Ke kala ʻia ʻana o kahi maʻi T-ALL i hoʻihoʻi ʻia me ka Leukemia Pūnaehana Nervous Central Ma hope o ka hoʻomaʻamaʻa CAR-T
ʻO kēia hihia e pili ana i kahi keikikāne 16 makahiki mai Northeast Kina, nona ka huakaʻi me ka maʻi leukemia i piha i nā pilikia mai kona ʻike ʻana i hoʻokahi makahiki i hala.
Ma ka lā 8 o Nowemapa, 2020, ua kipa ʻo Dawei (kahi pseudonym) i kahi haukapila kūloko ma muli o ka ʻoʻoleʻa o ka maka, ka ʻūhū, a me ka waha kekee. Ua ʻike ʻia ʻo ia me ka "leukemia lymphoblastic acute (T-cell type)." Ma hope o hoʻokahi papa induction chemotherapy, ʻaʻole maikaʻi ʻo MRD (maʻi koena liʻiliʻi), a ukali ʻia e ka chemotherapy mau. I loko o kēia manawa, ʻaʻole i hōʻike ʻia nā ʻano like ʻole o ka ʻāʻī ʻana o ka iwi iwi, ka lumbar puncture, a me nā injections intrathecal.
Ma ka lā 6 o Mei, 2021, ua hana ʻia kahi ʻāʻī lumbar me ka injection intrathecal, a ua hōʻoia ʻia ka loiloi cerebrospinal fluid (CSF) i "leukemia ʻōnaehana nerve waena." Ua ukali ʻia kēia e nā papa ʻelua o ka chemotherapy maʻamau. Ma ka lā 1 o Iune, ua hōʻike ʻia kahi puʻupuʻu lumbar me ka nānā ʻana i ka CSF i nā cell i oʻo ʻole. ʻEkolu hou lumbar punctures me intrathecal injections i lawelawe ʻia, me ka hōʻike CSF hope loa e hōʻike ana ʻaʻole nā pūnaewele tumo.
I ka lā 7 o Iulai, ua ʻike ʻo Dawei i ka nalo ʻana o ka ʻike ma kona maka ʻākau, ua hoʻemi ʻia i ka ʻike māmā wale nō. Ma hope o hoʻokahi papa o ka chemotherapy i hoʻoikaika ʻia, ua hoʻi ka ʻike maka ʻākau i ka maʻamau.
Ma ka lā 5 o ʻAukake, ua pōʻino hou ka ʻike maka ʻākau a hiki i ka makapō loa, a pohihihi kona maka hema. Mai ʻAukake 10 a hiki i 13, ua mālama ʻia ʻo ia ma ka lolo holoʻokoʻa a me ka spinal cord radiotherapy (TBI), ka mea i hoʻihoʻi hou i ka ʻike ma kona maka hema, akā ua mau ka maka ʻākau. Ma ka lā 16 o ʻAukake, ua hōʻike ʻia kahi MRI scan o ka lolo i ka hoʻomaikaʻi iki ʻana i ka mānoanoa o ke aʻalolo optic akau a me ka chiasm, me ka hoʻonui ʻia. ʻAʻole ʻike ʻia nā hōʻailona ʻino a i ʻole nā mea hoʻonui i ka parenchyma lolo.
I kēia manawa, ua hoʻomākaukau ka ʻohana no ka hoʻololi ʻana i ka iwi iwi, e kali ana i kahi moe i loko o ke keʻena transplant. ʻO ka mea pōʻino, ua hōʻike ʻia nā hoʻokolohua maʻamau ma mua o ka hoʻololi ʻana i nā pilikia i hiki ʻole ke hoʻololi.
Ma ka lā 30 o ʻAukake, ua hana ʻia kahi ʻoki iwi iwi, e hōʻike ana i ka iwi iwi MRD me nā lymphocytes T ʻaʻole i oʻo ʻole ʻia he 61.1%. Ua hoʻokō pū ʻia kahi puncture lumbar me ka injection intrathecal, e hōʻike ana i ka CSF MRD me 127 mau pūnaewele holoʻokoʻa, nona nā lymphocytes T ʻaʻole i oʻo ʻia he 35.4%, e hōʻike ana i ka hoʻi hou ʻana o ka maʻi leukemia.
Ma ʻAukake 31, 2021, ua hōʻea ʻo Dawei a me kona ʻohana i ka Halemai ʻo Yanda Lu Daopei a ua hoʻokomo ʻia i ka papa ʻelua o ka ʻoihana hematology. Ua hōʻike ʻia nā hoʻokolohua koko komo: WBC 132.91×10^9/L; ʻokoʻa koko ʻokoʻa (morphology): 76.0% pahū. Ua mālama ʻia ka chemotherapy induction no hoʻokahi papa.
Ma hope o ka nānā ʻana i ka lāʻau lapaʻau a Dawei ma mua, ua ʻike maopopo ʻia ʻo kāna T-ALL he refractory / hoʻi hou ʻana a ua komo nā cell tumor i ka lolo, e pili ana i ke aʻalolo optic. Ua hoʻoholo ka hui lapaʻau i alakaʻi ʻia e Kauka Yang Junfang ma ka papa hematology ʻelua ua hoʻokō ʻo Dawei i nā pae hoʻohālike no ke kākau inoa ʻana i ka CD7 CAR-T clinical trial.
Ma ka lā 18 o Kepakemapa, ua hana ʻia kekahi hoʻokolokolo hou: ʻo ka ʻokoʻa koko peripheral (morphology) i hōʻike ʻia he 11.0% pahū. Ua hōʻiliʻili ʻia nā lymphocytes koko ʻaoʻao no ka moʻomeheu cell CD7 CAR-T i ka lā hoʻokahi, a ua holo mālie ke kaʻina hana. Ma hope o ka hōʻiliʻili ʻana, mālama ʻia ka chemotherapy e hoʻomākaukau ai no ka immunotherapy cell CD7 CAR-T.
I ka wā o ka chemotherapy, ua hoʻomāhuahua koke nā pūnana maʻi tumora. Ma ka lā 6 o ʻOkakopa, ua hōʻike ʻia ka ʻokoʻa koko peripheral (morphology) i 54.0% blasts, a ua hoʻoponopono ʻia ka regimen chemotherapy e hōʻemi i ke kaumaha o ke koko. Ma ka lā 8 o ʻOkakopa, ua hōʻike ʻia he 30.50% o ka pahū ʻana o ka iwi iwi iwi; Ua hōʻike ʻo MRD he 17.66% o nā pūnaewele he mau lymphocytes T ʻoi ʻole.
Ma ka la 9 o Okatoba, ua hookomo hou ia na keena CD7 CAR-T. Ma hope o ka hoʻoinu hou ʻana, ua loaʻa i ka mea maʻi ke kuni mau a me ka ʻeha ʻāʻī. Me ka hoʻonui ʻia ʻana o ka mālama ʻana i ka maʻi maʻi, ʻaʻole i mālama maikaʻi ʻia ke kuni, ʻoiai ua emi iki ka ʻeha o ka ʻāʻī.
I ka lā 11 ma hope o ka reinfusion, ua hoʻonui ʻia nā pahū koko peripheral i 54%; i ka lā 12, ua hōʻike ʻia kahi hoʻāʻo koko e piʻi ana i ka 16x10^9/L. Ma ka lā 14 ma hope o ka reinfusion, ua hoʻomohala ka mea maʻi i ka CRS koʻikoʻi, me ka pōʻino o ka myocardial, ka ate a me ka hana kīkī, hypoxemia, haʻahaʻa koko o ka ʻōpū, a me nā convulsions. ʻO nā hōʻailona hōʻeuʻeu a me ke kākoʻo ʻana, me ka hoʻololi ʻana i ka plasma, hoʻomaikaʻi mālie i ka hana o nā kino i hoʻopilikia ʻia, e hoʻopaʻa ana i nā hōʻailona koʻikoʻi o ka mea maʻi.
Ma ʻOkakopa 27, ua loaʻa i ka mea maʻi ka ikaika ʻiʻo 0-grade ma nā lālā haʻahaʻa ʻelua. Ma ka lā 29 o ʻOkakopa (21 mau lā ma hope o ka hoʻihoʻi hou ʻana), ua hoʻololi maikaʻi ʻia kahi hōʻike MRD iwi iwi.
Ma ke kūlana o ke kala piha, ua hoʻoikaika ʻo Dawei i kāna ʻoihana haʻahaʻa me ke kōkua o nā kahu hānai a me ka ʻohana, me ka hoʻihoʻi ʻana i ka ikaika o ka ʻiʻo a hiki i nā papa 5. Ma ka lā 22 o Nowemapa, ua hoʻoneʻe ʻia ʻo ia i ke keʻena hoʻololi no ka hoʻomākaukau ʻana no ka hoʻololi ʻana o ka allogeneic hematopoietic stem cell transplant.
