Nnukwu ọrịa leukemia Lymphoblastic (T-ALL) -01

Atụmatụ ụlọ ọgwụ:

- Nchọpụta: T-cell lymphoblastic lymphoma/ leukemia

- Maachị 2020: E gosipụtara ya na ụkwara paroxysmal na oke mgbasa ozi, enwetara lymphoma T-cell lymphoblastic site na biopsy mediastinal mass puncture biopsy.

- Anatara usoro ọgwụgwọ chemotherapy 8 na usoro ọgwụgwọ redio karịrị 20, na-ebute mbelata dị ukwuu nke mediastinal mass.

- Jenuarị 16, 2021: Melitere mgbu n'akụkụ aka nri aka nri.

- Usoro ọbara: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- Ọdịdị nke ụmị ọkpụkpụ: 95.5% lymphoblasts ochie.

- cytometry nke ụmị ọkpụkpụ: 91.77% nke sel bụ T-cell lymphoblast na-etobeghị.

- Usoro mkpụrụ ndụ ihe nketa: Mmụba na mkpụrụ ndụ ihe nketa NOTCH1, IL7R, ASXL2 achọpụtara.

- Anatara usoro Hyper-CVAD/B, usoro ESHAP mechaa, ha abụọ adịghị arụ ọrụ na ahụ ọkụ na-adịgide adịgide.

- Febụwarị 18, 2021: A nabatara ya n'ụlọ ọgwụ anyị.

- E gosipụtara ya na ahụ ọkụ, CT chest gosiri na oyi baa.

- Usoro ọbara: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Selụ ọbara akabeghị aka: 90%

- Ụmị ọkpụkpụ morphology: Hypercellular (IV ọkwa), 85% mbụ lymphoblasts.

- Immunophenotyping: 87.27% nke sel bụ T-cell lymphoblast ochie.

- Nyocha chromosomal: 46,XX [24]; karyotypes atọ ọzọ na-adịghị mma hụrụ.

- mkpụrụ ndụ ihe nketa agbanweela:

1. IL7R T244_I245insARCPL ngbanwe dị mma

2. NOTCH1 E1583_Q1584dup mutation nti

3. ASXL2 Q602R mutation ziri ezi

- Nyocha mkpụrụ ndụ mkpụrụ ndụ leukemia: adịghị mma

- Nsonaazụ PET/CT: Enweghị oke hypermetabolic tumor foci n'ime skeleton na ụmị ọkpụkpụ niile.

Ọgwụgwọ:

- Malitere usoro ọgwụgwọ VP, nkọwa zuru ezu dị ka ndị a: Vincristine (VDS) 3mg otu ugboro, Dexamethasone (Dex) 7mg kwa awa 12 ọ bụla maka ụbọchị 9, yana ọgwụgwọ mgbochi ọrịa.

- Machị 1: mkpụrụ ndụ akabeghị aka n'ọbara belatara ruo 7%.

- Maachị 4: Anakọtara lymphocytes autologous maka omenala cell CD7-CAR T.

- Maachị 8: Malitere usoro VLP jikọtara ya na ọgwụgwọ benzamine Sida.

- Machị 14: Natara FC usoro ọgwụgwọ chemotherapy (Fludarabine 0.35g maka ụbọchị 3, Cyclophosphamide 45mg maka ụbọchị 3).

- Maachị 17 (mgbanye tupu cell):

- Ụmị ọkpụkpụ residual immunophenotyping: 15.14% mkpụrụ ndụ na-egosipụta CD7 na-egbuke egbuke, CD3 dim, cytoplasmic CD3, T cell receptor restricted delta (TCRrd), akụkụ akụkụ nke CD99, na-egosi sel T ochie ochie.

- Maachị 19: sel CD7-CAR T nke akpaaka (1 x 10^6/kg).

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

- Eprel 6 (Ụbọchị 17): Ọkpụkpụ ụmị ọkpụkpụ gosipụtara mgbaghara, cytometry erughi achọpụta mkpụrụ ndụ ochie.