Leukemia Lymphoblastic Acute (B-ALL)-03

Nā hiʻohiʻona:

- Ua ʻike ʻia me ka maʻi leukemia lymphoblastic B-cell ma ka hopena o Mei 2020.

- Nā hana maʻamau o ke koko: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- Hoʻololi i ka iwi iwi: Hypocellular me 67% primitive lymphocytes.

- Kahea cytometry: 82.28% o nā pūnaewele hōʻike CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, hōʻike hapa CD9, hōʻike nāwaliwali iā CD13.

- ʻAʻole ka nānā ʻana i nā gene Fusion; WT1 57.3%; ʻaʻole i ʻike ʻia nā genes fusion pili i PH-like ALL.

- IʻA: TP53 hoʻololi maikaʻi.

- Nā 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].

- Loaʻa iā VCDLP regimen no 2 mau papa me ke kala ʻole.

- CAM-VL regimen (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) ma Iulai 22, 2020, ʻaʻohe kala ʻia.

- ʻO ka cytometry kahe o ka iwi ma ka lā 25 o Kepakemapa, 2020: 7.35% o nā cell e hōʻike nei i ka CD81, CD19, CD10, CD38, CD33, hōʻike nāwaliwali iā CD20, CD45.

- Ka hoʻololi ʻana o ke koko koko: TP53 hoʻololi.

- Nā Chromosomes: 46, XY[20].

- Hoʻomaka ka lāʻau lapaʻau CD19-CART.

- FC regimen (FLU 62.7mg x 4 lā, CTX 1045mg x 2 lā) chemotherapy.

- ʻOkakopa 1, 2020: Autologous CD19-CART cell infusion ma 4.7x10^7/kg.

- CRS papa 2 me ka papa 1 neurotoxicity, hoʻomaikaʻi ma hope o ke kākoʻo ʻana.

- ʻOkakopa 29, 2020: Hoʻopau i ke kala ʻana i ka morphology o ka iwi iwi, ʻaʻohe mea maʻi maʻi mua ma ka cytometry kahe.

- Kekemapa 31, 2020: Ka ʻū maloʻo, nausea, luaʻi, nāwaliwali ākea.

- Nā hana maʻamau o ke koko: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- ʻO ka manaʻo o ka iwi iwi e hōʻike ana i ka hoʻi hou ʻana.

- Ianuali 2, 2021: Hoʻokomo ʻia i ko mākou haukapila.

- Nā hana maʻamau o ke koko: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

- Creatinine 134umol/L, pae 3 hypertension, moʻolelo olakino o 4 mau makahiki.

- Ka hoʻokaʻawale ʻana o ke koko ʻaoʻao: 62% nā pūnaewele kahiko.

- Immunophenotyping: 28.48% o nā pūnaewele (nucleated cell) hōʻike CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, hōʻike hapa CD123, TDT, mai hōʻike CD34, CD19, MPO, CD19, MPO , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, e hōʻike ana i nā lymphocytes B primitive malignant.

- Ka nānā 'ana i ka ho'ololi 'ana o ke koko: TP53 R196P maika'i.

Lapaʻau:

- Loaʻa iā VLP chemotherapy, me ka mālama ʻana no ka hypertension, ka hoʻemi ʻana o ka creatinine, a me ka hydration alkalinization.

- Ianuali 19: Hōʻike ʻia ke koko maʻamau WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Hoʻokaʻawale koko ʻaoʻao: ʻAʻohe lymphocytes primitive.

- Ka moʻo o ka iwi iwi: Hypercellularity (V grade), nā wahi kiko o ka IV grade, me 42% primitive lymphocytes.

- Flow cytometry: 13.91% o nā pūnaewele hōʻike CD10, cCD79a, CD38, CD81, CD22, ʻaʻole hōʻike CD20, CD34, CD19, hōʻike i nā pūnaʻi B primitive malignant.

- Karyotype Chromosomal:

- 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,hoʻonui(1)(q42),- 2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].

- Ianuali 20: ʻOhi ʻia nā Lymphocytes no ka moʻomeheu cell CD22-CART.

- Ianuali 21: Hana ʻia ka ʻāʻī lumbar, lawelawe ʻia ka chemotherapy intrathecal no ka pale ʻana i ka maʻi leukemia ʻōnaehana waena; ʻAʻole i hōʻike ʻia ka ʻike ʻole o ka wai cerebrospinal.

- Ianuali 22: Loaʻa iā Arac, 6MP, L-ASP chemotherapy, a me FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.

- Fepeluali 7 (ma mua o ka infusion): Ua hōʻike ʻia ka morphology o ka iwi i ka 93% o nā lymphocytes primitive.

- Flow cytometry: 76.42% o nā pūnaewele hōʻike CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, ʻaʻole hōʻike CD4, CD3, CD13+33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), e hōʻike ana i ka maʻi kino kino kino B.

- Hoʻoulu ʻia ka ʻili a me ka ʻiʻo palupalu me ke kuni; hoʻomaikaʻi ʻia ma hope o ka mālama ʻana i ka antibiotic.

- Feberuari 9: Autologous CD22-CART cell infusion (5x10^5/kg).

- Nā hopena pili pili i ka CAR-T: CRS grade 1, ke kuni ma ka lā 6 me ka Tmax 40°C, ka mahana wela i ka lā 10; ʻaʻohe neurotoxicity.

- Malaki 11: Ua hōʻike ʻia ka loiloi ʻana o ka iwi iwi i ke kala ʻana o ke kino, ʻaʻole i hōʻike ʻia ke kahe o ka cytometry.