Kev tso tawm ntawm tus neeg mob rov qab los ntawm T-ALL Tus Neeg Mob nrog Central Nervous System Leukemia Tom Qab Kev Kho CAR-T
Cov ntaub ntawv no muaj xws li ib tug tub hluas hnub nyoog 16 xyoo los ntawm Northeast Tuam Tshoj, uas nws txoj kev nrog leukemia tau tag nrho ntawm cov teeb meem txij li thaum nws kuaj tau ntau tshaj ib xyoos dhau los.
Thaum Lub Kaum Ib Hlis 8, 2020, Dawei (lub npe hu ua) tau mus xyuas lub tsev kho mob hauv zos vim lub ntsej muag tawv, pob khaus, thiab lub qhov ncauj nkhaus. Nws tau kuaj pom tias "mob lymphoblastic leukemia (T-cell type). Tom qab ib chav kawm induction chemotherapy, MRD (cov kab mob tsawg kawg nkaus) yog qhov tsis zoo, ua raws li kev kho mob tsis tu ncua. Thaum lub sij hawm no, pob txha pob txha puncture, lumbar puncture, thiab intrathecal txhaj tshuaj tsis pom qhov txawv txav.
Thaum Lub Tsib Hlis 6, 2021, kev txhaj tshuaj lumbar nrog kev txhaj tshuaj intrathecal tau ua tiav, thiab kev tshuaj xyuas cov kua dej cerebrospinal (CSF) tau lees paub tias "lub plawv paj hlwb leukemia." Qhov no tau ua raws li ob chav kawm ntawm cov kws khomob tsis tu ncua. Thaum Lub Rau Hli 1, lub lumbar puncture nrog CSF tsom xam pom cov hlwb tsis paub qab hau. Peb ntxiv lumbar punctures nrog intrathecal txhaj tshuaj, nrog rau qhov kawg CSF xeem tsis pom cov qog hlwb.
Thaum Lub Xya Hli 7, Dawei tau ntsib qhov tsis pom kev hauv nws lub qhov muag sab xis, txo qis rau qhov pom kev pom tsuas yog pom. Tom qab ib chav kawm ntawm kev siv tshuaj kho mob hnyav, nws lub qhov muag sab xis rov qab mus rau qhov qub.
Lub Yim Hli 5, nws qhov muag sab xis tsis pom kev zoo dua, ua rau qhov muag tsis pom kev, thiab nws qhov muag sab laug ua qhov muag tsis pom. Txij thaum Lub Yim Hli 10 txog rau 13, nws tau txais kev kho mob hlwb thiab txha caj qaum (TBI), uas tau kho qhov muag ntawm nws sab laug, tab sis qhov muag sab xis tseem tsis pom. Thaum Lub Yim Hli 16, kev kuaj MRI ntawm lub hlwb tau pom tias muaj kev txhim kho me ntsis hauv cov thickening ntawm txoj cai optic paj hlwb thiab chiasm, nrog kev txhim kho pom. Tsis muaj cov cim txawv txav lossis kev txhim kho tau pom nyob rau hauv lub hlwb parenchyma.
Lub sijhawm no, tsev neeg tau npaj rau kev hloov cov pob txha pob txha, tos tsuas yog ib lub txaj hauv pawg hloov pauv. Hmoov tsis zoo, niaj hnub kev kuaj ua ntej hloov pauv tau qhia txog cov teeb meem uas ua rau hloov tsis tau.
Thaum Lub Yim Hli 30, tau ua tiav cov pob txha pob txha, nthuav tawm cov pob txha pob txha MRD nrog qhov txawv txav tsis paub tab T lymphocytes suav txog 61.1%. Ib qho lumbar puncture nrog kev txhaj tshuaj intrathecal kuj tau ua, uas qhia CSF MRD nrog 127 tag nrho cov hlwb, ntawm cov uas txawv txav T lymphocytes suav nrog 35.4%, qhia txog kev rov ua tiav ntawm leukemia.
Thaum Lub Yim Hli 31, 2021, Dawei thiab nws tsev neeg tuaj txog ntawm Yanda Lu Daopei Tsev Kho Mob thiab tau mus rau hauv pawg ntseeg thib ob ntawm lub tuam tsev hematology. Kev kuaj ntshav pom pom: WBC 132.91 × 10^9 / L; peripheral ntshav sib txawv (morphology): 76.0% blasts. Induction chemotherapy tau muab rau ib chav kawm.
Tom qab tshuaj xyuas Dawei cov kev kho mob yav dhau los, nws tau pom tseeb tias nws T-ALL tau rov ua dua / rov ua dua thiab cov qog hlwb tau nkag mus rau lub hlwb, cuam tshuam rau cov paj hlwb. Pawg kws kho mob coj los ntawm Dr. Yang Junfang nyob rau hauv lub thib ob hematology pawg ntseeg tau txiav txim siab tias Dawei ua tau raws li cov txheej txheem rau kev cuv npe hauv CD7 CAR-T kev sim tshuaj.
Thaum lub Cuaj Hlis 18, lwm qhov kev ntsuam xyuas tau ua: peripheral ntshav sib txawv (morphology) pom 11.0% blasts. Peripheral ntshav lymphocytes tau sau rau CD7 CAR-T cell kab lis kev cai nyob rau tib hnub, thiab cov txheej txheem mus zoo. Tom qab sau, tshuaj kho mob tau muab tshuaj los npaj rau CD7 CAR-T cell immunotherapy.
Thaum chemotherapy, cov qog hlwb proliferated sai heev. Thaum Lub Kaum Hli 6, qhov sib txawv ntawm cov ntshav peripheral (morphology) tau pom 54.0% blasts, thiab kev kho tshuaj kho mob tau hloov kho kom txo cov qog nqaij hlav. Thaum Lub Kaum Hli 8, ib qho kev soj ntsuam ntawm cov pob txha pob txha ntawm tes morphology pom 30.50% blasts; MRD qhia tias 17.66% ntawm cov hlwb yog malignant T lymphocytes tsis paub qab hau.
Thaum Lub Kaum Hli 9, CD7 CAR-T hlwb tau rov ua dua. Tom qab reinfusion, tus neeg mob tau rov ua npaws thiab mob pos hniav. Txawm tias muaj kev kho kom zoo los tiv thaiv kab mob, qhov kub taub hau tsis tswj tau zoo, txawm hais tias qhov mob ntawm cov pos hniav maj mam txo qis.
Nyob rau hnub 11th tom qab reinfusion, peripheral ntshav blasts nce mus rau 54%; Hnub tim 12, kev kuaj ntshav pom cov qe ntshav dawb nce mus rau 16 × 10^9 / L. Nyob rau hnub 14th tom qab reinfusion, tus neeg mob tau tsim CRS mob hnyav, suav nrog kev puas tsuaj ntawm myocardial, siab thiab lub raum tsis ua haujlwm, hypoxemia, qis plab hnyuv los ntshav, thiab convulsions. Cov tsos mob hnyav thiab kev txhawb nqa kev kho mob, nrog rau kev sib pauv ntshav plasma, maj mam txhim kho cov haujlwm ntawm lub cev cuam tshuam, ua kom tus neeg mob cov cim tseem ceeb.
Thaum Lub Kaum Hli 27, tus neeg mob muaj 0-qib cov leeg muaj zog hauv ob qho tib si qis. Thaum Lub Kaum Hli 29 (21 hnub tom qab rov ua dua), qhov kev kuaj mob pob txha MRD hloov tsis zoo.
Nyob rau hauv lub xeev ntawm kev zam txim tiav, Dawei ntxiv dag zog rau nws cov ceg qis nrog kev pab los ntawm cov kws saib xyuas neeg mob thiab tsev neeg, maj mam rov ua kom cov leeg muaj zog mus rau 5 qib. Thaum Lub Kaum Ib Hlis 22, nws tau raug xa mus rau lub chaw hloov pauv los npaj rau kev hloov pauv ntawm cov kab mob allogeneic hematopoietic qia cell.
