Leukemia Lymphoblastic Acute (T-ALL)-02

Nā hiʻohiʻona lapaʻau:

- Hōʻoia: ʻO ka maʻi leukemia lymphoblastic T-cell

- Hoʻomaka: Ka hopena o Malaki 2018

- Nā hōʻailona mua: ʻO ka hoʻonui ʻia ʻana o nā pūni lymph superficial ma ke kino

- Ka hana maʻamau koko mua: WBC: 39.46*10^9/L, Hb: 129g/L, PLT: 77*10^9/L

- ʻO ke kino iwi iwi: 92% pahū

-Flow cytometry: 95.3% hōʻike ʻia nā cell abnormal

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

- Nā genes hui pū: ʻAʻohe

- Hoʻololi Gene: ʻike ʻia ka hoʻololi gene NOTCH1

- Ka nānā 'ana o Chromosome: Karyotype ma'amau

Moʻolelo lapaʻau:

- ʻApelila 3, 2018: Induction therapy me VDCP regimen

- ʻApelila 18, 2018: He 96% ka pahū ʻana o ka iwi.

- ʻApelila 20, 2018: Loaʻa i ke kala ʻana ma hope o ka hoʻoponopono CAG

- Mei 18, 2018: Hoʻohui i ka lāʻau lapaʻau me CMG+VP regimen

- Iune 22, 2018: Ua hoʻonui ʻia ka pahū o ka iwi i 40%, hoʻihoʻi hou i ka maʻi leukemia

- Iulai 25, 2018: Hoʻoponopono CLAM (clarithromycin+cyclophosphamide+amikacin)

- Ka hoʻololi ʻana o ke kaikunāne hemopoietic mai ke kaikunāne i hoʻohālikelike ʻia me ka HLA me ka hoʻohana ʻana i ka hoʻomaʻamaʻa FLU+BU ma ʻAukake 14.

- Ka nānā ʻana ma hope o ka hoʻololi ʻana: kala ʻia o ka iwi iwi ma 1 mahina, 3 mahina, 6 mahina, 9 mahina, a me 11 mahina

- Ua hōʻike ʻia ke kala ʻia ʻana o ka momona o ka iwi ma 16 mau mahina ma hope o ka hoʻololi ʻana, me ka cytometry kahe e hōʻike ana he 0.02% mau lymphocytes makua ʻole.

- Nowemapa 13, 2020: He 97.9% ka chimerism koko peripheral mai ke kumu hāʻawi.

- Nā pūnaewele mua o ke koko pili: 20%

- Kekemapa 18, 2020: ʻO ke kino o ka iwi iwi: 60.6% pahū

- Ke kahe o ka cytometry: 30.85% nā lymphocytes T oo ʻole

- Ka nānā 'ana o Chromosome: 46, XY (20)

- Loaʻa iā DA regimen chemotherapy ma Ianuali 19, 2021

- ʻO ke kino iwi iwi ma Ianuali 19, 2021: Papa III hyperplasia, 16% pahū

- Ka nānā 'ana i ke karyotype Chromosome: 46, XY (20)

- Flow cytometry: 7.27% o nā pūnaewele (ma waena o nā pūnaewele nuklea) i hōʻike ʻia CD99bri, CD13, CD38, cbcl-2, cCD3, HLA-ABC bri, CD7bri, a me CD5dim i hōʻike ʻia, e hōʻike ana i nā lymphocytes T ʻoi loa.

- Ka nānā ʻana i ka maʻi leukemia fusion gene: ʻAʻohe

- Ka nānā ʻana i ka hoʻololi ʻana o ke koko (86 ʻano):

1. PHF6 K299Efs*13 mutation maikai

2. RUNX1 S322* hoʻololi maikaʻi

3. FBXW7 E471G hoʻololi maikaʻi

4. JAK3 M511I hoʻololi maikaʻi

5. NOTCH1 Q2393* hoololi maikai

Lapaʻau:

- Ianuali 22: Ohi a moʻomeheu o nā lymphocytes koko peripheral autologous no CD7-CART

- Ma mua o ka CD7-CART infusion, ua loaʻa i ka mea maʻi ka VLP (vincristine, l-asparaginase, prednisone) me ka bortezomib chemotherapy.

- Pepeluali 3: FC regimen chemotherapy (Flu 50mg no 3 lā + CTX 0.45g no 3 lā)

- Feberuari 5 (pre-infusion): Ua hōʻike ʻia ka morphology o ka iwi iwi i ka 23% pahū.

- Hōʻike ʻia ka cytometry kahe he 4.05% mau keena e hōʻike ana i ka CD99bri, CD5dim, CD7bri, TDT, cCD3, e hōʻike ana i nā lymphocytes T makua ʻole.

- Ka nānā 'ana o Chromosome: 46, XY (20)

- Ka nānā 'ana o Chimerism (post-HSCT): He 52.19%.

- Feberuari 7: Infusion o autologous CD7-CART cell ma ka nui o 5*10^5/kg.

- Feberuari 15: Ua hoʻemi ʻia nā ʻōuli o ke koko ʻokoʻa i 2%.

- Feberuari 19 (La 12 post-infusion): Ua loaʻa ka maʻi i ke kuni, i mau no 5 mau lā ma mua o ka loaʻa ʻana o ka mālama wela.

- Malaki 2: Ua hōʻike ʻia ka loiloi ʻana o ka iwi iwi i ke kala ʻana o ka morphological, me ka flow cytometry ʻaʻole i ʻike i nā cell immature malignant.