Yafewar T-ALL Mara lafiya mai Ciwon Jijiya na Tsakiyar Jijiya Ciwon daji Bayan Jiyya na CAR-T
Wannan shari'ar ta shafi wani yaro dan shekara 16 daga Arewa maso Gabashin kasar Sin, wanda tafiyarsa da cutar sankarar bargo ke cike da kalubale tun bayan da aka gano shi sama da shekara guda da ta wuce.
A ranar 8 ga Nuwamba, 2020, Dawei (wani mai suna) ya ziyarci wani asibiti na gida saboda taurin fuska, kurji, da murguɗin baki. An gano shi da "m cutar sankarar bargo ta lymphoblastic (nau'in T-cell)." Bayan kwas ɗin ilimin chemotherapy guda ɗaya, MRD (ƙananan cutar saura) ba ta da kyau, sannan chemotherapy na yau da kullun. A wannan lokacin, huda kasusuwan kasusuwa, huda lumbar, da alluran intrathecal ba su nuna rashin daidaituwa ba.
A ranar 6 ga Mayu, 2021, an yi huda lumbar tare da allurar intrathecal, kuma bincike na ruwa na cerebrospinal (CSF) ya tabbatar da "cutar jini ta tsakiya." Wannan ya biyo bayan darussa biyu na chemotherapy na yau da kullun. Ranar 1 ga Yuni, wani nau'i na lumbar tare da bincike na CSF ya nuna sel marasa girma. An yi amfani da ƙarin ƙwayoyin lumbar guda uku tare da alluran intrathecal, tare da gwajin CSF na ƙarshe da ya nuna babu ƙwayoyin ƙwayar cuta.
A ranar 7 ga Yuli, Dawei ya sami hasarar hangen nesa a idonsa na dama, ya rage zuwa hasashe kawai. Bayan kwas guda ɗaya na haɓakar chemotherapy, ganin idonsa na dama ya dawo daidai.
A ranar 5 ga Agusta, ganin idonsa na dama ya sake lalacewa, wanda ya haifar da makanta gaba daya, kuma idonsa na hagu ya zama blush. Daga ranar 10 zuwa 13 ga watan Agusta, an yi masa tiyatar kwakwalwar gaba daya da kuma kashin baya (TBI), wanda ya dawo da hangen nesa a idonsa na hagu, amma idon dama ya kasance makaho. A ranar 16 ga Agusta, wani hoton MRI na kwakwalwa ya nuna ɗan ingantawa a cikin kauri na jijiyar gani na dama da chiasm, tare da haɓakawa. Ba a sami sigina ko haɓakawa mara kyau ba a cikin ɓarnawar ƙwaƙwalwa.
A wannan lokacin, dangi sun shirya don dashen kasusuwa, suna jiran gado ne kawai a cikin sashin dashen. Abin takaici, gwaje-gwaje na yau da kullun kafin dasa shuki sun nuna al'amuran da suka sa dashen ba zai yiwu ba.
A ranar 30 ga Agusta, an yi huda gabobin kasusuwa, wanda ke nuna MRD na kasusuwa tare da ƙarancin T lymphocytes waɗanda ba su da girma na 61.1%. An kuma yi huda lumbar tare da allurar intrathecal, yana nuna CSF MRD tare da jimillar sel guda 127, wanda ƙananan ƙwayoyin T lymphocytes marasa balagagge sun ƙunshi 35.4%, yana nuna cikakkiyar koma baya na cutar sankarar bargo.
A ranar 31 ga Agusta, 2021, Dawei da iyalinsa sun isa Asibitin Yanda Lu Daopei kuma an kwantar da su a sashi na biyu na sashen nazarin jini. Gwaje-gwajen jinin shiga sun nuna: WBC 132.91×10^9/L; bambancin jini na gefe (kwayoyin halittar jiki): 76.0% fashewa. An gudanar da chemotherapy induction na kwas ɗaya.
Bayan nazarin maganin Dawei na baya, ya bayyana a fili cewa T-ALL ya kasance mai juyayi / sake dawowa kuma cewa ƙwayoyin tumo sun shiga cikin kwakwalwa, suna shafar jijiyar gani. Tawagar likitocin da Dokta Yang Junfang ya jagoranta a sashin nazarin jini na biyu sun tabbatar da cewa Dawei ya cika ka'idojin shiga cikin gwajin asibiti na CD7 CAR-T.
A ranar 18 ga Satumba, an sake yin wani gwajin: bambancin jini na gefe (kwayoyin halittar jiki) ya nuna fashewar 11.0%. An tattara ƙwayoyin lymphocytes na jini na gefe don al'adun sel na CD7 CAR-T a wannan rana, kuma tsarin ya tafi lafiya. Bayan tattarawa, an gudanar da chemotherapy don shirya don CD7 CAR-T immunotherapy.
A lokacin chemotherapy, ƙwayoyin tumo sun yaɗu da sauri. A ranar 6 ga Oktoba, bambance-bambancen jini na gefe (kwayoyin halittar jiki) ya nuna fashewar 54.0%, kuma an daidaita tsarin ilimin chemotherapy don rage nauyin ƙari. A ranar 8 ga Oktoba, nazarin ilimin halittar jini na kasusuwa ya nuna 30.50% fashewa; MRD ya nuna cewa 17.66% na sel sun kasance marasa girma T lymphocytes.
A ranar 9 ga Oktoba, an sake shigar da ƙwayoyin CD7 CAR-T. Bayan sake dawowa, majiyyacin ya sami maimaituwar zazzabi da ciwon danko. Duk da ingantaccen maganin rigakafin cutar, zazzabin ba a iya sarrafa shi sosai ba, kodayake ciwon ƙoƙon yana raguwa a hankali.
A rana ta 11 bayan sake dawowa, fashewar jini na gefe ya karu zuwa 54%; A rana ta 12th, gwajin jini ya nuna farin jinin da ke tashi zuwa 16×10^9/L. A ranar 14th bayan sake dawowa, mai haƙuri ya ci gaba da CRS mai tsanani, ciki har da lalacewa ta zuciya, hanta da rashin aikin koda, hypoxemia, ƙananan jini na gastrointestinal, da maƙarƙashiya. Ƙunƙarar bayyanar cututtuka da jiyya na tallafi, tare da musayar jini, sannu a hankali ya inganta aikin gabobin da abin ya shafa, yana tabbatar da alamun masu haƙuri.
A ranar 27 ga Oktoba, mai haƙuri yana da ƙarfin tsoka na 0-grade a cikin ƙananan ƙafafu biyu. A ranar 29 ga Oktoba (kwanaki 21 bayan sake dawowa), gwajin MRD na kasusuwa ya juya mara kyau.
A cikin cikakkiyar gafara, Dawei ya ƙarfafa aikinsa na ƙasa tare da taimakon ma'aikatan jinya da iyali, a hankali ya dawo da ƙarfin tsoka zuwa maki 5. A ranar 22 ga Nuwamba, an canza shi zuwa sashin dashen shuka don shirya don dashen kwayar halitta na allogeneic hematopoietic stem cell.
