Indwara ya Lymphoblastique ikaze (B-BYOSE) -01

Yasuzumwe na B-selile lymphoblastique leukemia ku ya 28 Ugushyingo 2017.

Umuti hamwe na VDLP muburyo bwambere, kugera kubice bimwe byo gukuramo amagufwa (ibisobanuro ntabwo byatangajwe).

Gashyantare 2018: Yahinduwe kuri gahunda ya VLCAM. Amagufa yo mu magufa cytometrie yerekanaga 60.13% ingirabuzimafatizo B idakuze.

Werurwe 2018: Yiyandikishije mu igeragezwa rya BiTE. Kwiyongera kwa Morphologiya mumagufa, nta selile mbi idakuze igaragara na cytometrike.

Ku ya 8 Gicurasi 2018: Yakiriye gahunda ya TBI / CY + VP16 itondekanya hanyuma ikurikirwa no guterwa ingirabuzimafatizo ya allogeneic stem selile ivuye murumunawe (AB + umuterankunga kuri A + uwahawe). Kugarura Neutrophil kumunsi +11, gukira megakaryocyte kumunsi +12.

Ukuboza 5, 2018: Kurandura burundu morphologie mumagufa, nta selile mbi idakuze yagaragaye na cytometrike. Yakiriye abaterankunga lymphocyte infusion (DLI) hamwe no kuvura prophylactique hamwe na dasatinib na imatinib kugirango wirinde gusubira.

Ku ya 2 Gashyantare 2019: Morphologiya yerekanye selile 6.5% zidakuze, cytometrike yerekana 0.08% lymphoblasts B idakuze. Yakiriye imiti ya DLI. Ku ya 28 Werurwe 2019: Flow cytometry yerekanye ko bidasanzwe.

Ku ya 11 Kanama 2019: Amagufa yongeye kugaruka, avurwa na dasatinib.

Ku ya 2 Nzeri 2019: Morphologiya yerekanye 3% ingirabuzimafatizo zidakuze, cytometrike yerekana 0.04% ingirabuzimafatizo zidakuze. Gukomeza kuvura hamwe na dasatinib, hagakurikiraho inzinguzingo 2 za chimiotherapie methotrexate.

Gicurasi 11, 2020: Amagufwa yongeye kugaruka.

Yakiriye CD 2-autologique CD19-CAR-T ivura selile na 2 allogeneic CD19-CAR-T ivura selile muri 2020, ntanumwe wagezeho gukira.

26 Ukwakira 2020: Yinjiye mu bitaro byacu.

Ibyavuye muri Laboratoire:

Gahunda y'amaraso: WBC 22,75 x 10 ^ 9 / L, HGB 132 g / L, PLT 36 x 10 ^ 9 / L

Amaraso ya periferique adakuze: 63%

Amagufwa yo mu magufa: Hypercellular (icyiciro cya II), lymphoblasts 96% idakuze.

Immunophenotyping: Ingirabuzimafatizo zigaragaza CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; imvugo igice cya CD123. Kumenyekana nka lymphoblasts idakuze.

Guhindura ibibyimba mu maraso: Bibi.

Leukemia fusion gene: NUP214-ABL1 fusion gene nziza.

Isesengura rya Chromosome: 46, XX, t (1; 9) (p34; p24), ongeraho (11) (q23) [4] / 46, XX, t (1; 9) (p34; p24), ongeraho (11) (q23) x2 [2] / 46, XX [3]

Chimerism: Ingirabuzimafatizo zikomoka ku baterankunga zingana na 7,71%.

Umuti:

- VDS, DEX, LASP ya chimiotherapie gahunda yatanzwe.

- 20 Ugushyingo: Ingirabuzimafatizo zidakuze 0%.

- Ikusanyirizo rya autologique peripheral maraso lymphocytes ya CD19 / 22 umuco wa CAR-T ebyiri.

- 29 Ugushyingo: FC regimen chimiotherapie (Flu 50mg x 3, CTX 0.4gx 3).

- 2 Ukuboza (mbere yo kwinjiza selile CAR-T):

- Gahunda y'amaraso: WBC 0.44 x 10 ^ 9 / L, HGB 66 g / L, PLT 33 x 10 ^ 9 / L.

- Amagufwa ya marphologiya: Hypercellular (icyiciro cya IV), 68% lymphoblasts idakuze.

- Isuzuma ryinshi rya NUP214-ABL1 fusion gene: 24.542%.

- Flow cytometrie: 46.31% yingirabuzimafatizo zigaragaza CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, byerekana lymphoblasts B idakuze.

- 4 Ukuboza: Kwinjiza CD19 autologique CD19 / 22 selile ebyiri CAR-T (3 x 10 ^ 5 / kg).

- Ingaruka zijyanye na CAR-T: Icyiciro cya 1 CRS, umuriro kumunsi wa 6 hamwe na Tmax ya 40 ° C, umuriro ugenzurwa numunsi wa 10. Nta neurotoxicity yagaragaye.

- 22 Ukuboza (Isuzuma ryumunsi wa 18): Morphologie yuzuye yuzuye mumagufwa, nta selile mbi idakuze yagaragaye na cytometrike. Isuzuma ryinshi rya NUP214-ABL1 fusion gene: 0%.