Diffuse loj B-cell lymphoma (DLBCL), non-germinal center subtype, nrog rau qhov ntswg kab noj hniav thiab sinuses-02

Thaum Lub Peb Hlis 2021, tus txiv neej hnub nyoog 52 xyoo los ntawm Northeast Tuam Tshoj tau nthuav tawm nrog qhov ntswg qhov ntswg pom thaum lub sijhawm kuaj xyuas. Nws tau ntsib cov tsos mob ntawm qhov ntswg congestion, mob taub hau, qhov muag tsis pom kev, thiab hmo ntuj tawm hws, tsis kub taub hau lossis poob phaus.

Kev tshuaj xyuas thawj zaug tau nthuav tawm cov ntaub so ntswg loj uas cuam tshuam nrog txoj cai qhov ntswg kab noj hniav thiab cov qhov txhab, cuam tshuam rau cov qauv tseem ceeb xws li lub orbit, pob txha taub hau sab hauv, sphenoid sinus, thiab sab laug ethmoid sinus ntawm MRI. Pathological kev soj ntsuam ntawm txoj cai maxillary sinus pom tias diffuse loj B-cell lymphoma (DLBCL), non-germinal center subtype.

Immunohistochemistry (IHC) tau qhia tias muaj kev cuam tshuam loj heev nrog kev qhia ob zaug ntawm Ki-67 (90% +), CD20 (+), c-Myc (> 80% +), Bcl-2 (> 90%), Bcl-6 (+) , CD10 (-), Mum1 (+), CD79a (+), CD30 (-), thiab CyclinD1 (-), uas tsis muaj tus kab mob Epstein-Barr-encoded me RNA (EBER).

Fluorescence hauv situ hybridization (FISH) kuaj pom Bcl-6 thiab c-myc translocations, tab sis tsis muaj Bcl-2 gene translocation. Tom ntej no-generation sequencing (NGS) tau lees paub kev hloov pauv hauv MYD88, CD79B, IGH-MYC, BAP1, thiab TP53 noob, qhia txog qib B-cell lymphoma nrog MYC thiab BCL2 thiab / lossis BCL6 translocations.

Positron emission tomography-xws li tomography (PET-CT) qhia txog cov ntaub so ntswg tsis tu ncua nyob rau hauv txoj cai qhov ntswg kab noj hniav thiab cov qhov txhab zoo tshaj plaws, kwv yees li 6.3x3.8cm hauv qhov loj, nrog cov ciam teb tsis meej. Cov kab mob txuas ntxiv mus rau sab xis ethmoid sinus, outwardly mus rau phab ntsa nruab nrab ntawm lub orbit thiab intraorbital cheeb tsam, thiab posteriorly mus rau sphenoid sinus thiab pob txha taub hau puag. Qhov mob tshwm sim tau nce fluorodeoxyglucose (FDG) uptake nrog ib tug SUVmax ntawm 20. Mucosal thickening tau sau tseg nyob rau hauv sab laug ethmoid thiab superior sinus, nrog ib txwm FDG metabolism.

Tus neeg mob yav dhau los tau raug R2-CHOP, R-ESHAP, BEAM + ASCT, thiab kev kho hluav taws xob hauv zos, nrog cov kab mob tshwm sim. Vim yog cov tshuaj tiv thaiv kab mob thiab kev koom tes ntau yam hauv nruab nrog cev (xws li lub ntsws, lub siab, tus po, thiab cov pob txha), tus neeg mob tau kuaj pom tias yog thawj DLBCL refractory. Tus kab mob no tau nce zuj zus nrog kev nce siab, nce qib LDH, hloov kho International Prognostic Index (NCCN-IPI) tus qhab nia ntawm 5, TP53 kev hloov pauv, thiab MCD subtype, muaj kev rov ua dua li ntawm 6 lub hlis tom qab hloov pauv hloov hauv autologous.

Tom qab kev kho txuas txuas, tus neeg mob luv luv tau txais kev kho mob steroid nrog cov lus teb tsis zoo. Tom qab kev kho mob suav nrog CD79 monoclonal antibodies ua ke nrog bendamustine thiab mechlorethamine hydrochloride, ua rau txo qis hauv qib LDH thiab pom cov qog nqaij hlav.

Tom qab ua tiav kev npaj ntawm CAR-T txoj kev kho, tus neeg mob tau txais kev kho mob lymphocyte depletion (lymphodepletion) chemotherapy nrog FC regimen, ua tiav cov kev npaj lymphocyte clearance thiab tom qab mob leukopenia. Txawm li cas los xij, peb hnub ua ntej CAR-T infusion, tus neeg mob tsim kub taub hau, herpes zoster nyob rau hauv thaj tsam lumbar, thiab elevated serum lactate dehydrogenase (LDH) qib nce mus txog 25.74ng / ml, qhia tau tias muaj kev sib xyaw ua ke ntawm cov kab mob tsis zoo (AE. ). Xav txog qhov kev pheej hmoo siab ntawm CAR-T infusion vim muaj kev kis kab mob, uas ua rau muaj kev tuag taus, tus neeg mob tau txais cov tshuaj tua kab mob dav dav uas npog ntau yam kab mob.

Tom qab CAR-T infusion, tus neeg mob tau kub taub hau nyob rau hnub infusion, nce mus rau dyspnea, hemoptysis, thiab cov tsos mob pulmonary zuj zus los ntawm hnub peb. Pulmonary venous CT angiography nyob rau hnub tsib qhia tau hais tias tawg hauv av-iav opacities thiab interstitial hloov pauv, paub meej tias pulmonary hemorrhage. Txawm hais tias thawj zaug kev zam ntawm steroids vim muaj peev xwm CAR-T tsub kom, thiab kev txhawb nqa kev kho mob tsom mus rau kev tswj hwm kev tiv thaiv kab mob, tus neeg mob tus mob tau pom tias muaj kev txhim kho tsawg.

Hnub xya, qhov tseem ceeb CAR gene luam tus lej nthuav dav tau kuaj pom hauv cov ntshav peripheral, ua rau muaj kev kho mob nrog cov tshuaj methylprednisolone (40mg-80mg). Tsib hnub tom qab, ob sab ntsws rales txo qis, thiab cov tsos mob hemoptysis tau tswj tau zoo.

Txog hnub yim, CAR-T txoj kev kho tau pom tias muaj txiaj ntsig zoo heev. Tsis pub dhau ib hlis ntawm kev kho CAR-T, tus neeg mob tau ua tiav kev zam txim (CR). Cov kev ntsuam xyuas tom ntej mus txog rau Lub Xya Hli 2023 tau lees paub tias tus neeg mob tseem nyob hauv CR, qhia qhov kev teb tob rau CAR-T txoj kev kho thiab muaj peev xwm kho tau.