Nnukwu ọrịa leukemia Lymphoblastic (B-ALL) -02

Àgwà ikpe:

- Mee 19, 2019: Achọpụtara ya na nnukwu ọrịa leukemia B-cell lymphoblastic (B-ALL)

- Egosiputara ya na otutu isi isi na lymphadenopathy

- Usoro ọbara: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, lymphocytes na-adịghị mma 4%

- Ọdịdị ụmị ọkpụkpụ: 80.2% lymphoblasts akabeghị aka (mgbawa)

- Immunophenotyping: 74.19% nke mkpụrụ ndụ bụ mkpụrụ ndụ precursor B-lineage ọjọọ na-egosipụta CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, na-egosipụta akụkụ nke cIgM. Nchọpụta nchọpụta: B-ALL (Ogbo tupu B)

- Fusion gene: MLL-ENL ziri ezi, chromosome Philadelphia dị ka (Ph-dị ka) ihuenyo adịghị mma

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

- VDLD usoro ọgwụgwọ chemotherapy na mbụ nwetara mgbaghara immunological mgbe ọnwa 1 gachara, MLL-ENL quantitative PCR 0.026%

- Chemotherapy na-aga n'ihu dị ka usoro iwu ụmụaka si dị, MLL-ENL quantitative PCR 0 mgbe okirikiri nke anọ gasịrị. Usoro ọgwụgwọ ọzọ gara n'ihu.

- Maachị 2020: ọrịa mpụta nke mgbochi ọrịa ụmị ọkpụkpụ 0.35%, MLL-ENL quantitative PCR 0.53%, na-egosi omume na-aga nlọghachi. Ezinụlọ jụrụ mbugharị. Chemotherapy na-aga n'ihu maka okirikiri 3.

- Julaị 2020: ụmị ọkpụkpụ laghachiri azụ kpamkpam.

- Nọvemba 11, 2020: Chemotherapy intrathecal, ọrịa mgbochi mgbochi nke CSF 66%, chọpụtara ọrịa leukemia sistemu akwara etiti. Intrathecal chemotherapy ugboro ugboro ugboro abụọ, CSF tụgharịrị na-adịghị mma.

- Disemba 31, 2020: Anabatara n'ụlọ ọgwụ anyị.

- Usoro ọbara: WBC 3.99 x 10^9/L, HGB 66 g/L, PLT 57 x 10^9/L

- Ọnụ ọgụgụ mgbawa ọbara dị n'akụkụ: 69%

- Ọdịdị ụmị ọkpụkpụ: 90% lymphoblasts akabeghị aka (mgbawa)

- Immunophenotyping: 84.07% nke mkpụrụ ndụ na-egosipụta CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, egosipụtara akụkụ ụfọdụ CD24, CD15dim, na-egosi malignant im ntozu B lymphoblasts.

- Fusion gene: MLL-ENL fusion gene positive, quantitative PCR 44.419%

- Mmụba mkpụrụ ndụ ihe nketa: KMT2D mmụgharị dị mma (sitere germline)

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

- PET-CT: Na-agbasawanye mmụba nke metabolic na oghere ọkpụkpụ na ọkpụkpụ ọkpụkpụ, nnukwu enyo nke nlọghachi azụ leukemia; splenomegaly nwere ụbara metabolism, ikekwe gụnyere leukemia.

- Emere mgbatị lumbar na intrathecal chemotherapy otu ugboro, ọ nweghị ihe na-adịghị mma a hụrụ na ule metụtara CSF.

Ọgwụgwọ:

- Izu abụọ nke chemotherapy VLP, mpụta ọbara gbawara 5% na Jenụwarị 18.

- Jenụwarị 25: ọbara gbawara 91%, ejiri CTX, Ara-C, 6-MP chemotherapy gwọọ ya.

- Febụwarị 3: ọbara n'akụkụ gbawara 22%.

- Febụwarị 4: mkpokọta 50ml autologous peripheral ọbara maka omenala cell CD19-CART.

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

- February 13 (tupu infusion): morphology ụmị ọkpụkpụ na-egosi mgbawa 87.5%, cytometry eruba na-egosi 79.4% mgbawa ọjọọ.

- MLL-ENL fusion gene quantitative analysis: 42.639%.

- Febụwarị 14: Ntinye nke mkpụrụ ndụ CART na nha 5 x 10^5 / kg.

- Mmetụta ọjọọ metụtara CAR-T: ọkwa 1 CRS (ọkụ), enweghị neurotoxicity.

- Day 20 post-infusion: ọbara smear na-egosi mmụba tumor, CART cell proportion 0.07%.

- Ọgwụgwọ mkpụrụ ndụ CART adịghị arụ ọrụ.

- Maachị 8, 2021: Usoro ọbara: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- Mgbawa ọbara n'akụkụ: 83%. Ọbara dị n'akụkụ akpaaka anakọtara 60ml maka omenala cell CART abụọ CD19/CD22.

- A na-agwọ ya na cytarabine na dexamethasone iji chịkwaa ibu akpụ.

- Machị 18: FC chemotherapy (Flu 15mg kwa ụbọchị x ụbọchị 3, CTX 0.12g kwa ụbọchị x ụbọchị 3).

- Maachị 22 (tupu infusion): Usoro ọbara: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Mkpesa ọbara dị n'akụkụ: 6% mgbawa.

- Ọdịdị nke ụmị ọkpụkpụ: 91% mgbawa. Mwepụta n'ime ụmị ọkpụkpụ: 88.61% mkpụrụ ndụ na-egosipụta CD38, CD19, cCD79a, CD81, CD22, na-egosi ajọ ọrịa B lymphoblasts.

- MLL-ENL fusion gene quantitative analysis: 62.894%.

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

- Maachị 23: ntinye nke mkpụrụ ndụ CART na dose nke 3 x 10 ^ 5 / kg.

- Maachị 26 gawa n'ihu: oke ahụ ọkụ na-adịgide adịgide na edema sistemu mechara.

- Maachị 29: Mkpesa ọbara dị n'akụkụ: 92% mgbawa; mmụba nke transaminases na bilirubin.

- Eprel 2: Mmalite ọdịdọ, ejiri diazepam gwọọ ya.

- Eprel 2 (Ụbọchị 10): Malitere ọgwụgwọ methylprednisolone maka ụbọchị 3.

- Mmeghachi omume CRS: Ọkwa 3, CRES: Ọkwa 3.

- Eprel 8 (Ụbọchị 16): Nyocha ụmị ọkpụkpụ na-egosi mgbaghara morphological zuru oke, cytometry na-asọpụta adịghị mma maka mgbawa ọjọọ; MLL-ENL fusion gene quantitative analysis: 0.