Acute Lymphoblastic Leukemia(B-ALL)-01

Mwoyo murefu: Munhu XX

Gender:Murume

Age: ane makore 24

Nyika: Chinese

Kuongororwa:Acute Lymphoblastic Leukemia (B-ALL)

Taura nesu

Akaonekwa aine acute B-cell lymphoblastic leukemia musi waNovember 28, 2017.

Kurapa neVDLP regimen pakutanga, kuwana kuregererwa kwemwongo wemapfupa (mashoko asina kutaurwa).

Kukadzi 2018: Kuchinjira kuchirongwa cheVLCAM. Bone marrow flow cytometry yakaratidza 60.13% yakaipa immature B masero.

Kurume 2018: Akanyoresa muBiTE kiriniki yekuedza. Morphological remission mumwongo wemapfupa, hapana masero asina kunaka anoonekwa nekuyerera cytometry.

Chivabvu 8, 2018: Yakagamuchira TBI/CY+VP16 conditioning regimen inoteverwa neallogeneic stem cell transplant kubva kuhanzvadzi yakanyatsoenderana (AB+ donor kune A+ anogamuchira). Neutrophil kupora pazuva +11, megakaryocyte kupora pazuva +12.

Zvita 5, 2018: Yakazara morphological remission mumwongo wemapfupa, hapana masero asina kunaka anoonekwa nekuyerera cytometry. Yakagamuchira donor lymphocyte infusion (DLI) uye prophylactic kurapwa ne dasatinib uye imatinib kudzivirira kudzoka zvakare.

Kukadzi 2, 2019: Morphology yakaratidza 6.5% immature cells, flow cytometry yakaratidza 0.08% yakaipa immature B lymphoblasts. Yakagamuchira DLI therapy. Kurume 28, 2019: Flow cytometry yakaratidza kusajairika.

Nyamavhuvhu 11, 2019: Bone marrow kudzokazve, kurapwa nedasatinib.

Gunyana 2, 2019: Morphology yakaratidza 3% immature masero, kuyerera cytometry yakaratidza 0.04% yakashata immature masero. Kuenderera mberi nekurapa ne dasatinib, inoteverwa ne 2 cycles ye methotrexate chemotherapy.

Chivabvu 11, 2020: Bone marrow kudzoka zvakare.

Yakagamuchira maviri autologous CD19-CAR-T cell therapies uye maviri allogeneic CD19-CAR-T cell therapies muna 2020, hapana akawana kuregererwa.

Gumiguru 26, 2020: Akapinzwa muchipatara chedu.

Murabhoritari Zvakawanikwa:

Nguva yeropa: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Peripheral ropa immature masero: 63%

Bone marrow morphology: Hypercellular (giredhi II), 96% immature lymphoblasts.

Immunophenotyping: Masero anoratidza CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; chikamu cheCD123. Kuzivikanwa seanokuvadza immature B lymphoblasts.

Mutation yebundu reropa: Negative.

Leukemia fusion gene: NUP214-ABL1 fusion gene yakanaka.

Kuongorora kwechromosome: 46, XX, t(1;9)(p34;p24), wedzera(11)(q23)[4]/46, XX, t(1;9)(p34;p24), wedzera(11) (q23)x2 [2]/46, XX[3]

Chimerism: Masero anopihwa-anopihwa anoverengera 7.71%.

Kurapa:

- VDS, DEX, LASP chemotherapy regimen inopihwa.

- Mbudzi 20: Peripheral ropa immature masero 0%.

-Kuunganidzwa kweautologous peripheral blood lymphocytes yeCD19/22 mbiri mbiri CAR-T cell tsika.

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

- Zvita 2 (pamberi peCAR-T cell infusion):

- Kurongeka kweropa: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- Bone marrow morphology: Hypercellular (giredhi IV), 68% immature lymphoblasts.

- Quantitative assessment yeNUP214-ABL1 fusion gene: 24.542%.

- Kuyerera kwe cytometry: 46.31% yemasero anoratidza CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, zvichiratidza zvakashata immature B lymphoblasts.

- Zvita 4: Infusion ye autologous CD19/22 dual CAR-T masero (3 x 10 ^ 5 / kg).

- CAR-T yakabatana nemigumisiro: Grade 1 CRS, fever paZuva 6 neTmax ye40 ° C, fever inodzorwa neZuva 10. Hapana neurotoxicity yakaonekwa.

- Zvita 22 (Zuva 18 kuongorora): Morphological kuregererwa kwakakwana mumwongo wepfupa, hapana masero akashata asina kukwana akaonekwa nekuyerera kwe cytometry. Quantitative assessment yeNUP214-ABL1 fusion gene: 0%.