Mob Lymphoblastic Leukemia (T-ALL)-02

Clinical Nta:

- Kev kuaj mob: Mob T-cell lymphoblastic leukemia

- Pib: Lub Peb Hlis 2018

- Cov tsos mob pib: Ntau cov qog nqaij hlav qog nqaij hlav loj thoob plaws lub cev

- Cov ntshav thawj zaug: WBC: 39.46 * 10^9 / L, Hb: 129g / L, PLT: 77 * 10^9 / L

- Pob txha morphology: 92% blasts

-Flow cytometry: 95.3% cov hlwb txawv txav qhia

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

- Fusion noob: Tsis zoo

- Gene mutation: NOTCH1 noob mutation kuaj pom

- Kev tsom xam chromosome: Ib txwm karyotype

Kev Kho Mob Keeb Kwm:

- Plaub Hlis 3, 2018: Induction therapy nrog VDCP regimen

- Plaub Hlis 18, 2018: Pob txha pob txha tawg muaj 96%

- Lub Plaub Hlis 20, 2018: Tau txais kev tso cai tom qab CAG txoj cai

- Tsib Hlis 18, 2018: Kev sib koom ua ke nrog CMG + VP txoj cai

- Lub Rau Hli 22, 2018: Cov pob txha pob txha tawg tau nce mus rau 40%, rov ua dua ntawm leukemia

- Lub Xya hli ntuj 25, 2018: CLAM regimen (clarithromycin + cyclophosphamide + amikacin)

- Hematopoietic stem cell transplantation los ntawm HLA-matched nus muag siv FLU + BU txias rau lub Yim Hli 14

- Kev soj ntsuam tom qab hloov pauv: Kev tshem tawm cov pob txha pob txha morphology ntawm 1 hli, 3 hlis, 6 hli, 9 hli, thiab 11 hli

- Cov pob txha pob txha morphology pom kev tso tawm ntawm 16 lub hlis tom qab hloov pauv, nrog kev ntws cytometry nthuav tawm 0.02% malignant lymphocytes tsis paub qab hau.

- Kaum Ib Hlis 13, 2020: Peripheral ntshav chimerism los ntawm qhov chaw pub dawb yog 97.9%

- Peripheral ntshav primitive cells: 20%

- Kaum Ob Hlis 18, 2020: Pob txha pob txha morphology: 60.6% blasts

- Flow cytometry: 30.85% malignant tsis paub tab T lymphocytes

- Kev tshuaj ntsuam chromosome: 46, XY (20)

- Tau txais DA regimen chemotherapy thaum Lub Ib Hlis 19, 2021

- Pob txha pob txha morphology thaum Lub Ib Hlis 19, 2021: Qib III hyperplasia, 16% blasts

- Chromosome karyotype tsom xam: 46, XY (20)

- Flow cytometry: 7.27% ntawm cov hlwb (ntawm cov hlwb nuclear) qhia CD99bri, CD13, CD38, cbcl-2, cCD3, HLA-ABC bri, CD7bri, thiab ib feem qhia CD5dim, qhia tias malignant tsis paub tab T lymphocytes

- Leukemia fusion noob tshuaj ntsuam xyuas: Tsis zoo

- Ntshav qog hloov pauv (86 hom):

1. PHF6 K299Efs*13 mutation positive

2. RUNX1 S322* mutation positive

3. FBXW7 E471G kev hloov pauv zoo

4. JAK3 M511I kev hloov pauv zoo

5. NOTCH1 Q2393 * kev hloov pauv zoo

Kev kho mob:

- Lub Ib Hlis 22: Sau thiab kab lis kev cai ntawm autologous peripheral ntshav lymphocytes rau CD7-CART

- Ua ntej CD7-CART infusion, tus neeg mob tau txais VLP (vincristine, l-asparaginase, prednisone) ntxiv rau bortezomib chemotherapy.

- Lub Ob Hlis 3: FC txoj kev siv tshuaj khomob (Flu 50mg rau 3 hnub + CTX 0.45g rau 3 hnub)

- Lub Ob Hlis 5 (pre-infusion): Pob txha pob txha morphology pom 23% blasts.

- Flow cytometry tau nthuav tawm 4.05% hlwb qhia CD99bri, CD5dim, CD7bri, TDT, cCD3, qhia tias tsis paub tab T lymphocytes.

- Kev tshuaj ntsuam chromosome: 46, XY (20)

- Chimerism tsom xam (post-HSCT): Cov hlwb pub dawb suav txog 52.19%.

- Lub Ob Hlis 7: Infusion ntawm autologous CD7-CART hlwb ntawm ib koob ntawm 5 * 10^5 / kg.

- Lub Ob Hlis 15: Peripheral cov ntshav tsis paub qab hau txo mus rau 2%.

- Lub Ob Hlis 19 (Hnub 12 tom qab txhaj tshuaj): Tus neeg mob tau ua npaws, uas kav ntev li 5 hnub ua ntej tswj qhov kub thiab txias.

- Lub Peb Hlis 2: Kev ntsuam xyuas pob txha pob txha pom tau tias ua tiav morphological tshem tawm, nrog cov cytometry ntws tsis pom cov hlwb tsis paub tab.