Nnukwu ọrịa leukemia Lymphoblastic (T-ALL) -02

Atụmatụ ụlọ ọgwụ:

- Nchọpụta: nnukwu ọrịa leukemia lymphoblastic T-cell

- mmalite: mbubreyo March 2018

- Mgbaàmà mbụ: Otutu oghere lymph na-ebuwanye ibu n'ime ahụ dum

- Usoro ọbara izizi: WBC: 39.46*10^9/L, Hb: 129g/L, PLT: 77*10^9/L

- Ọdịdị nke ụmị ọkpụkpụ: 92% mgbawa

cytometry na-agba ọsọ: 95.3% mkpụrụ ndụ na-adịghị mma na-egosipụta

TdT+CD99+CyCD3+CD7stCd5DdimCD4-CD8-mCD3-CD45dim

- Ngwakọta mkpụrụ ndụ ihe nketa: adịghị mma

- Mgbanwe mkpụrụ ndụ: achọpụtara mmụgharị mkpụrụ ndụ NOTCH1

- Nyocha chromosome: karyotype nkịtị

Akụkọ ọgwụgwọ:

- Eprel 3, 2018: ọgwụgwọ nnabata na usoro VDCP

- Eprel 18, 2018: Mgbawa ụmị ọkpụkpụ nwere 96%

- Eprel 20, 2018: Enwetara mgbaghara mgbe usoro CAG gasịrị

- Mee 18, 2018: Ngwọta nkwado na usoro CMG+VP

- June 22, 2018: Mgbawa ụmị ọkpụkpụ mụbara ruo 40%, nlọghachi nke leukemia

- Julaị 25, 2018: Usoro CLAM (clarithromycin+cyclophosphamide+amikacin)

- Mgbanwe mkpụrụ ndụ hematopoietic sitere na nwanne HLA dakọtara na-eji ntụ oyi FLU + BU na August 14

- Nleba anya mgbe transplant: mgbaghara nke ụmị ọkpụkpụ morphology na ọnwa 1, ọnwa 3, ọnwa 6, ọnwa 9 na ọnwa 11

- morphology ụmị ọkpụkpụ gosipụtara mgbaghara na ọnwa 16 ka a tụgharịchara ya, yana cytometry eruba na-ekpughe 0.02% lymphocytes na-akabeghị aka.

- Nọvemba 13, 2020: Peripheral blood chimerism sitere na isi mmalite nyere onyinye bụ 97.9%

- Mkpụrụ ndụ mbụ nke ọbara: 20%

- Disemba 18, 2020: morphology ọkpụkpụ: 60.6% gbawara

- cytometry na-asọ: 30.85% na-adịghị mma T lymphocytes

- Nyocha chromosome: 46, XY (20)

- Anatara usoro chemotherapy DA na Jenụwarị 19, 2021

- Ọdịdị ụmị ọkpụkpụ na Jenụwarị 19, 2021: hyperplasia ọkwa III, mgbawa 16%

- Nyocha karyotype chromosome: 46, XY (20)

- cytometry na-agba ọsọ: 7.27% nke mkpụrụ ndụ (n'etiti sel nuklia) gosipụtara CD99bri, CD13, CD38, cbcl-2, cCD3, HLA-ABC bri, CD7bri, na akụkụ ụfọdụ gosipụtara CD5dim, na-egosi na ọ dị njọ T lymphocytes.

- Nyocha mkpụrụ ndụ mkpụrụ ndụ leukemia: adịghị mma

- Nyocha mmụgharị ọbara tumor (ụdị 86):

1. PHF6 K299Efs*13 ngbanwe dị mma

2. RUNX1 S322* mutation ziri ezi

3. Mgbanwe FBXW7 E471G dị mma

4. JAK3 M511I mutation ziri ezi

5. NOTCH1 Q2393* mutation ziri ezi

Ọgwụgwọ:

- Jenuarị 22: mkpokọta na omenaala nke mkpụrụ ndụ lymphocytes ọbara autologous maka CD7-CART

- Tupu infusion CD7-CART, onye ọrịa natara VLP (vincristine, l-asparaginase, prednisone) gbakwunyere bortezomib chemotherapy.

- February 3: FC usoro ọgwụgwọ chemotherapy (Flu 50mg maka ụbọchị 3 + CTX 0.45g maka ụbọchị 3)

- February 5 (tupu infusion): morphology ụmị ọkpụkpụ gosipụtara mgbawa 23%.

- cytometry na-agba ọsọ kpughere sel 4.05% na-egosipụta CD99bri, CD5dim, CD7bri, TDT, cCD3, na-egosi na-adịghị mma T lymphocytes.

- Nyocha chromosome: 46, XY (20)

- Nyocha nke Chimerism (post-HSCT): Selụ ndị nyere onyinye nwetara 52.19%.

- Febụwarị 7: ntinye nke sel CD7-CART autologous na nha 5*10^5/kg.

- Febụwarị 15: mkpụrụ ndụ akabeghị aka n'ọbara belatara ruo 2%.

- February 19 (Day 12 post-infusion): Onye ọrịa nwere ahụ ọkụ, nke were ụbọchị 5 tupu enwee njikwa okpomọkụ.

- Machị 2: Ntụle ụmị ọkpụkpụ gosipụtara mgbaghara morphological zuru oke, yana cytometry na-erugharị anaghị achọpụta mkpụrụ ndụ na-eto eto.