Na-agbasa nnukwu lymphoma B-cell (DLBCL), subtype nke etiti na-abụghị germinal, gụnyere oghere imi na sinuses-02

Na Machị 2021, otu nwoke onye ọrịa dị afọ 52 si Northeast China gosipụtara oke imi achọpụtara n'oge a na-enyocha ya oge niile. O nwetara ihe mgbaàmà nke njigide imi, isi ọwụwa, ịhụ ụzọ na-adịghị ahụkebe, na ọsụsọ abalị, n'enweghị ahụ ọkụ ma ọ bụ ibu ibu.

Nnyocha mbụ gosipụtara nnukwu anụ ahụ dị nro nke metụtara oghere imi na sinuses ziri ezi, na-emetụta akụkụ dị egwu dị ka orbit, isi okpokoro isi, sphenoid sinus, na ethmoid sinus ekpe na MRI. Nnyocha pathological nke sinus maxillary ziri ezi tụrụ aro ịgbasa nnukwu lymphoma B-cell (DBCL), subtype na-abụghị germinal center.

Immunohistochemistry (IHC) gosiri nnukwu invasiveness na okwu abụọ nke Ki-67 (90%+), CD20 (+), c-Myc (> 80%+), Bcl-2 (> 90%), Bcl-6 (+) , CD10 (-), Mum1 (+), CD79a (+), CD30 (-), na CyclinD1 (-), na-enweghị nje Epstein-Barr nke nwere obere RNA (EBER).

Fluorescence in situ hybridization (FISH) achọpụtara ntụgharị Bcl-6 na c-myc, mana enweghị ntụgharị mkpụrụ ndụ Bcl-2. Usoro nke ọgbọ na-esote (NGS) kwadoro mmụgharị na MYD88, CD79B, IGH-MYC, BAP1, na TP53 genes, na-egosi ọkwa B-cell lymphoma dị elu na MYC na BCL2 na / ma ọ bụ BCL6 ntụgharị.

Positron emission tomography-computed tomography (PET-CT) na-egosipụta oke anụ ahụ dị nro na-adịghị agafe agafe n'oghere imi aka nri na sinus dị elu, ihe dịka 6.3x3.8cm n'ogo, nwere oke na-enweghị atụ. Ọnya ahụ gbatịpụrụ n'elu n'ime ethmoid sinus aka nri, n'èzí ruo na mgbidi etiti nke mpaghara orbit na intraorbital, na azụ ruo n'isi sphenoid sinus na okpokoro isi. Ọnya ahụ gosipụtara mmụba nke fluorodeoxyglucose (FDG) na SUVmax nke 20. Achọpụtara mkpụkọ mucosal na ethmoid aka ekpe na sinus dị elu, yana metabolism FDG nkịtị.

Onye ọrịa ahụ enweelarị R2-CHOP, R-ESHAP, BEAM + ASCT, na redio redio mpaghara, na-enwe ọganihu ọrịa. N'ihi nguzogide chemotherapy na itinye aka n'ọtụtụ akụkụ (gụnyere ngụgụ, imeju, splin, na ọkpụkpụ), a chọpụtara onye ọrịa nwere DLBCL bụ isi refractory. Ọrịa ahụ na-aga n'ihu ngwa ngwa site na oke mbuso agha, ọkwa LDH dị elu, akara International Prognostic Index (NCCN-IPI) gbanwere nke 5, TP53 mutation, na MCD subtype, na-enwe nlọghachi azụ n'ime ọnwa 6 ka ọ gafechara autologous transplantation.

Na-esochi usoro ọgwụgwọ, onye ọrịa ahụ nwetara ọgwụgwọ steroid nwa oge na nzaghachi adịghị mma. Ọgwụgwọ mechara gụnyere CD79 monoclonal antibodies jikọtara ya na bendamustine na mechlorethamine hydrochloride, na-ebute mbelata dị ukwuu na ọkwa LDH na mbelata etuto ahụ pụtara ìhè.

Mgbe nkwadebe nke CAR-T na-aga nke ọma, onye ọrịa ahụ nwetara mbelata lymphocyte (lymphodepletion) chemotherapy na usoro FC, na-enweta mkpochapụ nke lymphocyte ezubere na leukopenia siri ike na-esote. Otú ọ dị, ụbọchị atọ tupu ntinye nke CAR-T, onye ọrịa ahụ malitere ahụ ọkụ, herpes zoster na mpaghara lumbar, na ọkwa dị elu nke lactate dehydrogenase (LDH) ruo 25.74ng / ml, na-egosi na enwere ike ịme ụdị ọrịa na-adịghị mma (AE). ). N'ịtụle mmụba dị ukwuu nke infusion CAR-T n'ihi ọrịa na-arụsi ọrụ ike, nke nwere ike ịkpata ọnwụ, onye ọrịa ahụ nwetara ọgwụ nje dị iche iche na-ekpuchi nje dị iche iche.

Na-eso mmịnye CAR-T, onye ọrịa ahụ malitere ahụ ọkụ dị elu n'ụbọchị infusion, na-aga n'ihu na dyspnea, hemoptysis, na mgbaàmà na-akawanye njọ n'ime ụbọchị atọ. Pulmonary venous CT angiography n'ụbọchị ise kpughere oghere-glass ala gbasasịrị na mgbanwe interstitial, na-akwado ọbara ọgbụgba nke akpa ume. N'agbanyeghị nkwụsị mbụ nke steroid n'ihi nkwụsị nke CAR-T nwere ike ime, na ọgwụgwọ nkwado na-elekwasị anya na njikwa ọrịa na-efe efe, ọnọdụ onye ọrịa gosipụtara ọganihu dị nta.

N'ụbọchị asaa, achọpụtara mmụba dị ịrịba ama nke ọnụọgụ mkpụrụ ndụ CAR n'ọbara dị n'akụkụ, na-eme ka a gbanwee ọgwụgwọ ya na obere dose methylprednisolone (40mg-80mg). Ụbọchị ise ka e mesịrị, ọnụọgụ ngụgụ nke abụọ na-ebelata, a na-achịkwa akara ngosi hemoptysis.

N'ime ụbọchị asatọ, ọgwụgwọ CAR-T gosipụtara arụmọrụ dị ịrịba ama. N'ime naanị otu ọnwa nke ọgwụgwọ CAR-T, onye ọrịa ahụ nwetara mgbaghara zuru oke (CR). Nyocha ndị sochirinụ ruo Julaị 2023 gosipụtara na onye ọrịa ahụ ka nọ na CR, na-egosi nzaghachi miri emi na ọgwụgwọ CAR-T na ikike ọgwụgwọ.