Acute Lymphoblastic Leukemia (B-ALL)-01

Anapezeka ndi acute B-cell lymphoblastic leukemia pa November 28, 2017.

Kuchiza ndi VDLP regimen poyambirira, kukwaniritsa pang'ono m'mafupa kukhululukidwa (zambiri sizinafotokozedwe).

February 2018: Anasinthira ku regimen ya VLCAM. Bone marrow flow cytometry adawonetsa 60.13% ma cell owopsa osakhwima a B.

Marichi 2018: Adalembetsa ku mayeso azachipatala a BiTE. Kukhululukidwa kwa morphological m'mafupa, palibe maselo owopsa omwe amapezeka ndi flow cytometry.

Meyi 8, 2018: Analandira regimen yokhazikika ya TBI/CY+VP16 yotsatiridwa ndi allogeneic stem cell transplant kuchokera kwa abale omwe ali ofanana kwambiri (wopereka AB+ kwa wolandira A+). Kuchira kwa Neutrophil pa tsiku +11, kuchira kwa megakaryocyte pa tsiku +12.

Disembala 5, 2018: Kukhululukidwa kwathunthu kwa morphological m'mafupa, palibe maselo owopsa omwe amazindikiridwa ndi flow cytometry. Analandira donor lymphocyte infusion (DLI) ndi chithandizo cha prophylactic ndi dasatinib ndi imatinib kuteteza kubwereranso.

February 2, 2019: Morphology idawonetsa ma cell 6.5% osakhwima, ma flow cytometry adawonetsa 0.08% ma lymphoblasts oyipa osakhwima a B. Analandira chithandizo cha DLI. Marichi 28, 2019: Flow cytometry sinawonetse zolakwika.

Ogasiti 11, 2019: Kuyambiranso kwa mafupa, kuthandizidwa ndi dasatinib.

Seputembara 2, 2019: Morphology idawonetsa ma cell 3% osakhwima, ma flow cytometry adawonetsa 0.04% ma cell oyipa osakhwima. Kupitilira chithandizo ndi dasatinib, kutsatiridwa ndi ma 2 a methotrexate chemotherapy.

Meyi 11, 2020: Mafupa amabwereranso.

Tidalandira 2 autologous CD19-CAR-T cell therapy ndi 2 allogeneic CD19-CAR-T cell therapy mu 2020, palibe amene adakhululukidwa.

October 26, 2020: Adalandiridwa kuchipatala chathu.

Zotsatira za Laboratory:

Magazi: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Maselo osakhwima a magazi: 63%

Mafupa a mafupa: Hypercellular (giredi II), 96% ma lymphoblasts osakhwima.

Immunophenotyping: Maselo amasonyeza CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; Chithunzi cha CD123. Kuzindikiridwa ngati malignant immature B lymphoblasts.

Kusintha kwa chotupa m’magazi: Kuipa.

Mtundu wa leukemia fusion: NUP214-ABL1 gene fusion positive.

Kusanthula kwa chromosome: 46, XX, t(1;9)(p34;p24), add(11)(q23)[4]/46, XX, t(1;9)(p34;p24), add(11) (q23)x2 [2]/46, XX[3]

Chimerism: Maselo opangidwa ndi opereka amawerengera 7.71%.

Chithandizo:

- VDS, DEX, LASP chemotherapy regimen yoyendetsedwa.

- Novembala 20: Maselo ozungulira amagazi osakhwima 0%.

- Kusonkhanitsa kwa autologous zotumphukira magazi lymphocyte kwa CD19/22 wapawiri CAR-T cell chikhalidwe.

- November 29: FC regimen chemotherapy (Flu 50mg x 3, CTX 0.4gx 3).

- Disembala 2 (isanafike kulowetsedwa kwa cell ya CAR-T):

- Chizoloŵezi chamagazi: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- Mapangidwe a mafupa a mafupa: Hypercellular (kalasi IV), 68% ma lymphoblasts osakhwima.

- Kuwunika kochulukira kwa jini yophatikizika ya NUP214-ABL1: 24.542%.

- Flow cytometry: 46.31% ya maselo amawonetsa CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, kuwonetsa ma lymphoblasts owopsa a B.

- December 4: Kulowetsedwa kwa autologous CD19/22 maselo awiri a CAR-T (3 x 10 ^ 5 / kg).

- Zotsatira zokhudzana ndi CAR-T: Gulu la 1 CRS, kutentha kwa Tsiku la 6 ndi Tmax ya 40 ° C, malungo olamulidwa ndi Tsiku 10. Palibe neurotoxicity yomwe inawonedwa.

- December 22 (Tsiku la 18 assessment): Kukhululukidwa kwathunthu kwa morphological m'mafupa, palibe maselo oipa okhwima omwe amadziwika ndi kutuluka kwa cytometry. Kuwunika kochulukira kwa jini yophatikizika ya NUP214-ABL1: 0%.