Acute Lymphoblastic Leukemia(B-ALL)-02

Mamiriro ezvinhu:

- Chivabvu 19, 2019: Akaonekwa aine acute B-cell lymphoblastic leukemia (B-ALL)

- Inoratidzwa neakawanda scalp masasi uye lymphadenopathy

- Kurongeka kweropa: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, abnormal lymphocytes 4%

- Bone marrow morphology: 80.2% immature lymphoblasts (kuputika)

- Immunophenotyping: 74.19% yemasero akaipa B-lineage precursor masero anoratidza CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, chikamu chinoratidza cIgM. Kuongororwa: B-ALL (Pre-B nhanho)

- Fusion gene: MLL-ENL yakanaka, Philadelphia chromosome-yakafanana (Ph-yakafanana) skrini isina kunaka

- Chromosome: 46, XX, t(11;19)(q23;p13), del(20)(q12) [3]/46, XX [7]

- VDLD regimen chemotherapy yakatanga kuwana immunological remission mushure memwedzi 1, MLL-ENL yakawanda PCR 0.026%

- Inoenderera mberi chemotherapy maererano neprotocol yevana, MLL-ENL yehuwandu PCR 0 mushure mekutenderera kwe4. Imwezve chemotherapy yakapfuurira.

- Kurume 2020: Bone marrow immunological residual chirwere 0.35%, MLL-ENL yehuwandu PCR 0.53%, ichiratidza maitiro ekudzokera kumashure. Mhuri yakaramba kusiiwa. Kuenderera mberi chemotherapy ye3 cycles.

- Chikunguru 2020: Bone marrow akadzokazve zvizere.

- Mbudzi 11, 2020: Intrathecal chemotherapy, CSF immunological residual chirwere 66%, akaonekwa aine central nerve system leukemia. Intrathecal chemotherapy yakadzokororwa kaviri, CSF yakashanduka isina kunaka.

- Zvita 31, 2020: Kugamuchirwa kuchipatara chedu.

- Kurongeka kweropa: WBC 3.99 x 10^9/L, HGB 66 g/L, PLT 57 x 10^9/L

- Peripheral kuputika kweropa kuverenga: 69%

- Bone marrow morphology: 90% immature lymphoblasts (kuputika)

- Immunophenotyping: 84.07% yemasero anoratidza CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, chikamu cheCD24, CD15dim, zvichiratidza zvakashata immature B lymphoblasts.

- Fusion gene: MLL-ENL fusion gene yakanaka, yakawanda PCR 44.419%

-Genetic mutation: KMT2D mutation yakanaka (germline mabviro)

- Chromosome karyotype: 46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3), wedzera( 14)(q34), -17, +mar [7]/46, idem, t(3;16)(p21;p13.3) [1]/46, XX [13]

- PET-CT: Kuparadzanisa kuwedzera kwemetabolism mune yese skeletal uye bone marrow mhango, kunyumwira kukuru kwekudzokazve kweleukemia; splenomegaly nekuwedzera kwemetabolism, zvichida inosanganisira leukemia.

- Yakaitwa lumbar puncture uye intrathecal chemotherapy kamwe chete, hapana kukanganisa kunowanikwa mune CSF-inoenderana bvunzo.

Kurapa:

- Vhiki mbiri dzeVLP chemotherapy, peripheral ropa rinoputika 5% muna Ndira 18.

- January 25: Peripheral ropa rinoputika 91%, rinorapwa neCTX, Ara-C, 6-MP chemotherapy.

- February 3: Peripheral ropa rinoputika 22%.

- Kukadzi 4: Kuunganidzwa kwe50ml autologous peripheral ropa yeCD19-CART cell tsika.

- MTX 1g, FC chemotherapy (Flu 15mg zuva nezuva x 3 mazuva, CTX 0.12g zuva nezuva x 3 mazuva).

- February 13 (pre-infusion): Bone marrow morphology inoratidza 87.5% kuputika, kuyerera kwe cytometry kunoratidza 79.4% kuputika kwakashata.

- MLL-ENL fusion gene quantitative analysis: 42.639%.

- February 14: Infusion yeCART masero pachiyero che5 x 10 ^ 5 / kg.

- CAR-T-yakabatana yakashata mhedzisiro: Giredhi 1 CRS (fivha), hapana neurotoxicity.

- Zuva rechi20 post-infusion: Ropa smear inoratidza bundu kuwedzera, CART cell chikamu 0.07%.

- Kusashanda CART cell therapy.

- Kurume 8, 2021: Maitiro eropa: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- Peripheral ropa kuputika: 83%. Autologous peripheral blood yakaunganidza 60ml yeCD19/CD22 mbiri mbiri CART cell tsika.

- Yakarapwa ne cytarabine uye dexamethasone kudzora bundu mutoro.

- Kurume 18: FC chemotherapy (Flu 15mg zuva nezuva x 3 mazuva, CTX 0.12g zuva nezuva x 3 mazuva).

- Kurume 22 (pre-infusion): Maitiro eropa: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Peripheral ropa morphology: 6% kuputika.

- Bone marrow morphology: 91% kuputika. Zvisaririra mumwongo: 88.61% masero anoratidza CD38, CD19, cCD79a, CD81, CD22, zvichitaridza malignant immature B lymphoblasts.

- MLL-ENL fusion gene quantitative analysis: 62.894%.

- Chromosome karyotype ongororo: 46, XX, del(1)(p36.1), del(11)(q13), t(11;19)(q23;p13.3), wedzera(14)(q34), - 17, +mar [2]/46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3) ), wedzera(14)(q34).

- Kurume 23: Kuiswa kwemasero eCART pachiyero che3 x 10 ^ 5 / kg.

- Kurume 26 zvichienda mberi: Kuramba kuchipisa kupisa uye kuzoita systemic edema.

- March 29: Peripheral ropa morphology: 92% kuputika; yakakwira transaminases uye bilirubin.

- Kubvumbi 2: Kutanga kwekubatwa, kurapwa nediazepam.

- Kubvumbi 2 (Zuva 10): Yakatanga methylprednisolone kurapwa kwemazuva matatu.

-CRS maitiro: Giredhi 3, CRES: Giredhi 3.

- Kubvumbi 8 (Zuva 16): Kuongororwa kwemwongo wemapfupa kunoratidza kuregererwa kwakakwana kwe morphological, kuyerera kwe cytometry yakaipa kune kuputika kwakashata; MLL-ENL fusion gene quantitative analysis: 0.