Indwara ya Lymphoblastique ikaze (B-BYOSE) -03

Ibiranga urubanza:

- Yasuzumwe na B-selile lymphoblastique leukemia mu mpera za Gicurasi 2020.

- Gahunda y'amaraso: WBC 5.14x10 ^ 9 / L, HGB 101.60g / L, PLT 6x10 ^ 9 / L.

- Amagufa yo mu magufa: Hypocellular hamwe na 67% lymphocytes.

- Flow cytometrie: 82.28% by'utugingo ngengabuzima tugaragaza CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, ugaragaza CD9 igice, ugaragaza CD13.

- Fusion gene yerekana nabi; WT1 57.3%; nta PH-isa na Bose bifitanye isano na fusion genes yagaragaye.

- AMAFI: TP53 ihinduka ryiza.

- Chromosomes: 63-58, XXY, + Y, +1, + del (1) (q41q42), -2, -3, +6, -7, +8, -9, +10, -12, -13 , +14, +15, -17, +18, -20, +22 (cp16) / 46, XY [4].

- Yakiriye gahunda ya VCDLP kumasomo 2 atarinze.

- Gahunda ya CAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) ku ya 22 Nyakanga 2020, ariko nta kurekurwa.

- Amagufa yo mu magufa cytometrie ku ya 25 Nzeri 2020: 7.35% by'utugingo ngengabuzima tugaragaza CD81, CD19, CD10, CD38, CD33, byerekana CD20, CD45.

- Isesengura ryimitsi yamaraso: ihinduka rya TP53.

- Chromosomes: 46, XY [20].

- Yatangiye kuvura CD19-CART.

- Gahunda ya FC (FLU 62.7mg x iminsi 4, CTX 1045mg x iminsi 2) chimiotherapie.

- 1 Ukwakira 2020: Autologous CD19-CART yinjiza selile kuri 4.7x10 ^ 7 / kg.

- CRS icyiciro cya 2 hamwe nicyiciro cya 1 neurotoxicity, cyateye imbere nyuma yo kuvurwa.

- Ku ya 29 Ukwakira 2020: Kurangiza burundu muri morfologiya yo mu magufa, nta selile primaire mbi kuri cytometrie.

- 31 Ukuboza 2020: Inkorora yumye, isesemi, kuruka, intege nke muri rusange.

- Gahunda y'amaraso: WBC 15.53x10 ^ 9 / L, HGB 134g / L, PLT 71x10 ^ 9 / L.

- Icyifuzo cy'amagufa yerekana gusubira inyuma.

- Ku ya 2 Mutarama 2021: Yinjiye mu bitaro byacu.

- Gahunda y'amaraso: WBC 20.87x10 ^ 9 / L, HGB 118.30g / L, PLT 58.60x10 ^ 9 / L.

- Creatinine 134umol / L, icyiciro cya 3 hypertension, amateka yubuvuzi bwimyaka 4.

- Amaraso ya periferique: 62% selile yibanze.

. , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, byerekana lymphocytes mbi ya primitique B.

- Isesengura ryimiterere yamaraso: TP53 R196P ihinduka ryiza.

Umuti:

- Yakiriye chimiotherapie ya VLP, hamwe no kuvura hypertension, kugabanya creinine, hamwe na alkalinisation ya hydration.

- Mutarama 19: Gahunda y'amaraso yerekanaga WBC 1.77x10 ^ 9 / L, HGB 71g / L, PLT 29.8x10 ^ 9 / L.

- Amaraso ya periferique: Nta lymphocytes yambere.

- Amagufa ya marrow morphologie: Hypercellularity (V grade), ahantu hibandwa mucyiciro cya IV, hamwe na lymphocytes 42% yibanze.

- Flow cytometrie: 13,91% by'utugingo ngengabuzima tugaragaza CD10, cCD79a, CD38, CD81, CD22, ntugaragaza CD20, CD34, CD19, byerekana selile mbi ya primite B.

- Chromosomal karyotype:

- 35, XY, -2, -3, -4, -5, -7, -9, -12, -13, -16, -17, -20 [8] / 35, XY, + X, -2 , -3, -4, -5, -7, -9, -10, -12, -13, -16, -17, -20 [1] / 36, XY, ongeraho (1) (q42), - 2, -3, -4, -7, -9, -12, -13, -16, -17, -20 [1] / 46, XY [20].

- 20 Mutarama: Lymphocytes yakusanyirijwe kuri CD22-CART umuco w'akagari.

- Tariki ya 21 Mutarama: Gutobora Lumbar byakozwe, chimiotherapie intrathecal yakozwe kugirango ikingire sisitemu yo hagati ya leukemia; isuzuma ryubwonko bwa cerebrospinal ryerekanye ko bidasanzwe.

- 22 Mutarama: Yakiriye Arac, 6MP, L-ASP chimiotherapie, na FC (Flu 50mg x 3, CTX 0.5gx 3) chimiotherapie.

- 7 Gashyantare (mbere yo gushiramo): Amagufwa ya marrow morphologie yerekanaga 93% lymphocytes yibanze.

- Flow cytometrie: 76.42% yingirabuzimafatizo zigaragaza CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, ntugaragaze CD4, CD3, CD13 + 33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), byerekana selile mbi ya selile B.

- Indwara yateye imbere yanduye hamwe nuduce tworoshye hamwe na feri; byateye imbere nyuma yo kuvura antibiotique.

- 9 Gashyantare: Autologous CD22-CART infusion selile (5x10 ^ 5 / kg).

- Ingaruka zijyanye na CAR-T: CRS icyiciro cya 1, umuriro kumunsi wa 6 hamwe na Tmax 40 ° C, ubushyuhe bugenzurwa kumunsi wa 10; nta neurotoxicity.

- Tariki ya 11 Werurwe: Isuzuma ry'amagufwa ryerekanaga ko ryuzuye rya morfologiya, cytometrie yerekana nta selile mbi ya selile.