Acute Lymphoblastic Leukemia(B-ALL)-03

Mea Fa'apitoa:

- Na maua i le ma'i B-cell lymphoblastic leukemia i le fa'ai'uga o Me 2020.

- Fa'asologa o le toto: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- Fa'avasegaga o ga'o ivi: Hypocellular ma 67% lymphocytes muamua.

- Flow cytometry: 82.28% o sela e faʻaalia CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, faʻaalia vaega CD9, faʻaalia vaivai le CD13.

- Fa'aletonu su'esu'ega o kenera fusi; WT1 57.3%; leai se PH-pei o ALL-fesoasoani genes iloa.

- I'A: TP53 suiga lelei.

- 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].

- Maua le VCDLP mo vasega 2 e aunoa ma se fa'amagaloga.

- CAM-VL regimen (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) ia Iulai 22, 2020, e aunoa ma se faʻamagaloga.

- Cytometry o le tafe o ga'o ponaivi i le aso 25 o Setema, 2020: 7.35% o sela e fa'aalia le CD81, CD19, CD10, CD38, CD33, vaivai le fa'aalia CD20, CD45.

- Su'esu'ega suiga ole toto toto: TP53 suiga.

- Chromosomes: 46, XY[20].

- Na amata togafitiga CD19-CART.

- FC regimen (FLU 62.7mg x 4 aso, CTX 1045mg x 2 aso) chemotherapy.

- Oketopa 1, 2020: Autologous CD19-CART sela tui ile 4.7x10^7/kg.

- CRS vasega 2 ma le vasega 1 neurotoxicity, faʻaleleia pe a maeʻa togafitiga lagolago.

- Oketopa 29, 2020: Fa'amagaloga atoatoa i le ga'o o ponaivi, leai ni sela fa'aleaga muamua ile cytometry tafe.

- Tesema 31, 2020: Tale mago, faufau, pua'i, vaivai lautele.

- Fa'asologa o le toto: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- Mana'o o ga'o ponaivi e ta'u mai ai le toe fa'afo'i.

- Ianuari 2, 2021: Faʻatagaina i le matou falemaʻi.

- Fa'asologa o le toto: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

- Creatinine 134umol/L, tulaga 3 maualuga maualuga, tala'aga faafomai o le 4 tausaga.

- Fa'avasegaga toto pito i luga: 62% sela muamua.

- Immunophenotyping: 28.48% o sela (nucleated sela) fa'aalia le CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, fa'aalia vaega CD123, TDT, aua le fa'aalia CD34, CD19, MPO, CD19, MPO. , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, o loʻo faʻaalia ai lymphocytes muamua B maʻi.

- Su'esu'ega o suiga ole toto toto: TP53 R196P suiga lelei.

Togafitiga:

- Maua VLP chemotherapy, faʻatasi ai ma togafitiga mo le toto maualuga, faʻaitiitia o le creatinine, ma le faʻamamaina o le alkalinization.

- Ianuari 19: Fa'asologa o le toto na fa'aalia le WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Fa'avasegaga o le toto pito i luga: Leai ni lymphocytes muamua.

- Fa'avasegaga o ga'o o ponaivi: Hypercellularity (Vaega V), vaega fa'apitoa ole vasega IV, fa'atasi ai ma le 42% o lymphocytes muamua.

- Flow cytometry: 13.91% o sela o loʻo faʻaalia CD10, cCD79a, CD38, CD81, CD22, e le faʻaalia CD20, CD34, CD19, faʻaalia o sela B maʻi muamua.

- 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,faaopoopo(1)(q42),- 2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].

- Ianuari 20: Lymphocytes aoina mo le CD22-CART tu ma aga.

- Ianuari 21: Fa'atino tu'uga lumbar, fa'ata'ita'i le chemotherapy e puipuia ai le leukemia o le tino; Ole su'esu'ega ole sua ole cerebrospinal e leai ni fa'aletonu.

- Ianuari 22: Maua Arac, 6MP, L-ASP chemotherapy, ma FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.

- Fepuari 7 (a'o le'i fa'asusu): O le su'esu'e o ponaivi na fa'aalia ai le 93% o lymphocytes muamua.

- Flow cytometry: 76.42% o sela e faʻaalia CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, aua le faʻaalia CD4, CD3, CD13+33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), faʻaalia o sela B maʻi muamua.

- Atia'e le pa'u ma a'ano vaivai ile fiva; faʻaleleia pe a maeʻa togafitiga faʻamaʻi.

- Fepuari 9: Autologous CD22-CART tui sela (5x10^5/kg).

- A'afiaga a'afiaga a le CAR-T: CRS grade 1, fiva ile Aso 6 ma le Tmax 40°C, pulea le vevela ile Aso 10; leai se neurotoxicity.

- Mati 11: O su'esu'ega o ga'o o ponaivi na fa'aalia ai le fa'amagaloga atoatoa, o le flow cytometry e le'i fa'aalia ai ni sela fa'aleaga.