Mob Lymphoblastic Leukemia (B-ALL)-02

Cov yam ntxwv ntawm Case:

- Tsib Hlis 19, 2019: kuaj pom muaj mob B-cell lymphoblastic leukemia (B-ALL)

- nthuav tawm nrog ntau cov tawv taub hau thiab lymphadenopathy

- Cov ntshav niaj hnub: WBC 13.3 x 10^9 / L, HGB 94 g / L, PLT 333 x 10^9 / L, lymphocytes txawv txav 4%

- Pob txha morphology: 80.2% lymphoblasts tsis paub qab hau (blasts)

- Immunophenotyping: 74.19% ntawm cov hlwb yog malignant B-lineage precursor hlwb qhia CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, ib feem qhia cIgM. Kev kuaj mob: B-ALL (Pre-B theem)

- Fusion noob: MLL-ENL zoo, Philadelphia chromosome-zoo li (Ph-like) tshuaj ntsuam tsis zoo

- Chromosome: 46, XX, t(11; 19)(q23; p13), del(20)(q12) [3]/46, XX [7]

- VDLD txoj kev siv tshuaj khomob pib ua tiav kev tiv thaiv kab mob tom qab 1 lub hlis, MLL-ENL quantitative PCR 0.026%

- Kev siv tshuaj kho mob txuas ntxiv raws li cov txheej txheem menyuam yaus, MLL-ENL quantitative PCR 0 tom qab lub voj voog thib 4. Cov kws khomob ntxiv txuas ntxiv mus.

- Lub Peb Hlis 2020: Pob txha pob txha tiv thaiv kab mob seem 0.35%, MLL-ENL quantitative PCR 0.53%, qhia txog kev rov qab los. Tsev neeg tsis kam hloov. Txuas ntxiv chemotherapy rau 3 lub voj voog.

- Lub Xya Hli 2020: Cov pob txha pob txha rov qab ua tiav.

- Kaum Ib Hlis 11, 2020: Intrathecal chemotherapy, CSF immunological residual kab mob 66%, kuaj mob hauv nruab nrab paj hlwb leukemia. Intrathecal chemotherapy rov ua dua ob zaug, CSF hloov tsis zoo.

- Lub Kaum Ob Hlis 31, 2020: Nkag mus rau peb lub tsev kho mob.

- Cov ntshav niaj hnub: WBC 3.99 x 10^9 / L, HGB 66 g / L, PLT 57 x 10^9 / L

- Peripheral ntshav blast suav suav: 69%

- Pob txha pob txha morphology: 90% tsis paub qab hau lymphoblasts (blasts)

- Immunophenotyping: 84.07% ntawm cov hlwb qhia CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, ib feem nthuav qhia CD24, CD15dim, qhia tias malignant B lymphoblasts.

- Fusion noob: MLL-ENL fusion noob zoo, ntau PCR 44.419%

- Kev hloov caj ces: KMT2D kev hloov pauv zoo (kab mob keeb kwm)

- Chromosome karyotype: 46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3), add( 14)(q34), -17, +mar [7]/46, idm, t(3; 16)(p21; p13.3) [1]/46, XX [13]

- PET-CT: Diffuse metabolic nce nyob rau hauv tag nrho cov pob txha pob txha thiab pob txha kab noj hniav, siab suspicion ntawm leukemia rov tshwm sim; splenomegaly nrog nce metabolism, tej zaum yuav muaj leukemia.

- Ua lumbar puncture thiab intrathecal chemotherapy ib zaug, tsis muaj qhov txawv txav nyob rau hauv cov kev ntsuam xyuas txog CSF.

Kev kho mob:

- Ob lub lis piam ntawm VLP chemotherapy, peripheral ntshav blasts 5% thaum Lub Ib Hlis 18.

- Lub Ib Hlis 25: Cov ntshav peripheral blasts 91%, kho nrog CTX, Ara-C, 6-MP chemotherapy.

- Lub Ob Hlis 3: Peripheral ntshav blasts 22%.

- Lub Ob Hlis 4: Sau ntawm 50ml autologous peripheral ntshav rau CD19-CART cell kab lis kev cai.

- MTX 1g, FC chemotherapy (Flu 15mg txhua hnub x 3 hnub, CTX 0.12g txhua hnub x 3 hnub).

- Lub Ob Hlis 13 (pre-infusion): Pob txha pob txha morphology qhia 87.5% blasts, ntws cytometry qhia 79.4% malignant blasts.

- MLL-ENL fusion gene quantitative tsom xam: 42.639%.

- Lub Ob Hlis 14: Infusion ntawm CART hlwb ntawm ib koob ntawm 5 x 10^5 / kg.

- CAR-T-txog cov teebmeem tsis zoo: Qib 1 CRS (ua npaws), tsis muaj tshuaj lom.

- Hnub 20 tom qab txhaj tshuaj: Cov ntshav smear qhia cov qog nqaij hlav, CART cell feem 0.07%.

- Kev kho mob CART cell tsis zoo.

- Lub Peb Hlis 8, 2021: Ntshav niaj hnub: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- Peripheral ntshav blasts: 83%. Autologous peripheral ntshav sau 60ml rau CD19 / CD22 dual CART cell kab lis kev cai.

- Kho nrog cytarabine thiab dexamethasone los tswj cov qog nqaij hlav.

- Lub Peb Hlis 18: FC chemotherapy (Flu 15mg txhua hnub x 3 hnub, CTX 0.12g txhua hnub x 3 hnub).

- Lub Peb Hlis 22 (pre-infusion): Cov ntshav niaj hnub: WBC 0.42 x 10^9 / L, HGB 93.70g / L, PLT 33.6 x 10^9 / L. Peripheral ntshav morphology: 6% blasts.

- Pob txha morphology: 91% blasts. Residual nyob rau hauv cov pob txha: 88.61% hlwb qhia CD38, CD19, cCD79a, CD81, CD22, qhia malignant B lymphoblasts.

- MLL-ENL fusion gene quantitative tsom xam: 62.894%.

- Chromosome karyotype analysis: 46, XX, del(1)(p36.1), del(11)(q13), t(11;19)(q23;p13.3), add(14)(q34), - 17, +mar [2]/46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3) ), ntxiv(14)(q34).

- Lub Peb Hlis 23: Infusion ntawm CART hlwb ntawm ib koob ntawm 3 x 10^5 / kg.

- Lub Peb Hlis 26 tom ntej: Ua npaws kub siab thiab tom qab tsim cov kab mob edema.

- Lub Peb Hlis 29: Peripheral ntshav morphology: 92% blasts; nce transaminases thiab bilirubin.

- Lub Plaub Hlis 2: Pib ntawm qaug dab peg, kho nrog diazepam.

- Lub Plaub Hlis 2 (Hnub 10): Pib kho methylprednisolone rau 3 hnub.

- CRS cov tshuaj tiv thaiv: Qib 3, CRES: Qib 3.

- Lub Plaub Hlis 8 (Hnub 16): Kev ntsuam xyuas pob txha pob txha qhia tau hais tias ua tiav morphological tshem tawm, ntws cytometry tsis zoo rau cov kab mob phem; MLL-ENL fusion gene quantitative tsom xam: 0.