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

Siffofin asibiti:

- Ganewa: Cutar sankarar bargo ta T-cell lymphoblastic

- Farawa: A ƙarshen Maris 2018

- Alamomin farko: Ƙirar kumburin ƙwayar ƙwayar cuta da yawa a cikin jiki

- Tsarin jini na farko: WBC: 39.46*10^9/L, Hb: 129g/L, PLT: 77*10^9/L

- Kwayoyin halittar kasusuwa: 92% fashewa

-Flow cytometry: 95.3% kwayoyin halitta mara kyau suna bayyana

TdT+CD99+CyCD3+CD7stCd5DdimCD4-CD8-mCD3-CD45dim

- Fusion genes: Korau

- maye gurbi: NOTCH1 an gano maye gurbi

- Binciken Chromosome: Karyotype na al'ada

Tarihin Jiyya:

- Afrilu 3, 2018: Jiyya na motsa jiki tare da tsarin VDCP

- Afrilu 18, 2018: fashewar kasusuwa ya ƙunshi kashi 96%

- Afrilu 20, 2018: An sami gafara bayan tsarin CAG

- Mayu 18, 2018: Ƙarfafawa tare da tsarin CMG+VP

- Yuni 22, 2018: Fashewar kasusuwa ya karu zuwa 40%, koma bayan cutar sankarar bargo.

- Yuli 25, 2018: tsarin CLAM (clarithromycin+cyclophosphamide+amikacin)

- Dashen kwayar halitta na Hematopoietic daga HLA-matching sibling ta amfani da FLU + BU conditioning a kan Agusta 14

- Kulawa da dashewa bayan dasawa: Kawar da kasusuwan kasusuwa a cikin wata 1, watanni 3, watanni 6, watanni 9, da watanni 11

- Ilimin halittar jiki na kasusuwa ya nuna gafara a cikin watanni 16 bayan dasawa, tare da cytometry mai gudana yana bayyana 0.02% m lymphocytes marasa girma.

- Nuwamba 13, 2020: Haɗin jini daga tushen mai ba da gudummawa ya kasance 97.9%

- Kwayoyin farko na jini: 20%

- Disamba 18, 2020: Kwayoyin halittar kasusuwa: 60.6% fashewa

- cytometry mai gudana: 30.85% m rashin balagagge T lymphocytes

- Binciken Chromosome: 46, XY (20)

- An karɓi DA tsarin chemotherapy a ranar 19 ga Janairu, 2021

- Kwayoyin halittar kasusuwa a ranar 19 ga Janairu, 2021: hyperplasia na digiri na uku, fashewar 16%

- Binciken karyotype na chromosome: 46, XY (20)

- Cytometry mai gudana: 7.27% na sel (a tsakanin kwayoyin nukiliya) sun bayyana CD99bri, CD13, CD38, cbcl-2, cCD3, HLA-ABC bri, CD7bri, da kuma CD5dim da aka bayyana a wani bangare, yana nuna mummunan T lymphocytes.

- Binciken kwayar cutar sankarar bargo: Rarrabe

- Binciken maye gurbi na jini (nau'i 86):

1. PHF6 K299Efs*13 tabbataccen maye gurbi

2. RUNX1 S322* maye gurbi tabbatacce

3. FBXW7 E471G maye gurbi tabbatacce

4. JAK3 M511I maye gurbi tabbatacce

5. NOTCH1 Q2393* maye gurbi tabbatacce

Jiyya:

- Janairu 22: Tari da al'adun lymphocytes na jini mai sarrafa kansa don CD7-CART

- Kafin jiko CD7-CART, mai haƙuri ya karɓi VLP (vincristine, l-asparaginase, prednisone) da bortezomib chemotherapy.

- Fabrairu 3: FC tsarin chemotherapy (Flu 50mg na kwanaki 3 + CTX 0.45g na kwanaki 3)

- Fabrairu 5 (pre-jiko): Kwayoyin halittar kasusuwa sun nuna fashewar 23%.

- Cytometry na gudana ya bayyana sel 4.05% suna bayyana CD99bri, CD5dim, CD7bri, TDT, cCD3, yana nuna rashin girma T lymphocytes.

- Binciken Chromosome: 46, XY (20)

- Binciken Chimerism (bayan-HSCT): Kwayoyin da aka samu masu bayarwa sun kai 52.19%.

- Fabrairu 7: Jiko na autologous CD7-CART Kwayoyin a kashi na 5*10^5/kg.

- Fabrairu 15: Kwayoyin da ba su girma na jini sun ragu zuwa 2%.

- Fabrairu 19 (Ranar 12 bayan jiko): Mara lafiya ya kamu da zazzaɓi, wanda ya ɗauki kwanaki 5 kafin a sami ikon sarrafa zafin jiki.

- Maris 2: Ƙididdigar ƙwayar kasusuwa ya nuna cikakkiyar gafarar ƙwayoyin cuta, tare da cytometry mai gudana ba tare da gano ƙwayoyin da ba su balaga ba.