Nnukwu ọrịa leukemia Lymphoblastic (B-ALL) -03

Akụkụ ikpe:

- Achọpụtara ya na nnukwu ọrịa leukemia lymphoblastic B-cell na njedebe nke Mee 2020.

- Usoro ọbara: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- Ụmị ọkpụkpụ morphology: Hypocellular nwere 67% lymphocytes oge ochie.

- cytometry na-agba ọsọ: 82.28% nke sel na-egosipụta CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, na-egosipụta CD9 nke ọma, na-egosipụta CD13 adịghị ike.

- Fusion gene screening adịghị mma; WT1 57.3%; ọnweghị mkpụrụ ndụ ihe nketa jikọrọ PH dịka PH.

- Azụ: TP53 mutation ziri ezi.

- 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].

- Anatara usoro VCDLP maka nkuzi 2 na-enweghị mgbaghara.

- Usoro CAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) na Julaị 22, 2020, ka enweghị mgbaghara.

- cytometry ụmị ọkpụkpụ na-eru na Septemba 25, 2020: 7.35% nke mkpụrụ ndụ na-egosipụta CD81, CD19, CD10, CD38, CD33, CD20 na-adịghị ike, CD45.

- Nyocha mmụgharị ọbara tumor: TP53 mutation.

- Chromosomes: 46, XY[20].

- Malitere ọgwụgwọ CD19-CART.

- usoro FC (FLU 62.7mg x 4 ụbọchị, CTX 1045mg x 2 ụbọchị) chemotherapy.

- Ọktoba 1, 2020: CD19-CART infusion cell autologous na 4.7x10^7/kg.

- CRS ọkwa 2 nwere neurotoxicity ọkwa 1, emelitere mgbe ọgwụgwọ nkwado gasịrị.

- Ọktoba 29, 2020: mgbaghara zuru oke na mpụta ụmị ọkpụkpụ, enweghị mkpụrụ ndụ ochie dị njọ na cytometry na-asọ.

- Disemba 31, 2020: ụkwara akọrọ, ọgbụgbọ, ọgbụgbọ, adịghị ike zuru oke.

- Usoro ọbara: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- Ọchịchọ ụmị ọkpụkpụ na-egosi nlọghachi azụ.

- Jenụwarị 2, 2021: A nabatara ya n'ụlọ ọgwụ anyị.

- Usoro ọbara: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

Creatinine 134umol/L, ọkwa ọbara mgbali elu 3, akụkọ ahụike nke afọ 4.

- Nkewa ọbara dị n'akụkụ: 62% sel mbụ.

- Immunophenotyping: 28.48% nke mkpụrụ ndụ (mkpụrụ ndụ akọrọ) na-ekwupụta CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, na-egosipụta akụkụ akụkụ CD123, TTT, ekwupụtala CD34,7 MP19, CD19 , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, na-egosi ajọ mbufụt B lymphocytes.

- Nyocha mmụgharị ọbara tumor: TP53 R196P mutation ziri ezi.

Ọgwụgwọ:

- Anatara VLP chemotherapy, yana ọgwụgwọ maka ọbara mgbali elu, mbelata creatinine, na hydration alkalinization.

- Jenụwarị 19: Usoro ọbara gosipụtara WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Nkewa ọbara dị n'akụkụ: Enweghị lymphocytes oge ochie.

- Ụmị ọkpụkpụ morphology: Hypercellularity (V grade), focal area of ​​IV grade, with 42% primitive lymphocytes.

- cytometry na-agba ọsọ: 13.91% nke mkpụrụ ndụ na-egosipụta CD10, cCD79a, CD38, CD81, CD22, anaghị egosipụta CD20, CD34, CD19, na-egosi sel B ochie ochie.

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

- Jenụwarị 20: Lymphocytes anakọtara maka ọdịbendị cell CD22-CART.

- Jenụwarị 21: puncture lumbar rụrụ, chemotherapy intrathecal a na-enye iji gbochie ọrịa leukemia nke sistemu ụjọ nke etiti; Nnyocha mmiri nke cerebrospinal egosighi ihe ọ bụla.

- Jenụwarị 22: natara Arac, 6MP, L-ASP chemotherapy, na FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.

- February 7 (tupu infusion): morphology ụmị ọkpụkpụ gosipụtara 93% lymphocytes oge ochie.

- cytometry na-asọ: 76.42% nke mkpụrụ ndụ na-ekwupụta CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, anaghị ekwupụta CD4, CD3, CD13+33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), nke na-egosi sel B nke ochie.

- Mepụta akpụkpọ ahụ na ọrịa anụ ahụ dị nro na ahụ ọkụ; emelitere mgbe ọgwụgwọ ọgwụ nje gasịrị.

- Febụwarị 9: CD22-CART infusion cell autologous (5x10^5/kg).

- Mmetụta metụtara CAR-T: CRS ọkwa 1, ahụ ọkụ na ụbọchị 6 na Tmax 40 Celsius, okpomọkụ na-achịkwa na Day 10; enweghị neurotoxicity.

- Maachị 11: Ntụle ụmị ọkpụkpụ gosipụtara mgbaghara morphological zuru oke, cytometry eruba egosighi mkpụrụ ndụ ochie adịghị njọ.