Acute Lymphoblastic Leukemia(T-ALL)-01

Clinical features:

- Kuongororwa: T-cell lymphoblastic lymphoma / leukemia

- Kurume 2020: Yakaratidzwa ine paroxysmal kukosora uye mediastinal mass, yakasimbiswa T-cell lymphoblastic lymphoma ne mediastinal mass puncture biopsy.

- Yakagamuchira 8 kutenderera kwechemotherapy uye anopfuura makumi maviri masesheni eradiotherapy, zvichikonzera kudzikiswa kwakanyanya kwe mediastinal mass.

- Ndira 16, 2021: Yakagadziridzwa marwadzo mugumbo rezasi rekurudyi.

- Kurongeka kweropa: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- Bone marrow morphology: 95.5% primitive lymphoblasts.

- Bone marrow flow cytometry: 91.77% yemasero aive asina kukwana T-cell lymphoblasts.

-Genetic sequencing: Shanduko muNOCH1, IL7R, ASXL2 majini akaonekwa.

- Yakagamuchira Hyper-CVAD/B regimen, ESHAP regimen yakazotevera, zvese zvisingaite nefivha inoramba iripo.

- Kukadzi 18, 2021: Kugamuchirwa kuchipatara chedu.

- Yakaratidzwa nefivha, chifuva CT chakaratidza mabayo.

- Kurongeka kweropa: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Peripheral ropa immature masero: 90%

- Bone marrow morphology: Hypercellular (IV giredhi), 85% primitive lymphoblasts.

- Immunophenotyping: 87.27% yemasero akanga akaipa primitive T-cell lymphoblasts.

- Chromosomal kuongorora: 46,XX [24]; matatu ekuwedzera abnormal karyotype akaonekwa.

- Mutated majini:

1. IL7R T244_I245insARCPL mutation positive

2. NOTCH1 E1583_Q1584dup mutation positive

3. ASXL2 Q602R mutation positive

- Leukemia fusion gene kuongorora: Negative

- PET / CT mhedzisiro: Hapana yakakosha hypermetabolic tumor foci mune yese skeleton uye mwongo mhango.

Kurapa:

- Yakatanga VP regimen chemotherapy, yakatsanangurwa sezvinotevera: Vincristine (VDS) 3mg kamwe, Dexamethasone (Dex) 7mg maawa ose e12 kwemazuva 9, pamwe chete nemishonga inorwisa-infective.

- Kurume 1: Peripheral ropa immature masero akaderedzwa kusvika 7%.

- Kurume 4: Yakaunganidzwa autologous lymphocytes yeCD7-CAR T cell tsika.

- Kurume 8: Vakatanga chirongwa cheVLP chakasanganiswa neSida benzamine kurapwa.

- March 14: Yakagamuchira FC regimen chemotherapy (Fludarabine 0.35g kwemazuva matatu, Cyclophosphamide 45mg kwemazuva 3).

- Kurume 17 (pre-cell infusion):

- Bone marrow residual immunophenotyping: 15.14% masero anoratidza CD7 inopenya, CD3 dim, cytoplasmic CD3, T cell receptor restricted delta (TCRrd), chikamu chemashoko eCD99, zvichiratidza masero ekare ekutanga T.

- March 19: Infused autologous CD7-CAR T masero (1 x 10 ^ 6 / kg).

- CAR-T inoenderana nemhedzisiro: Giredhi 1 CRS (fivha), hapana neurotoxicity.

- Kubvumbi 6 (Zuva 17): Bone marrow morphology yakaratidza kuregererwa, kuyerera kwe cytometry haina kuona masero ekare akaipa.