Systemic lupus erythematosus (SLE) -05

Mayi C ndi mkazi wazaka 32 yemwe adapezeka ndi matenda a systemic lupus erythematosus (SLE) zaka ziwiri zapitazo. Zizindikiro zake zazikulu zinali nephritis, nyamakazi, ndi totupa. Ngakhale adalandira ma immunosuppressive angapo (kuphatikiza glucocorticoids, hydroxychloroquine, ndi rituximab), matenda ake adakhalabe osalamulirika.

Chithandizo chisanachitike:

 Zizindikiro: Kupweteka kwambiri m'malo olumikizirana mafupa ndi kutupa, zotupa zosalekeza, kutopa kwakukulu, ndi nephritis flare.

 Zotsatira za Laboratory:

# SLEDAI-2K mphambu: 16

# Miyezo ya anti-stranded-stranded DNA ya seramu: Yokwezeka pamwamba pamlingo wabwinobwino

# Gwirizanitsani ma C3 ndi C4: Pansi pamtundu wabwinobwino

Njira Yochizira:

1.Kusankha Odwala: Chifukwa cha kusagwira ntchito kwa mankhwala achikhalidwe komanso kuopsa kwa matenda ake, Ms. C adalembedwa m'mayesero achipatala a CAR-T cell therapy.

2.Kukonzekera: Asanalandire kulowetsedwa kwa maselo a CAR-T, Ms. C adalandira mankhwala ovomerezeka a chemotherapy kuti athetse ma lymphocyte omwe alipo ndikukonzekera kuyambitsa maselo a CAR-T.

3.Kukonzekera Maselo:

Ma cell # T adalekanitsidwa ndi magazi a Mayi C.

# Maselo a T awa adapangidwa mwachilengedwe mu labu kuti afotokozere chimeric antigen receptors (CAR) akulunjika ma CD19 ndi ma antigen a BCMA.

Kulowetsedwa kwa 4.Cell: Pambuyo pakukulitsa ndi kuyesa kwa khalidwe, maselo opangidwa ndi CAR-T adalowetsedwanso m'thupi la Ms. C.

5.Inpatient Monitoring: Mayi C adayang'aniridwa m'chipatala kwa masiku a 25 pambuyo pa kulowetsedwa kuti ayang'ane zotsatira zomwe zingatheke ndikuwunika momwe angagwiritsire ntchito.

Zotsatira za Chithandizo:

1. Yankho lalifupi:

# Kusintha kwa Zizindikiro: Patangotha ​​milungu itatu atalowetsedwa, Mayi C anachepa kwambiri kupweteka kwa mafupa ndi kutupa, ndipo zidzolo zake zinazimiririka pang’onopang’ono.

Zotsatira za # Laboratory: Masiku awiri atatha kulowetsedwa, maselo a B m'magazi a Ms. C anathetsedwa kotheratu, kusonyeza kulunjika kogwira mtima ndi maselo a CAR-T.

2.Kuwunika kwapakati (miyezi 3):

# SLEDAI-2K mphambu: Yatsitsidwa mpaka 2, kuwonetsa kukhululukidwa kwa matenda.

# Ntchito Yaimpso: Kuchepetsa kwakukulu kwa proteinuria, ndi nephritis ikulamulidwa.

# Zolemba Zammunological: Kuchepa kwa ma antibodies a DNA olimbana ndi mizere iwiri, ndikuwonjezera ma C3 ndi C4 kubwerera mwakale.

3. Zotsatira Zanthawi Yaitali (miyezi 12):

# Chikhululukiro Chokhazikika: Mayi C adasunga chikhululukiro chopanda mankhwala kwa chaka chimodzi popanda zizindikiro za SLE kubwereranso.

# Chitetezo: Kupatula pa ofatsa a cytokine release syndrome (CRS), Ms. C sanakumane ndi zotsatira zoyipa. Chitetezo chake cha mthupi chinachira pang'onopang'ono atalandira chithandizo, ndipo maselo a B omwe adatulukanso sanawonetse matenda.

Ponseponse, chikhalidwe cha Mayi C chinawonetsa kusintha kodabwitsa komanso kukhululukidwa kosalekeza pambuyo pa chithandizo cha maselo a CAR-T, kusonyeza kuthekera kwa mankhwalawa kwa SLE yoopsa komanso yotsutsa.

Ripoti la mayeso a CART cell: