Acute Lymphoblastic Leukemia(T-ALL)-02

Clinical Features:

- Kuongororwa: Acute T-cell lymphoblastic leukemia

- Kutanga: Pakupera kwaKurume 2018

-Kutanga zviratidzo: Multiple pamusoro pepamusoro lymph node kuwedzera mumuviri wese

- Yekutanga maitiro eropa: WBC: 39.46*10^9/L, Hb: 129g/L, PLT: 77*10^9/L

- Bone marrow morphology: 92% kuputika

-Flow cytometry: 95.3% masero asina kukwana anotaura

TdT+CD99+CyCD3+CD7stCd5DdimCD4-CD8-mCD3-CD45dim

- Fusion majini: Negative

-Gene shanduko: NOTCH1 gene mutation yaonekwa

- Chromosome kuongororwa: Normal karyotype

Nhoroondo Yekurapa:

- Kubvumbi 3, 2018: Induction therapy neVDCP regimen

- Kubvumbi 18, 2018: Kuputika kwemapfupa kunosanganisira 96%

- Kubvumbi 20, 2018: Yakawana kuregererwa mushure meCAG regimen

- Chivabvu 18, 2018: Consolidation therapy neCMG + VP regimen

- June 22, 2018: Bone marrow blasts yakawedzera kusvika 40%, kudzokazve kweleukemia

- Chikunguru 25, 2018: CLAM regimen (clarithromycin+cyclophosphamide+amikacin)

- Hematopoietic stem cell transplantation kubva kuHLA-inofananidzwa sibling uchishandisa FLU+BU conditioning musi wa14 Nyamavhuvhu.

- Kuongorora mushure mekutapurirana: Kuregererwa kwemapfupa morphology pamwedzi 1, mwedzi mitatu, mwedzi mitanhatu, mwedzi 9, uye mwedzi gumi neimwe.

-Bone marrow morphology yakaratidza kuregererwa pamwedzi gumi nematanhatu mushure mekutapurirana, nekuyerera kwe cytometry ichiratidza 0.02% yakaipa immature lymphocytes.

- Mbudzi 13, 2020: Peripheral blood chimerism kubva kune donor source yaive 97.9%

- Peripheral ropa primitive masero: 20%

- Zvita 18, 2020: Bone marrow morphology: 60.6% kuputika

- Flow cytometry: 30.85% yakashata immature T lymphocytes

-Kuongorora kwechromosome: 46, XY (20)

- Yakagamuchira DA regimen chemotherapy muna Ndira 19, 2021

- Bone marrow morphology muna Ndira 19, 2021: Giredhi III hyperplasia, 16% kuputika

- Chromosome karyotype kuongororwa: 46, XY (20)

Kuyerera kwe cytometry: 7.27% yemasero (pakati pemaseru enyukireya) yakaratidza CD99bri, CD13, CD38, cbcl-2, cCD3, HLA-ABC bri, CD7bri, uye zvishoma yakaratidza CD5dim, zvichiratidza zvakaipa immature T lymphocytes.

- Leukemia fusion gene kuongorora: Negative

- Ropa mutation mutation kuongororwa (86 marudzi):

1. PHF6 K299Efs*13 mutation positive

2. RUNX1 S322* mutation positive

3. FBXW7 E471G shanduko yakanaka

4. JAK3 M511I mutation positive

5. NOTCH1 Q2393* mutation positive

Kurapa:

- Ndira 22: Kuunganidzwa uye tsika yeautologous peripheral blood lymphocytes yeCD7-CART

- Pamberi peCD7-CART infusion, murwere akagamuchira VLP (vincristine, l-asparaginase, prednisone) pamwe nebortezomib chemotherapy.

- Kukadzi 3: FC regimen chemotherapy (Flu 50mg kwemazuva matatu + CTX 0.45g kwemazuva matatu)

- Kukadzi 5 (pre-infusion): Bone marrow morphology yakaratidza 23% kuputika.

- Flow cytometry yakaratidza 4.05% masero anoratidza CD99bri, CD5dim, CD7bri, TDT, cCD3, zvichiratidza zvakashata immature T lymphocytes.

-Kuongorora kwechromosome: 46, XY (20)

- Chimerism analysis (post-HSCT): Masero evanopa-anotorwa akaenzana ne52.19%.

- February 7: Infusion ye autologous CD7-CART masero pamutengo we5 * 10 ^ 5 / kg.

- Kukadzi 15: Peripheral ropa immature masero akaderedzwa kusvika 2%.

- Kukadzi 19 (Zuva 12 mushure mekunyudzwa): Murwere akatanga fivha, iyo yakagara kwemazuva mashanu kusati kwaitwa tembiricha.

- Kurume 2: Bone marrow ongororo yakaratidza kuzere morphological kuregererwa, nekuyerera kwe cytometry isingaone masero asina kukwana.