Multiple Myeloma(MM)-01

Kuchira Kwabwino Kwa Wodwala Wapakhomo Wanga Wanga Wanga wa Myeloma Ndi CAR-T Therapy Ngakhale Kusowa Kwa BCMA Kufotokozera

Wodwala wamkazi yemwe adapezeka ndi gawo la IIIA IgD-λ mtundu wa myeloma mu 2018 adalandira chithandizo choyamba makamaka ndi bortezomib. Pambuyo pa 3 m'zinthu, adapeza chikhululukiro chonse (CR). Mu Okutobala 2018, adasinthidwa ndi autologous hematopoietic stem cell transplantation ngati consolidation therapy, kutsatiridwa ndi kukonza ndi lenalidomide. Mu Epulo 2020, matendawa adayambiranso, ndipo adalandira chithandizo chamzere wachiwiri ka 7, zomwe zidapangitsa kuti asagwire bwino ntchito. Kuyambira Disembala 2020 mpaka Epulo 2021, adalandira mankhwala a chemotherapy makamaka ndi daratumumab, koma biopsy ya m'mafupa idawonetsabe 21.763% maselo oyipa a monoclonal plasma, okhala ndi unyolo waulere wa seramu λ pa 1470 mg/L ndi unyolo wopanda mkodzo λ pa 5330 mg/L. Panthawiyi, anali atatopa ndi chithandizo chamankhwala chodziwika bwino komanso chatsopano chomwe chimapezeka m'nyumba, kuphatikiza kumuika autologous stem cell, ndikulowa mayeso azachipatala a CAR-T kukhala njira yabwino kwambiri yotsalira.

Wotumidwa ndi madotolo amderali, adakapereka kuchipatala cha Ludaopei pa Meyi 10, 2021, akuyembekeza kulembetsa mayeso awo azachipatala a BCMA CAR-T therapy mu multiple myeloma (MM). Atamuloledwa, anali wofooka chifukwa cha ululu wamba komanso kutentha thupi kosalekeza. Mayeso athunthu adatsimikizira "myeloma angapo, mtundu wa λ light chain, ISS siteji III, R-ISS siteji III, gulu lachiwopsezo cha mSMART."

Kujambula kwa PET-CT kunawonetsa kuchuluka kwa kagayidwe kachakudya mu kachulukidwe ka minofu yofewa mkati mwa mafupa am'mafupa a femurs ndi tibias, zomwe zikuwonetsa kukhudzidwa kwa chotupa. Bone marrow biopsy inawonetsa 60.13% maselo oopsa a plasma a monoclonal opanda mawu a BCMA.

Chipatala cha Ludaopei chinadziwitsa wodwalayo ndi banja lake za mphamvu ya chithandizo chamakono cha BCMA-negative multiple myeloma, chomwe ngakhale chingakhale chothandiza malinga ndi mabuku ena, chilibe chidziwitso chotsimikizika. Pambuyo polingalira bwino, wodwalayo ndi banja lake anasankha kupitiriza ndi dongosolo la chithandizo.

Kutsatira malamulo a FC regimen, ma cell a BCMA CAR-T adalowetsedwa pa June 1, 2021, ku Ludaopei Hospital. Wodwalayo anayamba malungo pambuyo kulowetsedwa, amene pang'onopang'ono ankalamulira ndi aukali odana ndi matenda ndi symptomatic chithandizo chithandizo. Masiku khumi ndi anayi atatha kulowetsedwa, ma biopsy a m'mafupa sanawonetse maselo otsalira a plasma a monoclonal. Patatha masiku makumi atatu ndi chimodzi pambuyo kulowetsedwa, fupa la m`mafupa biopsy anakhalabe alibe. Serum immunofixation inali yoipa, seramu yopanda kuwala kwa seramu λ inali mkati mwanthawi zonse, ndipo mapuloteni a seramu M anali opanda pake, kusonyeza kukhululukidwa kwathunthu kwa matendawa.

Pakalipano, miyezi yoposa 8 atalandira kulowetsedwa kwa selo la BCMA CAR-T, wodwalayo amakhalabe ndi chikhululukiro chonse ndi kuchira bwino komanso kukhutira kwakukulu ndi zotsatira za chithandizo.