Leukemia Lymphoblastic Acute (B-ALL)-01

Ua ʻike ʻia me ka maʻi leukemia lymphoblastic B-cell ma Nowemapa 28, 2017.

Hoʻomaʻamaʻa me ka hoʻoponopono VDLP ma mua, e loaʻa ana i ka kala ʻana o ka iwi iwi (ʻaʻole i hōʻike ʻia nā kikoʻī).

Pepeluali 2018: Ua hoʻololi ʻia i ka hoʻoponopono VLCAM. Ua hōʻike ʻia ka cytometry kahe o ka iwi iwi he 60.13% mau pūnaewele B makua ʻole.

Malaki 2018: Ua kākau inoa ʻia i ka hoʻokolohua lapaʻau BiTE. ʻO ke kala kala ʻana i ka iwi iwi, ʻaʻole ʻike ʻia e ka cytometry kahe.

Mei 8, 2018: Loaʻa iā TBI/CY+VP16 ka hoʻoponopono ʻana i ukali ʻia e ka allogeneic stem cell transplant mai ke kaikunāne i hoʻohālikelike piha ʻia (AB+ hāʻawi i ka mea loaʻa A+). ʻO ka hoʻihoʻi ʻana o Neutrophil i ka lā +11, megakaryocyte hoʻihoʻi i ka lā +12.

Kekemapa 5, 2018: Hoʻopau ʻia ke kala ʻana o ka morphological i loko o ka iwi iwi, ʻaʻohe mea ʻino i ʻike ʻia e ka cytometry kahe. Loaʻa i ka hāʻawi lymphocyte infusion (DLI) a me ka mālama prophylactic me dasatinib a me imatinib e pale i ka hoʻi hou ʻana.

Pepeluali 2, 2019: Ua hōʻike ʻo Morphology i ka 6.5% o nā cell immature, flow cytometry i hōʻike i ka 0.08% malignant immature B lymphoblasts. Loaʻa iā DLI therapy. Malaki 28, 2019: Flow cytometry i hōʻike ʻole i nā mea ʻino.

ʻAukake 11, 2019: Hoʻihoʻi hou ʻia ka momona o ka iwi, mālama ʻia me ka dasatinib.

Sepatemaba 2, 2019: Ua hōʻike ʻo Morphology i 3% mau ʻōhua ʻole, ua hōʻike ka cytometry kahe i ka 0.04% mau mea ʻino ʻole. Hoʻomau ka mālama ʻana me ka dasatinib, a ukali ʻia e 2 mau manawa o ka chemotherapy methotrexate.

Mei 11, 2020: Hoʻi hou ka iwi iwi.

Loaʻa iā 2 autologous CD19-CAR-T cell therapies a me 2 allogeneic CD19-CAR-T cell therapy ma 2020, ʻaʻohe mea i loaʻa i ke kala ʻana.

ʻOkakopa 26, 2020: Hoʻokomo ʻia i ko mākou haukapila.

Nā ʻike o ka Laboratory:

Nā hana maʻamau o ke koko: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

ʻO ke koko ʻokoʻa o ke koko ʻokoʻa: 63%

ʻO ke kino o ka iwi: Hypercellular (grade II), 96% lymphoblasts ʻaʻole.

Immunophenotyping: Hōʻike nā pūnaewele CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; hōʻike hapa o CD123. ʻIke ʻia ʻo ia he mau lymphoblast B ʻaʻole oʻo.

ʻO ka hoʻololi ʻana o ke koko koko: ʻino.

Leukemia fusion gene: NUP214-ABL1 fusion gene positive.

Ka nānā 'ana o Chromosome: 46, XX, t(1;9)(p34;p24), ho'ohui(11)(q23)[4]/46, XX, t(1;9)(p34;p24), ho'ohui(11) (q23)x2 [2]/46, XX[3]

Chimerism: He 7.71%.

Lapaʻau:

- VDS, DEX, LASP hoʻoponopono chemotherapy i lawelawe ʻia.

- Nowemapa 20: ʻO ke koko ʻokoʻa ʻē aʻe he 0%.

- ʻOhi o nā lymphocytes koko peripheral autologous no ka moʻomeheu cell CAR-T pālua CD19/22.

- Nowemapa 29: FC regimen chemotherapy (Flu 50mg x 3, CTX 0.4gx 3).

- Kekemapa 2 (ma mua o ka CAR-T cell infusion):

- Ka maʻamau o ke koko: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- Hoʻonaʻauao o ka iwi iwi: Hypercellular (grade IV), 68% lymphoblasts oʻo ʻole.

- Ka helu helu helu o NUP214-ABL1 fusion gene: 24.542%.

- Flow cytometry: 46.31% o nā pūnaewele hōʻike CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, e hōʻike ana i nā lymphoblast B ʻaʻole oʻo.

- Kekemapa 4: Infusion o autologous CD19/22 pālua CAR-T (3 x 10^5/kg).

- Nā hopena pili pili i ka CAR-T: Papa 1 CRS, ke kuni ma ka lā 6 me ka Tmax o 40°C, mālama ʻia ke kuni e ka lā 10. ʻAʻohe neurotoxicity i ʻike ʻia.

- Kekemapa 22 (La 18 loiloi): Morphological piha kala ʻia i loko o ka iwi iwi, ʻaʻohe kino ʻino ʻole i ʻike ʻia e ka cytometry kahe. Ka helu helu o NUP214-ABL1 fusion gene: 0%.