Acute Lymphoblastic Leukemia (T-ALL)-04

Ma Cellular acute lymphoblastic leukemia omwe amayamba kuyambiranso pambuyo pake komanso kuphatikiza pakati pa mitsempha yamagazi.

Wodwalayo anali wamwamuna wazaka 15, yemwe adapezeka ndi T-cell acute lymphoblastic leukemia (T-ALL yokhala ndi STIL-TAL1 positivity, jini yodziwika bwino) kumapeto kwa Disembala 2020, ndipo adalandira chithandizo m'chipatala chakumaloko ndi angapo. chemotherapy wanthawi zonse kuti akhululukidwe kwathunthu. Kuika kwa bambo-to-mwana wa hemizygous haematopoietic stem cell transplantation kunachitika pa 2 June 2021, koma mwatsoka kuyambiranso kwa mafupa kunadziwika m'miyezi ya 3 pambuyo pa kumuika, ndipo kachitidwe kamodzi ka mankhwala a chemotherapy sanagwire ntchito. Kachitidwe kamodzi ka mankhwala a chemotherapy kunali kosagwira ntchito, ndipo panthaŵi imodzimodziyo, iye anayamba kutukumuka masaya ndi kutuluka kwa mpweya, ngodya zokhota za mkamwa, ndi kubowola m’chiuno kunasonyeza kukula kwa leukemia yapakati pa mitsempha ya mitsempha.

T-ALL yokhala ndi STIL-TAL1 positivity, kubwereranso koyambirira pambuyo pa kupatsirana kwa allogeneic, kuphatikiza ndi leukemia yapakati pa mitsempha ya mitsempha, ndizovuta kwambiri kuchiza panthawiyi popanda CAR-T. Bambo wa mwanayo adafunsa za Director Zhang Qian wa chipatala cha Ludoupe kudzera mwa abwenzi ake, ndipo atayankhulana mwatsatanetsatane, adafika ku chipatala cha Yanda Ludoupe, akufuna kumenyera moyo wawo polembetsa ku CAR-T chipatala.

CAR-T yoyamba inalephera, maselo a chotupa anachuluka mofulumira kwambiri, ndipo moyo wake unali pangozi.

Pa 26 Okutobala 2021, wodwalayo adaloledwa ku ward yoyamba ya department of Hematology. Chifukwa chakuchulukirachulukira kwa maselo otupa, wodwalayo amatha kuthandizidwa ndi chemotherapy kuti achepetse kuchuluka kwa chotupacho, komanso kubaya jekeseni wamankhwala a chemotherapeutic m'chiuno. The cerebrospinal fluid anali negative. Matenda a wodwalayo atakhazikika, ma lymphocyte a abambo ake adasonkhanitsidwa ku chikhalidwe cha ma cell a CAR-T, ndipo pa 19 Novembala, ma cell a CD7 CAR-T adalowetsedwa mwa wodwalayo.

Patangotha ​​​​masiku ochepa kulowetsedwa, maselo a CAR-T asanakulitsidwe, maselo a chotupa cha wodwalayo anachulukanso mofulumira, ndipo maselo ambiri obadwa nawo amatha kuwoneka m'magazi a m'magazi, kotero kuti CAR-T yoyamba inalephera.

Zinachitika kuti chipatala chathu chikuyesa mayeso a universal CAR-T (CD7 UCAR-T) a acute T-lymphoblastic leukemia panthawiyi. Makolowo anali ndi nkhawa kwambiri ndipo ananena kuti akufuna kuyesa mwana wawo ngakhale atakhala ndi mwayi 1%. Director Zhang Qin adakambirananso ndi banjali ndipo adaganiza zolembetsa mwana wawo pamayesero athu azachipatala a CD7 UCAR-T.

# Kukhululukidwa kwathunthu mutalembetsa ku mayeso azachipatala a CD7 UCAR-T, tsopano miyezi iwiri pambuyo pomuika

Pa Disembala 2, wodwalayo adalowetsedwa ndi ma CD7 U-CART cell, omwe adagwiritsidwa ntchito kuti achepetse kuchuluka kwa chotupa pomwe akupereka chithandizo chothandizira chazizindikiro. Pa 2 December, maselo a CD7 U-CART adalowetsedwa mwa wodwalayo. Pambuyo pa kulowetsedwa, wodwalayo anali ndi malungo osalekeza kwa masiku angapo ndipo anali wofooka. Zizindikiro zofunika kwambiri za wodwalayo zimakhazikika pang'onopang'ono ndipo kutentha kwa thupi kumachepa pang'onopang'ono pambuyo poti wodwalayo athandizidwa ndi anti-infective and rehydration supportive therapy ndi ogwira ntchito zachipatala.

Kuphulika kwa mafupa ndi lumbar pa 18th ndi 28th masiku pambuyo pa kulowetsedwa kwa CD7 UCAR-T kunasonyeza kukhululukidwa kwathunthu ndi MRD yoipa. Maganizo a mwanayo anali kukhala bwino, chilakolako chake chinayambiranso ndipo adayambanso kugwira ntchito, ndipo amayi ake, omwe anali misozi tsiku ndi tsiku, adawona kumwetulira komwe sikunawoneke kwa nthawi yaitali.

Panopa, wodwalayo wadutsa yachiwiri hemi-yogwirizana HSCT m'chipatala chathu kwa miyezi 2, ndipo matendawa akadali chikhululukiro wathunthu.