Kukhululukidwa kwa Wodwala T-ALL Wobwereranso ndi Central Nervous System Leukemia Pambuyo pa CAR-T Therapy
Mlanduwu ndi wa mnyamata wazaka 16 wochokera kumpoto chakum'mawa kwa China, yemwe ulendo wake wodwala khansa ya m'magazi wakhala wodzaza ndi zovuta kuyambira pomwe adamupeza chaka chapitacho.
Pa Novembara 8, 2020, Dawei (dzina lachinyengo) adayendera chipatala chakumaloko chifukwa chakuuma kwa nkhope, zidzolo, komanso mkamwa mokhota. Anapezeka ndi "acute lymphoblastic leukemia (mtundu wa T-cell)." Pambuyo pa maphunziro amodzi a chemotherapy, MRD (matenda otsalira ochepa) anali opanda pake, kutsatiridwa ndi chemotherapy wamba. Panthawi imeneyi, kupunthwa kwa mafupa, kubaya m'chiuno, ndi jakisoni wa intrathecal sikunasonyeze zovuta.
Pa Meyi 6, 2021, kuphulika kwa lumbar ndi jekeseni wa intrathecal kunachitika, ndipo kusanthula kwa cerebrospinal fluid (CSF) kunatsimikizira "central nervous system leukemia." Izi zinatsatiridwa ndi maphunziro awiri a chemotherapy wamba. Pa June 1, kuphulika kwa lumbar ndi kusanthula kwa CSF kunasonyeza maselo okhwima. Zowonjezera zitatu za lumbar punctures ndi jekeseni wa intrathecal zinaperekedwa, ndi mayeso omaliza a CSF osonyeza kuti palibe maselo otupa.
Pa Julayi 7, Dawei adasiya kuona m'diso lake lakumanja, kuchepetsedwa kukhala kuzindikira kopepuka. Atalandira chithandizo champhamvu chamankhwala kamodzi, diso lake lakumanja linayambanso kuona bwinobwino.
Pa Ogasiti 5, diso lake lakumanja linasokonekeranso, zomwe zinachititsa khungu lake lonse, ndipo diso lake lakumanzere linachita khungu. Kuyambira pa Ogasiti 10 mpaka 13, adachitidwa opaleshoni yaubongo ndi msana (TBI), yomwe idabwezeretsa kuwona m'diso lake lakumanzere, koma diso lakumanja lidakhala lakhungu. Pa Ogasiti 16, kuyezetsa kwa MRI muubongo kunawonetsa kusintha pang'ono pakukhuthala kwa mitsempha yolondola ya optic ndi chiasm, ndikuwongolera. Palibe zizindikiro zachilendo kapena zowonjezera zomwe zidapezeka mu parenchyma yaubongo.
Pa nthawiyi, banjali linali litakonzekera kuikidwa m’mafupa, n’kumadikirira bedi m’chipinda chomuikamo. Tsoka ilo, kuyezetsa kwanthawi zonse asanamuike kunawonetsa zovuta zomwe zidapangitsa kuti kumuika kukhala kosatheka.
Pa Ogasiti 30, kuphulika kwa mafupa kunachitika, ndikuwulula fupa la MRD lomwe lili ndi ma T lymphocyte osakhwima omwe amawerengera 61.1%. Kuphulika kwa lumbar ndi jekeseni wa intrathecal kunachitidwanso, kusonyeza CSF MRD ndi maselo okwana 127, omwe ma lymphocyte osakhwima a T anali ndi 35.4%, kusonyeza kubwereranso kwathunthu kwa khansa ya m'magazi.
Pa Ogasiti 31, 2021, Dawei ndi banja lake adafika pachipatala cha Yanda Lu Daopei ndipo adagonekedwa m'chipinda chachiwiri cha dipatimenti ya hematology. Mayeso ovomerezeka a magazi amasonyeza: WBC 132.91 × 10 ^ 9 / L; Kusiyanitsa kwamagazi am'magazi (morphology): 76.0% kuphulika. Induction chemotherapy idaperekedwa kwa kosi imodzi.
Atatha kuunikanso chithandizo cham'mbuyomu cha Dawei, zidawonekeratu kuti T-ALL yake inali yosinthika / idabwereranso komanso kuti maselo otupa adalowa muubongo, zomwe zidakhudza mitsempha yamaso. Gulu lachipatala lotsogozedwa ndi Dr. Yang Junfang m'chipinda chachiwiri cha hematology adatsimikiza kuti Dawei adakwaniritsa zofunikira zolembera CD7 CAR-T chipatala mayesero.
Pa Seputembara 18, kuyezetsa kwina kunachitika: kusiyana kwa magazi am'magazi (morphology) kunawonetsa kuphulika kwa 11.0%. Ma lymphocyte amagazi ozungulira adasonkhanitsidwa ku chikhalidwe cha CD7 CAR-T cell tsiku lomwelo, ndipo njirayi idayenda bwino. Pambuyo pa kusonkhanitsa, chemotherapy idaperekedwa kukonzekera CD7 CAR-T cell immunotherapy.
Panthawi ya chemotherapy, maselo a chotupa amakula mofulumira. Pa Okutobala 6, kusiyanitsa kwa magazi kwapang'onopang'ono (morphology) kunawonetsa kuphulika kwa 54.0%, ndipo regimen ya chemotherapy idasinthidwa kuti muchepetse chotupa. Pa Okutobala 8, kafukufuku wama cell morphology wa mafupa adawonetsa kuphulika kwa 30.50%; MRD inasonyeza kuti 17.66% ya maselo anali oipa T lymphocyte.
Pa October 9, maselo a CD7 CAR-T anabwezeretsedwa. Pambuyo pobwezeretsa thupi, wodwalayo amamva kutentha thupi kosalekeza komanso kupweteka kwa chingamu. Ngakhale kuti mankhwala oletsa matendawo anali owonjezereka, malungowo sanawongoleredwe bwino, ngakhale kuti kupweteka kwa chingamu kunachepa pang’onopang’ono.
Patsiku la 11 pambuyo pobwezeretsanso, kuphulika kwa magazi kwapakati kunakwera kufika 54%; pa tsiku la 12, kuyezetsa magazi kunawonetsa maselo oyera amagazi akukwera mpaka 16 × 10 ^ 9/L. Patsiku la 14 pambuyo pobwezeretsanso, wodwalayo anayamba kudwala kwambiri CRS, kuphatikizapo kuwonongeka kwa myocardial, kuwonongeka kwa chiwindi ndi impso, hypoxemia, kuchepa kwa magazi m'mimba, ndi kukomoka. Chithandizo chaukali komanso chothandizira, komanso kusinthana kwa madzi a m'magazi, pang'onopang'ono kusintha magwiridwe antchito a ziwalo zomwe zakhudzidwa, kukhazikika kwa zizindikiro zofunika za wodwalayo.
Pa October 27, wodwalayo anali ndi mphamvu ya 0-grade minofu m'miyendo yonse yapansi. Pa Okutobala 29 (masiku 21 pambuyo pobwezeretsanso), kuyesa kwa mafupa a MRD kunasintha.
Atakhululukidwa kwathunthu, Dawei adalimbitsa ntchito yake ya m'munsi mothandizidwa ndi anamwino ndi mabanja, pang'onopang'ono kuchira mphamvu ya minofu mpaka 5. Pa Novembala 22, adasamutsidwa ku dipatimenti yoti akasinthidwe kuti akakonzekere kuyika ma cell a allogeneic hematopoietic stem cell.
