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Melanoma ocularium (initio) sequitur tumores metastaticos iecoris 02

Provectus scaena IV colorectal cancer-01

Summus gradus cancer prostatae cum metastasibus ossibus multiplex-05

Acuta Lymphoblastic Leukemia (B-ALL) -02

Patiens: Wang XX

Genderfemale

Aevum: III annos

Genus: Chinese

Diagnosis: Lymphoblastic Leukemia acuta (B-ALL)

Casus Characteres:

- Die 19 Maii 2019: Praecogniti acuta leukemia lymphoblastica B-cellula (B-ALL)

- Praesensae multae cutis massae et lymphadenopathy

- Sanguinis usitatum: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, lymphocytes abnormes 4%

- Medulla morphologia: 80.2% lymphoblastes immatura (flamina)

- Immunophenotyping: 74.19% cellularum malignae sunt cellae praecursores B-genus exprimentes CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, partim exprimentes cIgM. Diagnosis: B-ALL (Pre-B scaena)

- Fusion gene: MLL-ENL positive, Philadelphia chromosomatum quasi (Ph-sicut) velamentum negativum.

- Chromosome: 46, XX, t(11;19)(q23;p13), del(20)(q12)[3]/46, XX [7].

- VDLD regimen chemotherapy initio remissionis immunologicae consecutus post mensem 1, MLL-ENL quantitatis PCR 0.026%

- Chemotherapy continua ut per protocollum pediatrica, quantitatis MLL-ENL PCR 0 post cyclum 4th. Praeterea chemotherapy continuatur.

- March 2020: Medulla ossis morbus residualis immunologicus 0.35%, MLL-ENL quantitatis PCR 0.53%, significans inclinationem ad relapsus. Familia traducere noluit. Pars chemotherapy pro 3 circuitus.

- July 2020: Medulla bone comprehendens cosmi.

- Die 11 Novembris 2020: Chemotherapia intratheca, CSF morbo residuo immunologico 66%, praecogniti cum systemate nervoso centrali leukemia. Chemotherapia intratheca bis repetita, CSF negativa versa.

- Die 31 Decembris 2020: Hospitali nostro admissi.

- Sanguinis usitatum: WBC 3.99 x 10^9/L, HGB 66 g/L, PLT 57 x 10^9/L

- Periphericum sanguinis inspiratione comitem: 69%

- Medulla bone morphologiae: 90% lymphoblasts immatura (flamina)

- Immunophenotyping: 84.07% cellularum CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, partim exprimunt CD24, CD15dim, indicans lymphoblastas malignas immaturas B.

- Fusion gene: MLL-ENL Fusio gene positivus, quantitatis PCR 44,419%

- mutatio genetica: KMT2D mutatio positiva (germline origin)

- Chromosome karyotype: 46, XX, del(1)(p36.1), del(1)(q31q42), del (11)(q13), t(11;19)(q23; p13.3), add( 14)(q34), -17, +mar [7]/46, idem, t(3; 16)(p21;p13.3) [1]/46, XX [13].

- PET-CT: Diffuse metabolicae incrementi in totum sceleti et medullae ossis cavitatem, alta suspicione leukemia recursu; splenomegaly metabolismi auctis, verisimile leukemia involvens.

- PUNCTUM lumborum et chemothera intrathecalum semel praestitum, nullae abnormitates in probatis CSF relatas reperiuntur.

Curatio:

- Duae hebdomades VLP chemotherapy, flatus sanguinis peripherici 5% die 18 Ianuarii.

- Die 25 Ianuarii: flabra sanguinis peripherici 91%, tractata cum CTX, Ara-C, 6-MP chemotherapy.

- Februarius 3: flabra sanguinis peripherici 22%.

- Februarii 4: Collectio 50ml autologorum peripheralium sanguinis pro culturae cellae CD19-CART.

- MTX 1g, chemotherapy FC (Flu 15mg dies x 3 dies, CTX 0.12g dies x 3 dies).

- Februarii 13 (prae-infusion): Insecta ostendit medulla ossium 87,5% flatus, fluxus cytometriae ostendit 79,4% ventos malignos.

- MLL-ENL Fusio analysis quantitatis gene: 42,639%.

- Februarii 14: Infusio cellarum plaustri dose 5 x 10^5/kg.

- CAR-T adversa effectus relatas: Gradus 1 CRS (febris), non neurotoxicitas.

- Dies XX post-infusionem: Sanguis linunt ostendit tumorem multiplicationem, CART cellam proportionem 0.07%.

- Inefficax Cart cell justo.

- Die 8 Martii 2021: Sanguinis usitatum: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

— Flamina peripheralium sanguinis : 83%. Sanguis autologus periphericus collectus 60ml pro CD19/CD22 culturae cellae dualis CART.

- Curantur cum cytarabino et dexamethasone ad tumorem sistendum onus.

- Die Martii 18: FC chemotherapy (Flu 15mg cotidie x 3 dies, CTX 0.12g cotidie x 3 dies).

- Die 22 Martii (prae-infusio): Sanguinis usitatum: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Morphologia sanguinis peripherici: 6% flatus.

- Medulla bone morphologia: 91% flabra. Residua in medulla ossea: 88,61% cellulas exprimentes CD38, CD19, cCD79a, CD81, CD22, indicans lymphoblastas malignas immaturas B.

- MLL-ENL Fusio analysis quantitatis gene: 62,894%.

- Chromosome karyotype analysis: 46, XX, del(1)(p36.1), del (11)(q13), t(11;19)(q23; p13.3), add(14)(q34), - 17, +mar [2]/46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3 ), adde (14)(q34).

- Die 23 Martii: Infusio cellarum plaustri dosis 3 x 10^5/kg.

- Die 26 Martii: Febris alta perseverans et postea hydropica systemica elaborata est.

- 29 Martii: Morphologia sanguinis peripherici: 92% flabra; transaminases elevatum et bilirubin.

- Die 2 Aprilis: Incursus captiones, tractatas diazepam.

- II Aprilis (die X): Coepi curatio methylprednisolone per III dies.

- CRS reaction: Grade III, CRES: Grade III.

- 8 Aprilis (die 16): Medulla ossis aestimatio ostendit remissionem morphologicam integram, fluxum cytometriae negativae pro flatibus malignis; MLL-ENL Fusio analysis quantitatis gene: 0 .