Kufalitsa B-cell lymphoma (DLBCL) -03

Mu Marichi 2021, Bambo Wang (dzina lodziwika) mwadzidzidzi anamva kuwawa m'munsi mwa m'mimba, poyamba anaganiza kuti akudwala m'mimba, ndipo sanapite kuchipatala mwamsanga. M’miyezi iwiri yotsatira, mobwerezabwereza anakumana ndi zizindikiro za ululu m’munsi mwa m’mimba, zomwe zinam’pangitsa kukawonana ndi dokotala kuchipatala chapafupi. Kujambula kwa CT kunawonetsa zolakwika m'matumbo ndikukulitsa ma lymph nodes a retroperitoneal.

Madokotala adalimbikitsa colonoscopy ndi biopsy kuti adziwe zambiri, zomwe zidatsimikizira "kufalikira kwa B-cell lymphoma," chotupa chowopsa chomwe chimadziwika kuti lymphoma. PET-CT inatsimikiziranso kufalikira kwa zilonda zam'mimba za nodular hypermetabolic m'thupi lonse, ndi kulemera kwakukulu kwa 4.3 * 4.1 * 4.5cm.

Ndi chithandizo cha banja lake, Bambo Wang adalandira chithandizo chamankhwala cha R-CHOP chamagulu anayi. Kutsatira PET-CT pambuyo pa chemotherapy kunawonetsa kukhululukidwa pang'ono.

Komabe, chithandizo chotsatira chinayambitsa mavuto aakulu kwa Bambo Wang, monga kutsekeka kwa matumbo, kuphulika, ndi peritonitis yovuta kwambiri. Madokotala ochita opaleshoni ya m'mimba ndi madokotala omwe amapita nawo adagwirizana pa ndondomeko ya opaleshoni, kuchita opaleshoni ya m'matumbo ndi madzi, pamodzi ndi chithandizo chothandizira zizindikiro, kusamalira bwino zizindikiro zake za m'mimba.

Kuwunika kotsatira kwa PET-CT kunawonetsa kuchuluka kwa zotupa ndi kukula kwake. Kuti athetse bwino maselo a chotupa, madokotala anasintha njira yowonjezereka ya mankhwala amphamvu amphamvu ndipo analimbikitsa kuti pakhale ma cell a chotupa.

A Wang anakumana ndi zovuta zambiri, ndipo anavutika kwambiri m'thupi ndi m'maganizo pamene vuto lawo linali kuipiraipira. Kulowetsedwa kwa chotupa kunkawoneka m'madera angapo, ndi zotupa zatsopano za multifocal nodular hypermetabolic zomwe zimakulitsa kwambiri dera la khansa. Chifukwa cha zotupa m'thupi lake lonse, Bambo Wang ankavutika ndi ululu wamtundu uliwonse, zomwe zimapangitsa kuti zikhale zovuta kuti agone pansi ndi kugona chifukwa cha ululu.

Potaya mtima, Bambo Wang adaphunzira za chithandizo cha CAR-T, buku la CAR-T cell immunotherapy lomwe linapangidwira odwala omwe ali ndi B-cell lymphoma yobwereranso kapena refractory.

Asanalandire chithandizo cha CAR-T, ma lymph node biopsy m'dera lakumanja la inguinal amawonetsa CD19 ndi CD20 positivity, kupereka mipherezero yeniyeni ya chithandizo cha ma cell a CAR-T. Pulofesa Yu adakonza zowunikira mwatsatanetsatane zakuthupi, zomwe zidapangitsa kuti pakhale dongosolo lamankhwala la CAR-T la Bambo Wang.

Pa Julayi 25, 2022, Bambo Wang adalandira kulowetsedwa kwa cell CD19/20 CAR-T kuchipatala, ndi njirayo ikuyenda bwino. Kuwunika koyang'anira ndi chisamaliro chokhazikika chothandizira kumayang'anira zovuta zomwe zimachitika pambuyo pa kulowetsedwa popanda zovuta zowopsa.

Pasanathe miyezi itatu, pofika pa October 10, 2022, PET-CT scan inatsimikizira kuti wakhululukidwa, ndipo kuwunika kwake kunasonyeza kusintha kwakukulu kwa thanzi lake.

Pazotsatira zotsatila, Bambo Wang nthawi zonse ankayang'ana CT, MRI, kapena PET-CT scans, zonse zomwe zimatsimikizira kuti akhululukidwa kwathunthu. Pofika pano, thanzi lake limakhalabe labwino, kupitirira nthawi ya chikhululukiro chonse cha miyezi 14.