Acute Lymphoblastic Leukemia (T-ALL)-02

Zachipatala:

- Kuzindikira: Acute T-cell lymphoblastic leukemia

- Kuyamba: Chakumapeto kwa Marichi 2018

- Zizindikiro zoyamba: Kuchulukirachulukira kwa ma lymph node mthupi lonse

- Chizoloŵezi chamagazi choyamba: WBC: 39.46*10^9/L, Hb: 129g/L, PLT: 77*10^9/L

- Mapangidwe a mafupa a mafupa: 92% kuphulika

-Flow cytometry: 95.3% maselo achilendo akuwonetsa

TdT+CD99+CyCD3+CD7stCd5DdimCD4-CD8-mCD3-CD45dim

- Mitundu ya Fusion: Yoipa

- Kusintha kwa gene: NOTCH1 kusintha kwa jini kwapezeka

- Kusanthula chromosome: Normal karyotype

Mbiri ya Chithandizo:

- Epulo 3, 2018: Chithandizo chothandizira ndi VDCP regimen

- Epulo 18, 2018: Kuphulika kwa mafupa kunali 96%

- Epulo 20, 2018: Anakhululukidwa pambuyo pa regimen ya CAG

- May 18, 2018: Chithandizo chophatikizira ndi CMG + VP regimen

- June 22, 2018: Kuphulika kwa mafupa kunakwera kufika 40%, kubwereranso kwa khansa ya m'magazi

- July 25, 2018: CLAM regimen (clarithromycin+cyclophosphamide+amikacin)

- Kusintha kwa ma cell a hematopoietic kuchokera kwa abale ofananira ndi HLA pogwiritsa ntchito FLU+BU conditioning pa Ogasiti 14

- Kuwunika pambuyo pa kumuika: Kukhululukidwa kwa morphology ya mafupa mwezi umodzi, miyezi 3, miyezi 6, miyezi 9, ndi miyezi 11

- Mafupa a m'mafupa amasonyeza kukhululukidwa kwa miyezi 16 pambuyo pa kumuika, ndi kutuluka kwa cytometry kumavumbula 0.02% ya malignant immature lymphocytes

- Novembala 13, 2020: Zotumphukira magazi chimerism kuchokera kwa opereka anali 97.9%

- Maselo oyambira amagazi: 20%

- Disembala 18, 2020: Mapangidwe a mafupa a mafupa: 60.6% kuphulika

- Kuyenda kwa cytometry: 30.85% yoyipa ya T lymphocyte

- Kusanthula kwa chromosome: 46, XY (20)

- Analandira DA regimen chemotherapy pa Januware 19, 2021

- Bone marrow morphology pa Januware 19, 2021: Hyperplasia ya Gulu III, kuphulika kwa 16%

- Kusanthula kwa chromosome karyotype: 46, XY (20)

- Flow cytometry: 7.27% ya maselo (pakati pa ma cell a nyukiliya) amawonetsa CD99bri, CD13, CD38, cbcl-2, cCD3, HLA-ABC bri, CD7bri, ndi CD5dim yowonetsedwa pang'ono, kuwonetsa ma lymphocyte owopsa a T

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

- Kusanthula kwakusintha kwa chotupa chamagazi (mitundu 86):

1. PHF6 K299Efs*13 mutation positive

2. RUNX1 S322* kusintha kwabwino

3. FBXW7 E471G kusintha kwabwino

4. JAK3 M511I mutation positive

5. NOTCH1 Q2393* kusintha kwabwino

Chithandizo:

- Januware 22: Kusonkhanitsa ndi chikhalidwe cha autologous zotumphukira magazi lymphocytes kwa CD7-CART

- Asanayambe kulowetsedwa kwa CD7-CART, wodwala analandira VLP (vincristine, l-asparaginase, prednisone) kuphatikizapo bortezomib chemotherapy.

- February 3: FC regimen chemotherapy (Flu 50mg kwa masiku atatu + CTX 0.45g kwa masiku atatu)

- February 5 (pre-infusion): Mapangidwe a mafupa a mafupa amasonyeza kuphulika kwa 23%.

- Flow cytometry inavumbulutsa 4.05% maselo akuwonetsa CD99bri, CD5dim, CD7bri, TDT, cCD3, kuwonetsa ma lymphocyte owopsa a T.

- Kusanthula kwa chromosome: 46, XY (20)

- Kusanthula kwa Chimerism (post-HSCT): Maselo opangidwa ndi opereka amawerengera 52.19%.

- February 7: Kulowetsedwa kwa maselo a CD7-CART autologous pa mlingo wa 5 * 10 ^ 5 / kg.

- February 15: Maselo osakhwima a magazi ozungulira amachepetsedwa kufika 2%.

- February 19 (Tsiku la 12 pambuyo pa kulowetsedwa): Wodwala adayamba kutentha thupi, komwe kunatha masiku 5 kusanachitike kuwongolera kutentha.

- Marichi 2: Kuwunika kwa m'mafupa kunawonetsa kukhululukidwa kwathunthu kwa morphological, ndi flow cytometry osazindikira maselo owopsa.