Ngā Kāwai Take

Take Whakaaturanga

Ko te Whakatairanga Ira Hou e tuku ana i te tumanako hou mo nga turoro o te mate pukupuku me te thalassemia

FUCASO: Ko te Whakatairanga Tino-tangata BCMA CAR-T Therapy me te kaha me te haumaru kore e rite.

Melanoma mata (i te tuatahi), ka whai mai ko nga pukupuku ate metastatic-02

Ko te taumata matatau IV mate pukupuku-01

Ko te mate pukupuku repeure teitei e haere tahi ana me nga metastases wheua maha-05

Acute Lymphoblastic Leukemia(B-ALL)-03

Te manawanui: Mr. Ko Lu

Ira tangata：Tane

Te tau: 39 tau

Nationality: Hainamana

Te tātaritanga:Acute Lymphoblastic Leukemia(B-KATOA)

Whakapā mai

Ahuatanga Take:

- I te mutunga o Haratua 2020, kua kitea he mate pukupuku B-cell lymphoblastic mate whakapeka.

- Nga mahinga toto: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- Te ahua o te hinu wheua: Hypocellular me te 67% nga lymphocytes tuatahi.

- Rere cytometry: 82.28% o nga pūtau e whakaatu ana i te CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, he wahanga CD9, he ngoikore te whakaputa CD13.

- He kino te tirotiro ira ira; WT1 57.3%; karekau i kitea nga ira whakakotahi KATOA e rite ana ki te PH.

- IKA: TP53 irirangi pai.

- Chromosomes: 63-58, XXY, +Y, +1, +del(1)(q41q42), -2, -3, +6, -7, +8, -9, +10, -12, -13 , +14, +15, -17, +18, -20, +22(cp16)/46, XY[4].

- I whiwhi tikanga VCDLP mo nga akoranga e 2 kaore he murunga.

- Te tikanga CAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) i te Hōngongoi 22, 2020, kaore ano he murunga.

- Cytometry rere o te hinu wheua i te 25 o Hepetema 2020: 7.35% o nga pūtau e whakaatu ana i te CD81, CD19, CD10, CD38, CD33, he ngoikore te whakaputa CD20, CD45.

- Te tātari iratanga puku o te toto: TP53 huringa.

- Chromosomes: 46, XY[20].

- I timata te rongoa CD19-CART.

- Te tikanga FC (FLU 62.7mg x 4 ra, CTX 1045mg x 2 ra) te chemotherapy.

- Oketopa 1, 2020: Autologous CD19-CART whaowhia pūtau i te 4.7x10^7/kg.

- CRS kōeke 2 ki te kōeke 1 neurotoxicity, pai ake i muri i te maimoatanga tautoko.

- Whiringa-ā-nuku 29, 2020: Ka oti te murunga i roto i te ahua o te hinu wheua wheua, karekau he pūtau tawhito kino i runga i te cytometry rere.

- Hakihea 31, 2020: Mare maroke, whakapairuaki, ruaki, ngoikoretanga whanui.

- Nga mahinga toto: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- Ko te wawata o te hinu wheua e tohu ana i te hokinga mai.

- Hanuere 2, 2021: I whakauruhia ki to maatau hohipera.

- Nga mahinga toto: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

- Creatinine 134umol/L, wāhanga 3 takawhita, hītori hauora o 4 tau.

- Te whakarōpūtanga toto tahataha: 62% nga pūtau tuatahi.

- Immunophenotyping: 28.48% o ngā pūtau (ngā pūtau karihi) e whakaatu ana i te CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, CD123, TDT, kaua e whakapuaki CD34, CD19, MPO, CD19, MPO. , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, e tohu ana i nga lymphocytes B tuatahi o mua.

- Te tātaritanga huringa puku o te toto: TP53 R196P he pai te whakarereketanga.

Maimoatanga:

- I whakawhiwhia ki a VLP chemotherapy, me te maimoatanga mo te whakaheke toto, te whakaheke i te tohanga, me te whakamaarama wai.

- Hanuere 19: Ko nga mahinga toto i whakaatu i te WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Te whakarōpūtanga toto tahataha: Karekau he lymphocytes tuatahi.

- Te ahua o te hinu wheua: Hypercellularity (V grade), nga waahi arotahi o te tohu IV, me te 42% nga lymphocytes tuatahi.

- Rere cytometry: 13.91% o nga pūtau e whakaatu ana i te CD10, cCD79a, CD38, CD81, CD22, kaua e whakaatu i te CD20, CD34, CD19, e tohu ana i nga pūtau B kino kino.

- Karyotype Chromosomal:

- 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, tāpiri(1)(q42),- 2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].

- Hanuere 20: Kohia nga Lymphocytes mo te ahurea pūtau CD22-CART.

- Hanuere 21: I mahia te werohanga lumbar, i whakahaerehia te chemotherapy intrathecal hei aukati i te reukemia o te punaha nerve matua; Karekau he rerekee i te tirotiro i te wai cerebrospinal.

- Hanuere 22: I whiwhi a Arac, 6MP, L-ASP chemotherapy, me FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.

- Hui-tanguru 7 (i mua i te whaowhia): Ko te ahua o te hinu wheua i whakaatu i te 93% o nga lymphocytes tuatahi.

- Rere cytometry: 76.42% o nga pūtau e whakaatu ana i te CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, kaua e whakaatu CD4, CD3, CD13+33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), he tohu mo te kino o nga pūtau B tuatahi.

- Te mate kiri me te kiko ngohe ki te kirika; ka pai ake i muri i te maimoatanga antibiotic.

- Hui-tanguru 9: Autologous CD22-CART whaowhia pūtau (5x10^5/kg).

- Nga paanga o te taha CAR-T: CRS grade 1, kirikaa i te Ra 6 me te Tmax 40°C, te pāmahana whakahaere i te Ra 10; kahore he neurotoxicity.

- Poutū-te-rangi 11: Ko te aromatawai i te hinu wheua i whakaatu i te murunga o te ahua o te ahua, karekau i kitea e te cytometry te rere nga pūtau o mua kino.