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Txoj Kev Kho Mob Tshiab Muaj Kev Cia Siab Tshiab rau Sickle Cell thiab Thalassemia Cov Neeg Mob

FUCASO: Tus Revolutionary Tag Nrho-Human BCMA CAR-T Kev Kho Mob nrog Kev Ua Tau Zoo thiab Kev Nyab Xeeb

Ocular melanoma (thaum pib), ua raws li metastatic daim siab qog-02

Advanced theem IV mob qog noj ntshav-01

Qib siab qog nqaij hlav cancer nrog ntau cov pob txha metastases-05

Mob Lymphoblastic Leukemia (B-ALL)-03

Tus neeg mob: Mr. Lu

Poj niam txiv neej: Txiv neej

Hnub nyoog:39 xyoo

Haiv neeg: Suav

Kev kuaj mob: Mob Lymphoblastic Leukemia (B-ALL)

Tiv tauj peb

Case Features:

- kuaj pom tias mob B-cell lymphoblastic leukemia thaum kawg lub Tsib Hlis 2020.

- Cov ntshav niaj hnub: WBC 5.14x10^9 / L, HGB 101.60g / L, PLT 6x10^9 / L.

- Pob txha pob txha morphology: Hypocellular nrog 67% primitive lymphocytes.

- Flow cytometry: 82.28% ntawm cov hlwb qhia CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, ib feem qhia CD9, tsis muaj zog qhia CD13.

- Fusion noob tshuaj ntsuam tsis zoo; WT1 57.3%; tsis muaj PH-zoo li ALL-related fusion noob kuaj pom.

- FISH: TP53 kev hloov pauv zoo.

- 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].

- Tau txais VCDLP txoj cai rau 2 chav kawm yam tsis muaj kev zam txim.

- CAM-VL regimen (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) thaum Lub Xya Hli 22, 2020, tseem tsis tau tso cai.

- Pob txha pob txha ntws cytometry thaum lub Cuaj Hlis 25, 2020: 7.35% ntawm cov hlwb qhia CD81, CD19, CD10, CD38, CD33, tsis muaj zog qhia CD20, CD45.

- Ntshav qog mutation tsom xam: TP53 kev hloov pauv.

- Chromosomes: 46, XY[20].

- Pib kho CD19-CART.

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

- Lub Kaum Hli 1, 2020: Autologous CD19-CART cell infusion ntawm 4.7x10^7 / kg.

- CRS qib 2 nrog qib 1 neurotoxicity, txhim kho tom qab kev pab txhawb nqa.

- Lub Kaum Hli 29, 2020: Ua kom tiav kev tshem tawm hauv cov pob txha pob txha morphology, tsis muaj cov qog nqaij hlav hauv nruab nrab ntawm cov cytometry ntws.

- Kaum Ob Hlis 31, 2020: hnoos qhuav, xeev siab, ntuav, tsis muaj zog.

- Cov ntshav niaj hnub: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- Cov pob txha pob txha aspiration qhia txog kev rov qab los.

- Lub Ib Hlis 2, 2021: Tau txais peb lub tsev kho mob.

- Cov ntshav niaj hnub: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

- Creatinine 134umol / L, theem 3 mob ntshav siab, keeb kwm kho mob ntawm 4 xyoos.

- Kev faib cov ntshav peripheral: 62% cov hlwb qub.

- Immunophenotyping: 28.48% ntawm cov hlwb (cov hlwb nucleated) qhia CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, ib feem qhia CD123, TDT, tsis qhia CD37 MPO, CD11, , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, qhia txog malignant primitive B lymphocytes.

- Ntshav qog hloov pauv: TP53 R196P kev hloov pauv zoo.

Kev kho mob:

- Tau txais VLP chemotherapy, nrog rau kev kho mob ntshav siab, creatinine txo, thiab hydration alkalinization.

- Lub Ib Hlis 19: Cov ntshav niaj hnub pom WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Kev faib cov ntshav peripheral: Tsis muaj cov lymphocytes primitive.

- Pob txha pob txha morphology: Hypercellularity (V qib), focal thaj tsam ntawm qib IV, nrog 42% primitive lymphocytes.

- Flow cytometry: 13.91% ntawm cov hlwb qhia CD10, cCD79a, CD38, CD81, CD22, tsis txhob qhia CD20, CD34, CD19, qhia txog malignant primitive B hlwb.

- Chromosomal karyotype:

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

- Lub Ib Hlis 20: Lymphocytes sau rau CD22-CART kab lis kev cai ntawm tes.

- Lub ib hlis ntuj 21: Lumbar puncture ua, intrathecal chemotherapy tswj los tiv thaiv central paj hlwb leukemia; Kev kuaj ntshav cerebrospinal tsis pom muaj qhov txawv txav.

- Lub Ib Hlis 22: Tau txais Arac, 6MP, L-ASP chemotherapy, thiab FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.

- Lub Ob Hlis 7 (ua ntej infusion): Pob txha pob txha morphology pom 93% primitive lymphocytes.

- Flow cytometry: 76.42% ntawm cov hlwb qhia CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, tsis qhia CD4, CD3, CD13 + 33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), qhia txog malignant primitive B hlwb.

- txhim kho daim tawv nqaij thiab cov nqaij mos kab mob ua npaws; txhim kho tom qab kev kho mob tshuaj tua kab mob.

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

- CAR-T-kev mob tshwm sim: CRS qib 1, kub taub hau rau Hnub 6 nrog Tmax 40 ° C, tswj kub rau Hnub 10; tsis muaj neurotoxicity.

- Lub Peb Hlis 11: Kev ntsuam xyuas pob txha pob txha pom tau tias ua tiav morphological tshem tawm, ntws cytometry tsis pom muaj cov kab mob loj heev.