Acute Lymphoblastic Leukemia (T-ALL)-01

Zachipatala:

- Kuzindikira: T-cell lymphoblastic lymphoma/leukemia

- Marichi 2020: Woperekedwa ndi chifuwa cha paroxysmal ndi mediastinal mass, adatsimikizira T-cell lymphoblastic lymphoma ndi mediastinal puncture biopsy.

- Analandira ma 8 ma chemotherapy komanso magawo opitilira 20 a radiotherapy, zomwe zidapangitsa kuchepa kwakukulu kwa mediastinal mass.

- Januware 16, 2021: Kupweteka kwam'munsi kumanja.

- Magazi: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- Mapangidwe a mafupa a mafupa: 95.5% ma lymphoblasts oyambirira.

- Bone marrow flow cytometry: 91.77% ya maselo anali osakhwima T-cell lymphoblasts.

- Ma genetic: Kusintha kwamitundu ya NOTCH1, IL7R, ASXL2 kwapezeka.

- Analandira regimen ya Hyper-CVAD/B, ESHAP regimen pambuyo pake, onse osagwira ntchito ndi kutentha thupi kosalekeza.

- February 18, 2021: Adalandiridwa kuchipatala chathu.

- Kuwonetsedwa ndi malungo, chifuwa cha CT chinawonetsa chibayo.

- Mayendedwe amagazi: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Maselo am'magazi osakhwima: 90%

- Mafupa a mafupa: Hypercellular (IV kalasi), 85% ma lymphoblasts oyambirira.

- Immunophenotyping: 87.27% ya maselo anali oyipa akale T-cell lymphoblasts.

- Kusanthula kwa Chromosomal: 46,XX [24]; ma karyotypes atatu owonjezera omwe adawonedwa.

- Majini osinthika:

1. IL7R T244_I245insARCPL mutation positive

2. NOTCH1 E1583_Q1584dup mutation positive

3. ASXL2 Q602R kusintha kwabwino

- Kuwunika kwa majini a khansa ya m'magazi: Zoipa

- Zotsatira za PET / CT: Palibe chotupa chachikulu cha hypermetabolic foci mu mafupa onse a mafupa ndi mafupa.

Chithandizo:

- Anayambitsa VP regimen chemotherapy, mwatsatanetsatane motere: Vincristine (VDS) 3mg kamodzi, Dexamethasone (Dex) 7mg maola 12 aliwonse kwa masiku 9, pamodzi ndi mankhwala odana ndi matenda.

- Marichi 1: Maselo ozungulira amagazi ocheperako amachepetsedwa mpaka 7%.

- Marichi 4: Anasonkhanitsa ma lymphocyte a autologous a CD7-CAR T cell chikhalidwe.

- Marichi 8: Anayambitsa mankhwala a VLP ophatikizidwa ndi mankhwala a Sida benzamine.

- March 14: Analandira FC regimen chemotherapy (Fludarabine 0.35g kwa masiku 3, Cyclophosphamide 45mg kwa masiku 3).

- Marichi 17 (kulowetsedwa kwa cell):

- Bone marrow residual immunophenotyping: 15.14% maselo amawonetsa CD7 yowala, CD3 dim, cytoplasmic CD3, T cell receptor restricted delta (TCRrd), mawonekedwe a CD99, kuwonetsa ma cell owopsa a T.

- Marichi 19: Analowetsa CD7-CAR T cell autologous (1 x 10 ^ 6/kg).

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

- Epulo 6 (Tsiku 17): Mapangidwe a mafupa a mafupa adawonetsa kukhululukidwa, kutuluka kwa cytometry sikunapeze ma cell oyipa oyambilira.