Kuregererwa Kwemurwere T-ALL Murwere ane Central Nervous System Leukemia Mushure meCAR-T Therapy
Mhosva iyi ine chekuita nemukomana ane makore gumi nematanhatu anobva kuNortheast China, ane rwendo rweleukemia rwanga rwuzere nematambudziko kubva paakaongororwa gore rapfuura.
Musi waMbudzi 8, 2020, Dawei (zita rekunyepedzera) akashanyira chipatara cheko nekuda kwekuoma kwechiso, mapundu, uye muromo wakatsveyama. Akaonekwa kuti ane "acute lymphoblastic leukemia (T-cell type)." Mushure meimwe induction chemotherapy course, MRD (diki residual disease) yakanga isina kunaka, ichiteverwa nekemotherapy yenguva dzose. Munguva iyi, kuputika kwemwongo wemapfupa, kuputika kwechiuno, uye jekiseni reintrathecal zvakaratidza kusakanganiswa.
Musi waChivabvu 6, 2021, kubaya kwechiuno nejekiseni remukati-kati kwakaitwa, uye ongororo yecerebrospinal fluid (CSF) yakasimbisa "central nervous system leukemia." Izvi zvakateverwa nekosi mbiri dzenguva dzose chemotherapy. Musi waChikumi 1, kuputika kwechiuno neCSF kuongororwa kwakaratidza maseru asina kukura. Matatu ekuwedzera lumbar puncture ane intrathecal majekiseni akaiswa, uye yekupedzisira CSF bvunzo ichiratidza pasina bundu masero.
Musi waChikunguru 7, Dawei akaona kurasikirwa kwekuona muziso rake rekurudyi, kwakaderedzwa kusvika pakuona kwechiedza chete. Pashure peimwe kosi yechemotherapy yakasimba, kuona kwake ziso rekurudyi kwakadzokera kune zvakajairika.
Musi waNyamavhuvhu 5, ziso rake rekurudyi rakatadzazve kuona, zvichiita kuti ave upofu hwakakwana, uye ziso rake rekuruboshwe rakava nerima. Kubva munaAugust 10 kusvika ku13, akarapwa uropi hwose uye spinal cord radiotherapy (TBI), iyo yakadzorera kuona muziso rake rekuruboshwe, asi ziso rekurudyi rakaramba risingaoni. Musi waNyamavhuvhu 16, MRI scan yehuropi yakaratidza kuvandudzwa kudiki mukukora kwerudyi rweoptic nerve uye chiasm, nekuvandudzwa kwakaonekwa. Hapana zviratidzo zvisina kujairika kana zvigadziriso zvakawanikwa muuropi parenchyma.
Panguva iyi, mhuri yakanga yagadzirira kuisirwa mwongo, ichingomirira mubhedha muwadhi yokuisirwa. Nehurombo, bvunzo dzenguva dzose dzepre-transplant dzakaratidza nyaya dzakaita kuti kuisirwa kusaite.
Musi waNyamavhuvhu 30, kubvongodzwa kwemwongo wepfupa kwakaitwa, zvichiratidza mwongo MRD ine abnormal immature T lymphocytes accounting ye61.1%. A lumbar puncture ne intrathecal jekiseni yakaitwa zvakare, ichiratidza CSF MRD ine 127 yese masero, ayo abnormal immature T lymphocytes aisanganisira 35.4%, zvichiratidza kudzoka zvachose kweleukemia.
Musi waNyamavhuvhu 31, 2021, Dawei nemhuri yake vakasvika paYanda Lu Daopei Hospital uye vakapinzwa muwadhi yechipiri yedhipatimendi rehematology. Kubvuma kuongororwa kweropa kwakaratidza: WBC 132.91 × 10 ^ 9 / L; peripheral blood differential (morphology): 76.0% kuputika. Induction chemotherapy yakaitwa kune imwe kosi.
Mushure mekuongorora marapirwo akaitwa naDawei, zvaive pachena kuti T-ALL yake yaive refractory / yakadzokororwa uye kuti masero ebundu akange apinda muuropi, zvichikanganisa tsinga yemaziso. Chikwata chezvechiremba chinotungamirwa naDr. Yang Junfang muwadhi yechipiri yehematology chakaona kuti Dawei akasangana negwara rekunyoresa muCD7 CAR-T yekiriniki yekuedza.
Musi waSeptember 18, kumwe kuongorora kwakaitwa: peripheral blood differential (morphology) yakaratidza 11.0% kuputika. Peripheral blood lymphocytes yakaunganidzwa kuCD7 CAR-T cell tsika pazuva rimwe chete, uye maitiro akafamba zvakanaka. Mushure mekuunganidzwa, chemotherapy yakaitwa kugadzirira CD7 CAR-T cell immunotherapy.
Munguva yechemotherapy, masero emamota akawedzera nekukurumidza. Musi waGumiguru 6, iyo peripheral blood differential (morphology) yakaratidza 54.0% kuputika, uye chemotherapy regimen yakagadziridzwa kuderedza bundu mutoro. Musi waOctober 8, pfupa rekuongorora morphology yakaratidza 30.50% kuputika; MRD yakaratidza kuti 17.66% yemasero aive akaipa immature T lymphocytes.
Musi wa9 Gumiguru, masero eCD7 CAR-T akadzorerwa. Mushure mokuisirwazve, murwere akanzwa fivha inodzokororwa uye marwadzo emazingamu. Pasinei nekuvandudzwa kwemishonga inorwisa utachiona, fivha haina kunyatsodzorwa, kunyange zvazvo marwadzo echingamu akadzikira zvishoma nezvishoma.
Pazuva re11 mushure mekudzorerazve, kuputika kweropa kweperipheral kwakawedzera kusvika ku54%; pazuva regumi nemaviri, kuongororwa ropa kwakaratidza masero machena eropa achikwira kusvika ku16 × 10 ^ 9/L. Pazuva rechigumi nemana mushure mekuiswazve, murwere akaita CRS yakaipisisa, kusanganisira kukuvara kwemyocardial, kusashanda zvakanaka kwechiropa neitsvo, hypoxemia, kubuda ropa kwemudumbu kuderera, uye kugwinha. Zvirwere zvehasha zvezviratidzo uye zvinotsigira, pamwe chete nekuchinjana kweplasma, zvishoma nezvishoma zvakavandudza kushanda kwenhengo dzakakanganiswa, kudzikamisa zviratidzo zvakakosha zvemurwere.
Pana Gumiguru 27, murwere aive ne0-giredhi remhasuru simba mumakumbo ese ezasi. Musi waGumiguru 29 (mazuva makumi maviri neshanu mushure mekudzorerazve), bvunzo dzeMRD dzemafupa dzakashanduka dzisina kunaka.
Mumamiriro ekuregererwa kwakakwana, Dawei akasimbisa basa rake rezasi nerubatsiro rwevanamukoti nemhuri, zvishoma nezvishoma achiwana simba remhasuru kusvika kumagiredhi mashanu. Musi waMbudzi 22, akaendeswa kudhipatimendi rekudyara kuti agadzirire allogeneic hematopoietic stem cell transplant.
