Acuta Lymphoblastic Leukemia (T-ALL) -02

Fusce Features:

- Diagnosis: Acuta T-cellula lymphoblastica leukemia

- Impetus: Nuper Martii MMXVIII

- Signa initialis: Multiplex dilatatio nodi lymphatici superficialis per corpus

- Initialis sanguinis usitatum: WBC: 39.46*10^9/L, Hb: 129g/L, PLT: 77*10^9/L

- Medulla morphologia: 92% flatus

-Flow cytometría: 95.3% abnormes cellulae expressing

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

- Fusion genes: Negative

- Gene mutatio: NOTCH1 gene mutatio deprehensi

- Analysis chromosomatum: Normal karyotype

Curatio Historiae:

- Die 3 Aprilis 2018: Inductione curationis cum VDCP regimen

- Die 18 Aprilis 2018: Medulla bone flamina comprehenditur 96%.

- Die 20 Aprilis 2018: Remissio facta post regimen CAG

- Die 18 Maii 2018: Consolidatio curationis cum regimen CMG+VP

- 22 Iunii 2018: Medulla ossa aucta ad 40%, relapsus leukemia

- Die 25 Iulii 2018: CLAM regimen (clarithromycin+cyclophosphamide+amikacin)

- Truncus hematopoieticus cellae transplantationis ex HLA compositus fratrem utens FLU+BU condiciones die 14 Augusti.

- Monitoring post-transplantare: Remissio medullae morphologiae osseae in mense 1, mensibus 3, 6 mensibus, 9 mensis et 11 mensis

- Medulla morphologia ossium remissionem ostendit ante 16 menses post-transplantationem, cum cytometria fluente manifestans 0.02% lymphocytes immaturae malignae.

- Die 13 Novembris 2020: Chimerismus sanguinis peripherici e fonte donatoris erat 97,9%.

- Sanguis periphericus primitivae cellae: XX%

- Die 18 Decembris 2020: Morphologiae medullae: 60.6% flamina

- Flux cytometria: 30.85% maligna immatura T lymphocytes

- Analysis chromosomatum: 46, XY (20).

- Chemotherapy regimen receptum DA die 19 mensis Ianuarii anno 2021

- Morphologia ossis medulla die 19 ianuarii 2021: Gradus III hyperplasia, 16% flatus

- Analysis chromosomatum karyotypum: 46, XY (20).

- Fluunt cytometriae: 7.27% cellularum (inter cellas nuclei) expressae CD99bri, CD13, CD38, cbcl-2, cCD3, HLA-ABC bri, CD7bri, et partim CD5dim expressi, significans lymphocytas malignas immaturas T.

- Leukemia fusion gene protegendi: Negative

- Sanguinis tumoris mutatio analysis (86 genera);

1. PHF6 K299Efs* 13 mutatio affirmativa

2. RUNX1 S322* mutatio affirmativa

3. FBXW7 E471G mutatio affirmativa

4. JAK3 M511I mutatio affirmativa

5. NOTCH1 Q2393* mutatio affirmativa

Curatio:

- Ianuarii 22: Collectio et cultura lymphocytarum peripheralium sanguinis autologorum pro CD7-CART

- Prius infusionem CD7-CART, patienter accepit VLP (vincristine, l-asparaginas, prednisone) plus chemotherapy bortezomib.

- February 3: FC regimen chemotherapy (Flu 50mg pro 3 diebus + CTX 0,45g pro 3 diebus)

- Februario V (prae-infusione): Insecta os medulla 23% flatibus ostendit.

— Fluxus cytometriae revelatae 4.05% cellulas exprimentes CD99bri, CD5dim, CD7bri, TDT, cCD3, indicans lymphocytes malignas immaturas.

- Analysis chromosomatum: 46, XY (20).

- Analysis chimerismus (post-HSCT): cellulae donator-ectae pro 52.19% computantur.

- Februarii 7: Infusio cellularum autologorum CD7-CART ad dose 5*10^5/kg.

- Februarii 15: Sanguis periphericus cellulae immaturae ad 2% redactae.

- Februari 19 (Die 12 post-infusione): Febrem processit aeger, quae per 5 dies ante temperatura temperantia consecuta est.

- March 2: Os medullae aestimationem ostendit remissionem morphologicam integram, cum cytometria fluentis cellulas immaturas malignas non deprehendens.