-CAR T.

- Maris 8: An fara tsarin VLP tare da maganin Sida benzamine.

- Maris 14: An karɓi maganin chemotherapy na FC (Fludarabine 0.35g na kwanaki 3, Cyclophosphamide 45mg na kwanaki 3).

- Maris 17 (jiko kafin tantanin halitta):

- Kashi ragowar immunophenotyping: 15.14% Kwayoyin bayyana CD7 mai haske, CD3 dim, cytoplasmic CD3, T cell receptor restricted delta (TCRrd), bayanin bangare na CD99, yana nuna m primitive T Kwayoyin.

- Maris 19: Kwayoyin CD7-CAR T da aka haɗa (1 x 10^6/kg).

- CAR-T illa masu alaƙa: Grade 1 CRS (zazzabi), babu neurotoxicity.

- Afrilu 6 (Ranar 17): Halittar kasusuwa na kasusuwa ya nuna gafara, cytometry mai gudana bai gano kwayoyin halitta na farko ba.