Acute Lymphoblastic Leukemia (B-ALL)-02

Zomwe Zimachitika:

- Meyi 19, 2019: Anapezeka ndi acute B-cell lymphoblastic leukemia (B-ALL)

- Amawonetsedwa ndi ma scalp angapo komanso lymphadenopathy

- Kachitidwe ka magazi: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, ma lymphocyte achilendo 4%

- Mapangidwe a mafupa a mafupa: 80.2% ma lymphoblasts osakhwima (kuphulika)

- Immunophenotyping: 74.19% ya maselo ndi maselo oipa a B-mzere wotsogolera ma CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, kufotokoza pang'ono cIgM. Kuzindikira: B-ALL (Pre-B siteji)

- Fusion gene: MLL-ENL positive, Philadelphia chromosome-like (Ph-like) screen negative

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

- VDLD regimen chemotherapy poyambirira idapeza chikhululukiro cha chitetezo chamthupi patatha mwezi umodzi, MLL-ENL kuchuluka kwa PCR 0.026%

- Kupitilira chemotherapy malinga ndi protocol ya ana, MLL-ENL kuchuluka kwa PCR 0 pambuyo pa 4th cycle. Mankhwala ena amphamvu anapitiriza.

Marichi 2020: Bone marrow immunological residual matenda 0.35%, MLL-ENL kuchuluka kwa PCR 0.53%, kuwonetsa chizolowezi chobwereranso. Banja linakana kumuika munthu wina. Kupitilira chemotherapy kwa mizere itatu.

- Julayi 2020: Mafuta a mafupa adabwereranso kwathunthu.

- Novembala 11, 2020: Intrathecal chemotherapy, CSF immunological residual matenda 66%, omwe adapezeka ndi leukemia yapakati yamanjenje. Mankhwala a Intrathecal chemotherapy mobwerezabwereza, CSF inasintha.

- Disembala 31, 2020: Adalandiridwa kuchipatala chathu.

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

- Kuchuluka kwa kuphulika kwa magazi: 69%

- Mafupa a mafupa: 90% ma lymphoblasts osakhwima (kuphulika)

- Immunophenotyping: 84.07% ya maselo amawonetsa CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, kufotokoza pang'ono CD24, CD15dim, kuwonetsa ma lymphoblasts owopsa a B.

- Fusion jini: MLL-ENL fusion gene positive, kuchuluka kwa PCR 44.419%

- Kusintha kwa ma genetic: KMT2D mutation positive (majeremusi oyambira)

- 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: Kuchulukitsa kagayidwe kachakudya m'chigoba chonse ndi m'mafupa, kukayikira kwakukulu kwa kuyambiranso kwa leukemia; splenomegaly ndi kuchuluka kwa kagayidwe kachakudya, mwina kumaphatikizapo leukemia.

- Anachita puncture lumbar ndi intrathecal chemotherapy kamodzi, palibe zolakwika zomwe zimapezeka mu mayesero okhudzana ndi CSF.

Chithandizo:

- Masabata awiri a VLP chemotherapy, magazi ozungulira amaphulika 5% pa Januware 18.

- January 25: Magazi ozungulira akuphulika 91%, amathandizidwa ndi CTX, Ara-C, 6-MP chemotherapy.

- February 3: Kuphulika kwamagazi ozungulira 22%.

- February 4: Kutoleredwa kwa 50ml autologous zotumphukira magazi a CD19-CART cell chikhalidwe.

- MTX 1g, FC chemotherapy (Chimfine 15mg tsiku x masiku 3, CTX 0.12g tsiku lililonse x masiku 3).

- February 13 (pre-infusion): Mapangidwe a mafupa a mafupa amasonyeza kuphulika kwa 87.5%, kutuluka kwa cytometry kumasonyeza 79.4% kuphulika koopsa.

- MLL-ENL fusion gene kusanthula kuchuluka: 42.639%.

- February 14: Kulowetsedwa kwa maselo a CART pa mlingo wa 5 x 10 ^ 5 / kg.

- Zotsatira zoyipa zokhudzana ndi CAR-T: Gulu 1 CRS (malungo), palibe neurotoxicity.

- Tsiku 20 pambuyo kulowetsedwa: Kupaka magazi kumawonetsa kuchuluka kwa chotupa, gawo la CART cell 0.07%.

- Chithandizo cha ma cell a CART osagwira ntchito.

- Marichi 8, 2021: Kachitidwe ka magazi: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- Kuphulika kwamagazi: 83%. Magazi ozungulira a Autologous adatolera 60ml ya CD19/CD22 yapawiri CART cell chikhalidwe.

- Amathandizidwa ndi cytarabine ndi dexamethasone kuti achepetse kuchuluka kwa chotupa.

- March 18: FC chemotherapy (Chimfine 15mg tsiku ndi tsiku 3 masiku, CTX 0.12g tsiku lililonse x masiku 3).

- Marichi 22 (kulowetsedwa kusanachitike): Chizoloŵezi chamagazi: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Zozungulira magazi morphology: 6% kuphulika.

- Mapangidwe a mafupa a mafupa: 91% kuphulika. Zotsalira m'mafupa: 88.61% maselo osonyeza CD38, CD19, cCD79a, CD81, CD22, kusonyeza malignant immature B lymphoblasts.

- MLL-ENL fusion gene kusanthula kuchuluka: 62.894%.

- Kusanthula kwa chromosome karyotype: 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) ), kuwonjezera(14)(q34).

- March 23: Kulowetsedwa kwa maselo a CART pa mlingo wa 3 x 10 ^ 5 / kg.

- Marichi 26 kupita mtsogolo: Kutentha thupi kosalekeza ndipo kenako kumayambitsa edema ya systemic.

- March 29: Zozungulira magazi morphology: 92% kuphulika; kuchuluka kwa transaminases ndi bilirubin.

- Epulo 2: Kuyamba kwa khunyu, kuthandizidwa ndi diazepam.

- Epulo 2 (Tsiku 10): Anayambitsa mankhwala a methylprednisolone kwa masiku atatu.

- Zochita za CRS: Gulu 3, CRES: Gulu 3.

- Epulo 8 (Tsiku la 16): Kuwunika kwa m'mafupa kumawonetsa kukhululukidwa kwathunthu kwa morphological, kutuluka kwa cytometry kulibe chifukwa cha kuphulika koyipa; Kusanthula kuchuluka kwa jini ya MLL-ENL: 0.