Mgbaghara nke onye ọrịa T-ALL nke nwere ọrịa leukemia Central Nevous System Mgbe ọgwụgwọ CAR-T gasịrị.
Okwu ikpe a metụtara otu nwata nwoke dị afọ 16 si Northeast China, onye njem ya na ọrịa leukemia jupụtara na ihe ịma aka kemgbe nyocha ya ihe karịrị otu afọ gara aga.
Na Nọvemba 8, 2020, Dawei (aha pseudonym) gara n'ụlọ ọgwụ mpaghara n'ihi isi ike ihu, ọkụ ọkụ na ọnụ gbagọrọ agbagọ. Achọpụtara ya na ọ nwere "nnukwu ọrịa leukemia lymphoblastic (ụdị T-cell)." Mgbe otu nkuzi chemotherapy ebidochara, MRD (nrịanrịa fọdụrụnụ pere mpe) adịghị mma, chemotherapy sochiri ya. N'ime oge a, ọkpụkpụ ụmị ọkpụkpụ, ọkpụkpụ lumbar, na injections intrathecal egosighi ihe ọ bụla.
Na Mee 6, 2021, a na-eme ntụmadị lumbar nwere ntụtụ intrathecal, na nyocha nke cerebrospinal fluid (CSF) gosipụtara na "ọrịa leukemia sistemu ụjọ etiti." Nke a sochiri usoro ọmụmụ abụọ nke chemotherapy oge niile. Na June 1, nkwụsịtụ lumbar na nyocha CSF gosipụtara mkpụrụ ndụ akabeghị aka. A na-enye mgbatị lumbar atọ ọzọ na intrathecal injections, na nyocha CSF ikpeazụ na-egosi enweghị mkpụrụ ndụ tumo.
Na Julaị 7, Dawei nwetara ọhụhụ ọhụụ n'anya aka nri ya, belatara naanị nghọta. Mgbe otu usoro ọgwụgwọ chemotherapy gbasiri ike, ọhụhụ anya aka nri ya laghachiri nke ọma.
N'August 5, ọhụụ anya aka nri ya dara ọzọ, na-eduga n'ịkpu ìsì zuru oke, anya aka ekpe ya ghọkwara cha cha. Site n'August 10 ruo 13, ọ gara n'ụbụrụ na ụbụrụ redio redio (TBI), bụ nke weghachiri ọhụụ n'anya aka ekpe ya, mana anya aka nri ka kpuru ìsì. N'August 16, nyocha MRI nke ụbụrụ gosipụtara ntakịrị mmụba na nhịahụ nke akwara optic ziri ezi na chiasm, yana nkwalite a hụrụ. Enweghị mgbama ma ọ bụ nkwalite na-adịghị mma ahụghị na parenchyma ụbụrụ.
N'oge a, ezinaụlọ ahụ akwadola maka ịmịnye ụmị ọkpụkpụ, na-echere naanị akwa na ngalaba ntụgharị. N'ụzọ dị mwute, nnyocha ndị a na-eme tupu akpụgharị ya n'oge na-adịbeghị anya gosiri ihe ndị mere ka ntụgharị ahụ ghara ikwe omume.
N'August 30, a na-agbapụta ụmị ọkpụkpụ, na-ekpughe ụmị ọkpụkpụ MRD na T lymphocytes na-adịghị mma na-aza 61.1%. A na-emekwa nkwụsị nke lumbar na intrathecal injections, na-egosi CSF MRD nwere sel ngụkọta 127, nke ndị na-adịghị mma T lymphocytes nwere 35.4%, na-egosi nlọghachi azụ zuru oke nke leukemia.
Na Ọgọst 31, 2021, Dawei na ezinụlọ ya rutere n'ụlọ ọgwụ Yanda Lu Daopei ma kpọba ha na ngalaba nke abụọ nke ngalaba hematology. Nlele ọbara nnabata gosiri: WBC 132.91×10^9/L; mpụta ọbara dị iche iche (morphology): 76.0% gbawara. A na-enye ọgwụgwọ chemotherapy induction maka otu ọmụmụ.
Mgbe ọ tụlechara ọgwụgwọ Dawei gara aga, o doro anya na T-ALL ya na-atụgharị / laghachi azụ yana na mkpụrụ ndụ tumo abanyela n'ụbụrụ, na-emetụta akwara optic. Ndị otu ahụike nke Dr. Yang Junfang duziri na ngalaba hematology nke abụọ kpebisiri ike na Dawei zutere ụkpụrụ maka ntinye aha na CD7 CAR-T ụlọ ọgwụ.
Na Septemba 18, e mere nyocha ọzọ: ọdịiche ọbara dị n'akụkụ (morphology) gosipụtara mgbawa 11.0%. A na-anakọta lymphocytes ọbara dị n'akụkụ maka ọdịbendị cell CD7 CAR-T n'otu ụbọchị ahụ, usoro ahụ wee gaa nke ọma. Mgbe nchịkọta gasịrị, a na-enye ọgwụgwọ chemotherapy iji kwado maka CD7 CAR-T cell immunotherapy.
N'oge chemotherapy, mkpụrụ ndụ etuto na-amụba ngwa ngwa. N'October 6, ọdịiche ọbara dị n'akụkụ (morphology) gosipụtara mgbawa 54.0%, ma gbanwee usoro ọgwụgwọ chemotherapy iji belata ibu arọ. N'October 8, nyocha morphology nke ọkpụkpụ ọkpụkpụ gosipụtara 30.50% mgbawa; MRD gosiri na 17.66% nke sel bụ T-lymphocytes nke na-akabeghị aka.
N'October 9, eweghachiri sel CD7 CAR-T. Na-eso mweghachi, onye ọrịa ahụ nwetara ahụ ọkụ na-aga n'ihu na mgbu chịngọm. N'agbanyeghị nkwalite ọgwụgwọ mgbochi ọrịa, a chịkwaghị ahụ ọkụ ahụ nke ọma, ọ bụ ezie na mgbu chịngọm ji nwayọọ nwayọọ kwụsịlata.
N'ụbọchị nke iri na otu mgbe iweghachiteghachi ya, mgbawa ọbara dị n'akụkụ gbagoro ruo 54%; N'ụbọchị nke 12, nyocha ọbara gosiri na mkpụrụ ndụ ọbara ọcha na-arị elu ruo 16 × 10^9 / L. N'ụbọchị nke 14 ka ọ gachara, onye ọrịa ahụ malitere CRS siri ike, gụnyere mmebi nke myocardial, imeju na akụrụ na-adịghị arụ ọrụ, hypoxemia, ọbara ọgbụgba nke eriri afọ, na mgbagwoju anya. Ọgwụgwọ mgbaàmà ike na nkwado nkwado, yana mgbanwe plasma, jiri nwayọọ nwayọọ kwalite ọrụ nke akụkụ ahụ metụtara, na-eme ka ihe ịrịba ama dị mkpa nke onye ọrịa guzosie ike.
N'October 27, onye ọrịa ahụ nwere ike akwara 0-ọkwa na akụkụ abụọ nke ala. N'October 29 (ụbọchị iri abụọ na otu mgbe a ga-emegharịghachi), nyocha ụmị ọkpụkpụ MRD tụgharịrị na-adịghị mma.
N'ọnọdụ mgbaghara zuru oke, Dawei mere ka ọrụ ụkwụ ya dị ala sikwuo ike site n'enyemaka nke ndị nọọsụ na ezinụlọ, na-eji nwayọọ nwayọọ na-enweta ike ike ruo 5 ọkwa. Na Nọvemba 22, a kpọfere ya na ngalaba transplant iji kwadebe maka transplant cell hematopoietic allogeneic.
