Acuta Lymphoblastic Leukemia (B-ALL) -03

Casus Features:

- Praecogniti cum leukemia lymphoblastica B-cellula acutis exeunte Maio MMXX.

- Sanguinis usitatum: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- Medulla morphologia: Hypocellulare cum lymphocytis primitivis 67%.

- Cytometria fluunt: cellularum 82,28% exprimunt CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, partim exprimunt CD9, aegre exprimunt CD13.

- Fusion gene protegendo negativa; WT1 57.3%; no PH-sicut OMNES genesis fusione relata deprehenditur.

— PISCIS : TP53 mutatio positiva.

- Chromosomes: 63-58, XXY, +Y, +1, + del(1)(q41q42), -2, -3, +6, -7, +8, -9, +10, -12, -13. .

- Accepit VCDLP regimen pro 2 vicibus sine remissione.

- CAM-VL regimen (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) die 22 iulii 2020, sine remissione adhuc.

- Medulla bone cytometriae fluit die 25 Septembris, 2020: 7.35% cellularum exprimunt CD81, CD19, CD10, CD38, CD33, aegre exprimunt CD20, CD45.

- Sanguinis tumor mutatio analysis: mutatio TP53.

— Chromosomes: 46, XY[20].

- Coepi CD19-CART Lorem.

- FC regimen (FLU 62.7mg x 4 dies, CTX 1045mg x 2 dies) chemotherapy.

- October 1 2020: Autologus CD19-CART cellula infusio ad 4.7x10^7/kg.

- CRS gradus 2 cum gradu 1 neurotoxicitate, emendatur post curatio adminicula.

- Die 29 Octobris 2020: Remissio plena morphologiae medullae osseae, nullae primaevae malignae cellulae in cytometria fluente.

- December 31, 2020: tussis sicca, nausea, vomitus, infirmitas communis.

- Sanguinis usitatum: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

— Medulla bone aspirationis indicans relapsus.

- Die 2 Ianuarii 2021 ad hospitium nostrum admissi.

- Sanguinis usitatum: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

- Creatinum 134umol/L, scaena 3 hypertension, historia medicinae IV annorum.

- Classificatio sanguinis peripherici: 62% cellulae primitivae.

- Immunophenotyping: 28.48% cellularum (cellulae nucleatae) exprimunt CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, partim exprimunt CD123, TDT, non exprimunt CD34, CD19, MPO, CD117 , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, indicans malignam primitivam B lymphocytes.

- Tumor sanguinis mutatio analysis: TP53 R196P mutatio affirmativa.

Curatio:

- VLP chemotherapy accepistis, una cum curatione hypertensionis, reductionis creatinini, et hydrationis alkalinizationis.

- Ianuarii 19: usitatum sanguinis ostendit WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Periphericum sanguinis genus: lymphocytes primitivae.

- Medulla bone morphologia: hypercellularitas (V gradus), areas focalium IV gradus, cum lymphocytis primitivis 42%.

- Cytometría fluunt: 13.91% cellularum CD10, cCD79a, CD38, CD81, CD22 non exprimunt CD20, CD34, CD19, indicativum malignorum primitivae cellae B.

- Chromosomal karyotype:

- 35,XY, 2,-3,-4,-5,-7,-9,-12,-13,-16,-17,-20[8]/35,XY,+X,-2; , -3,-4,-5,-7,-9,-10,-12,-13,-16,-17,-20[1]/36, XY, add(1)(q42),- 2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[XX].

- 20 Ianuarii: Lymphocytes pro cellae culturae collectae pro CD22-CART.

- Die 21 Ianuarii: Punctura lumborum peracta, chemotherapy intratheca administratur ne leukemia centralis nervorum; examen fluidi cerebrospinalis nullas abnormitates demonstravit.

- Die 22 Ianuarii, Acceperunt Arac, 6MP, L-ASP chemotherapy, et FC (Flu 50mg x 3, CTX 0,5gx 3) chemotherapy.

- Die 7 Februarii (ante infusionem): Inmorphologia medulla ossis 93% lymphocytes primitivae ostendit.

- Cytometría fluunt: 76,42% cellularum exprimunt CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, non exprimunt CD4, CD3, CD13+33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1) primitiva B cellulae malignae indicativi.

- Developed cutis et mollis textus contagio cum febre; melius post curatio antibiotic.

- February 9: Autologous CD22-CART cellae infusio (5x10^5/kg).

- CAR-T effectus latus affinis: CRS gradus 1, febris in die 6 cum Tmax 40°C, temperatura moderata die 10; non neurotoxicity.

- March 11: medulla ossis taxatio plenam remissionem morphologicam ostendit, fluxus cytometriae nullas cellulas primitivas malignas ostendit.