Kurandura T-BYOSE BISUBIZE NA Sisitemu Nervous System Leukemia Nyuma yo kuvura CAR-T
Uru rubanza rurimo umuhungu wimyaka 16 ukomoka mu majyaruguru yuburasirazuba bwUbushinwa, urugendo rwe na leukemia rwuzuye ibibazo kuva yamusuzumye mu mwaka ushize.
Ku ya 8 Ugushyingo 2020, Dawei (izina ry'irihimbano) yasuye ibitaro byaho kubera gukomera mu maso, guhubuka, no mu kanwa kagoramye. Yasuzumwe "acute lymphoblastique leukemia (ubwoko bwa T-selile)." Nyuma yamasomo imwe ya chimiotherapie induction, MRD (indwara ntoya isigaye) yari mbi, ikurikirwa na chimiotherapie isanzwe. Muri kiriya gihe, gutobora amagufwa, gutobora mu gihimba, no gutera inshinge byerekanaga ko bidasanzwe.
Ku ya 6 Gicurasi 2021, hakozwe icyuma cyo mu gihimba hamwe no gutera inshinge, kandi isesengura ry’amazi yo mu bwonko (CSF) ryemeje "sisitemu yo hagati yo mu maraso." Ibyo byakurikiwe namasomo abiri ya chimiotherapie isanzwe. Ku ya 1 kamena, gucumita hamwe no gusesengura CSF byerekanaga selile zidakuze. Hakozwe ubundi buryo butatu bwo gutobora hamwe no guterwa intrathecal, hamwe na test ya nyuma ya CSF yerekana ko nta selile yibibyimba.
Ku ya 7 Nyakanga, Dawei yagize ikibazo cyo kutabona mu jisho rye ry'iburyo, agabanuka ku mucyo gusa. Nyuma yisomo rimwe rya chimiotherapie yakajije umurego, ijisho rye ryiburyo ryasubiye mubisanzwe.
Ku ya 5 Kanama, ijisho rye ry'iburyo ryongeye kwangirika, bituma ahuma amaso, maze ijisho rye ry'ibumoso rihinduka umwijima. Kuva ku ya 10 kugeza ku ya 13 Kanama, yabazwe ubwonko bwose n'umugongo radiotherapi (TBI), bigarura iyerekwa mu jisho rye ry'ibumoso, ariko ijisho ry'iburyo rikomeza kuba impumyi. Ku ya 16 Kanama, isuzuma rya MRI mu bwonko ryerekanye ko ryateye imbere mu kubyimba kwijimye rya optique na chiasm, hamwe no kwiyongera. Nta bimenyetso bidasanzwe cyangwa ibyongeweho byabonetse muri parenchyma yo mu bwonko.
Kuri ubu, umuryango wari witeguye guhindurwa amagufwa, utegereje uburiri gusa muri salle. Kubwamahirwe, ibizamini bisanzwe mbere yo guhindurwa byagaragaje ibibazo byatumye transplant idashoboka.
Ku ya 30 Kanama, hakozwe igufwa ryo mu magufa, ryerekana amagufwa ya MRD hamwe na lymphocytes T idakuze bidasanzwe bingana na 61.1%. Hakozwe kandi gucumita mu gihimba hamwe no gutera inshinge, byerekana CSF MRD ifite selile 127 zose, muri zo lymphocytes T idakuze idasanzwe yari 35.4%, byerekana ko leukemia yongeye kugaruka.
Ku ya 31 Kanama 2021, Dawei n'umuryango we bageze mu bitaro bya Yanda Lu Daopei maze binjira mu cyumba cya kabiri cy’ishami ry’amaraso. Kwipimisha amaraso byerekanaga: WBC 132.91 × 10 ^ 9 / L; amaraso ya peripheri atandukanye (morphologie): guturika 76.0%. Induction chimiotherapie yatanzwe kumasomo imwe.
Nyuma yo gusuzuma ubuvuzi bwa Dawei mbere, byaragaragaye ko T-ALL ye yanze / yisubiramo kandi ko selile yibibyimba yinjiye mubwonko, bigira ingaruka kumitsi ya optique. Itsinda ry’abaganga riyobowe na Dr. Yang Junfang mu cyumba cya kabiri cy’ubuvuzi bw’amaraso ryemeje ko Dawei yujuje ibisabwa kugira ngo yiyandikishe mu isuzuma ry’amavuriro rya CD7 CAR-T.
Ku ya 18 Nzeri, hakozwe ikindi kizamini: itandukaniro ry'amaraso ya periferique (morphologie) ryerekanye 11,0%. Lymphocytes zamaraso zegeranijwe zegeranijwe kumico ya CD7 CAR-T kumunsi umwe, kandi inzira yagenze neza. Nyuma yo gukusanya, chimiotherapie yatanzwe kugirango bategure immunoterapi ya CD7 CAR-T.
Mugihe cya chimiotherapie, selile yibibyimba yagwiriye vuba. Ku ya 6 Ukwakira, itandukaniro ry’amaraso ya periferique (morphologie) ryerekanye ibisasu 54.0%, kandi gahunda ya chimiotherapie yarahinduwe kugirango igabanye umutwaro wibibyimba. Ku ya 8 Ukwakira, isesengura ry’amagufwa ya selile yerekanaga 30.50%; MRD yerekanye ko 17,66% by'utugingo ngengabuzima T lymphocytes idakuze.
Ku ya 9 Ukwakira, CD7 CAR-T selile zongeye gushyirwaho. Nyuma yo kongera gushyirwaho, umurwayi yagize umuriro mwinshi nububabare. Nubwo uburyo bwo kuvura bwanduye bwongerewe imbaraga, umuriro ntiwagenzuwe neza, nubwo ububabare bwigifu bwagabanutse buhoro buhoro.
Ku munsi wa 11 nyuma yo gusubirana, guturika kw'amaraso ya peripheri byiyongereye kugera kuri 54%; kumunsi wa 12, isuzuma ryamaraso ryerekanye selile yera izamuka igera kuri 16 × 10 ^ 9 / L. Ku munsi wa 14 nyuma yo kwisubiraho, umurwayi yagize CRS ikabije, harimo kwangirika kwa myocardial, umwijima nimpyiko zidakora neza, hypoxemia, kuva amaraso yo munda yo hepfo, no guhungabana. Kuvura ibimenyetso simusiga kandi bifasha, hamwe no guhanahana plasma, byateje imbere imikorere yingingo zanduye, bihindura ibimenyetso byingenzi byumurwayi.
Ku ya 27 Ukwakira, umurwayi yari afite imbaraga zo mu cyiciro cya 0 mu ngingo zombi zo hepfo. Ku ya 29 Ukwakira (iminsi 21 nyuma yo kongera gushyirwaho), ikizamini cya magufa ya MRD cyahindutse nabi.
Mu bihe byuzuye, Dawei yashimangiye imikorere yo mu gihimba cyo hasi abifashijwemo n'abaforomo n'umuryango, buhoro buhoro agarura imbaraga z'imitsi kugeza ku byiciro 5. Ku ya 22 Ugushyingo, yimuriwe mu ishami rishinzwe guhinduranya kugira ngo yitegure guhindurwa ingirabuzimafatizo ya allogeneic hematopoietic stem selile.
