Acute Lymphoblastic Leukemia (B-ALL)-03

Nkhani Zake:

- Adapezeka ndi pachimake B-cell lymphoblastic leukemia kumapeto kwa Meyi 2020.

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

- Mapangidwe a mafupa a mafupa: Hypocellular yokhala ndi 67% ma lymphocyte oyambirira.

- Flow cytometry: 82.28% ya maselo amawonetsa CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, CD9 yofotokozera pang'ono, CD13 yofooka.

- Kuwunika kwa jini kwa fusion; WT1 57.3%; palibe majini ophatikizana okhudzana ndi PH omwe apezeka.

- NSOMBA: TP53 mutation positive.

- 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].

- Adalandira regimen ya VCDLP yamaphunziro awiri osakhululukidwa.

- CAM-VL regimen (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) pa Julayi 22, 2020, osakhululukidwa.

- Bone marrow flow cytometry pa Seputembara 25, 2020: 7.35% yama cell amawonetsa CD81, CD19, CD10, CD38, CD33, CD20, CD45.

-Kusanthula kusintha kwa chotupa chamagazi: kusintha kwa TP53.

- Chromosomes: 46, XY[20].

- Anayambitsa chithandizo cha CD19-CART.

- FC regimen (FLU 62.7mg x 4 days, CTX 1045mg x 2 days) mankhwala amphamvu.

- October 1, 2020: Autologous CD19-CART cell infusion pa 4.7x10^7/kg.

- CRS giredi 2 yokhala ndi neurotoxicity ya grade 1, imasinthidwa pambuyo pa chithandizo chothandizira.

- Okutobala 29, 2020: Kukhululukidwa kwathunthu mu morphology ya mafupa, palibe ma cell oyipa oyambira pa flow cytometry.

- Disembala 31, 2020: chifuwa chowuma, nseru, kusanza, kufooka kwathunthu.

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

- Kulakalaka kwa mafupa kusonyeza kubwereranso.

- Januware 2, 2021: Adalandiridwa kuchipatala chathu.

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

- Creatinine 134umol/L, siteji 3 matenda oopsa, mbiri yachipatala zaka 4.

- Gulu lamagazi ozungulira: 62% maselo oyamba.

- Immunophenotyping: 28.48% ya maselo (ma cell a nucleated) amawonetsa CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, CD123, TDT, osawonetsa CD34, CD19 , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, kusonyeza malignant primitive B lymphocytes.

- Kusanthula kwakusintha kwa chotupa chamagazi: TP53 R196P kusintha kwabwino.

Chithandizo:

- Analandira VLP chemotherapy, pamodzi ndi chithandizo cha matenda oopsa, kuchepetsa creatinine, ndi hydration alkalinization.

- Januwale 19: Zochita zamagazi zimawonetsa WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Gulu lamagazi ozungulira: Palibe ma lymphocyte akale.

- Mafupa a m'mafupa: Hypercellularity (V kalasi), madera okhazikika a kalasi ya IV, ndi 42% ma lymphocyte oyambirira.

- Flow cytometry: 13.91% ya maselo amawonetsa CD10, cCD79a, CD38, CD81, CD22, samawonetsa CD20, CD34, CD19, zomwe zikuwonetsa ma cell oyipa a 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[20].

- Januwale 20: Ma Lymphocyte asonkhanitsidwa ku chikhalidwe cha CD22-CART cell.

- January 21: lumbar puncture anachita, intrathecal chemotherapy kutumikiridwa kuteteza chapakati mantha dongosolo khansa ya m'magazi; Kuwunika kwa cerebrospinal fluid sikunawonetse zolakwika.

- January 22: Analandira Arac, 6MP, L-ASP chemotherapy, ndi FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.

- February 7 (asanalowedwe): Mapangidwe a mafupa a mafupa amasonyeza 93% ma lymphocyte oyambirira.

- Flow cytometry: 76.42% ya maselo amawonetsa CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, osawonetsa CD4, CD3, CD13 +33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), kuwonetsa ma cell oyipa a B.

- Kukula khungu ndi zofewa minofu matenda ndi malungo; kusintha pambuyo pa maantibayotiki.

- February 9: Autologous CD22-CART cell kulowetsedwa (5x10 ^ 5/kg).

- Zotsatira zokhudzana ndi CAR-T: CRS kalasi 1, kutentha kwa Tsiku 6 ndi Tmax 40 ° C, kutentha kolamulidwa pa Tsiku 10; palibe neurotoxicity.

- Marichi 11: Kuwunika kwa m'mafupa kunawonetsa kukhululukidwa kwathunthu kwa morphological, otaya cytometry sanawonetse ma cell oyipa oyambilira.