Leukemia ba'an ee Lymphoblastic (B-ALL) -01

Bukaan: Qofka XX

Jinsiga: lab

Da'da: 24 jir

Dhalashada: Shiine

ogaanshahaLeukemia ba'an oo Lymphoblastic ah (B-ALL)

Nala soo xidhiidh

Waxaa lagu ogaadey cudurka leukemia ba'an ee unugyada B-cell lymfoblastic bishii Noofambar 28, 2017.

Daawaynta nidaamka VDLP marka hore, gaaritaanka qayb ka mid ah dhuuxa lafta ka-dhaafitaan (faahfaahinta lama soo sheegin).

Febraayo 2018: Loo beddelay nidaamka VLCAM. Sitometry socodka dhuuxa lafta ayaa muujisay 60.13% unugyada B ee aan qaan-gaarin.

Maarso 2018: Ka diiwaan gashan tijaabada caafimaad ee BiTE. Cafiska maskaxeed ee dhuuxa lafta, ma jiro unug aan qaangaarin oo xun oo lagu ogaaday cytometry socodka.

Meey 8, 2018: Helay nidaamka qaboojinta TBI/CY+VP16 oo ay ku xigto xubinta taranka unugyada asliga ah ee walaalka si buuxda u dhigma (ku-deeqaha AB+ ee qaataha A+). Soo kabashada Neutrophil ee maalinta +11, soo kabashada megakaryocyte maalinta +12.

Diseembar 5, 2018: Dhamaystir cafis maskaxeed oo ku jira dhuuxa lafta, ma jiraan unugyo xun oo aan qaan-gaarin oo lagu ogaaday cytometry socodka. La helay faleebo ku-deeqaha lymphocyte (DLI) iyo daaweynta ka hortagga dasatinib iyo imatinib si looga hortago soo noqoshada.

Feebarwari 2, 2019: Cilmi-nafsigu wuxuu muujiyay 6.5% unugyo aan qaan-gaarin, cytometry qulqulka ayaa muujisay 0.08% malignant B lymphoblasts. La helay daawaynta DLI. Maarso 28, 2019: Cytometry socodka socodka ma muujin wax aan caadi ahayn.

Agoosto 11, 2019: dhuuxa lafta oo soo laabatay, oo lagu daweeyay dasatinib.

Sebtembar 2, 2019: Cilmi-nafsiga wuxuu muujiyay 3% unugyo aan qaan-gaarin, cytometry socodka qulqulka ayaa muujiyay 0.04% unugyo aan qaan-gaarin. Daawaynta joogtada ah ee dasatinib, oo ay ku xigto 2 wareeg oo daaweynta kemotrexate ee methotrexate.

Meey 11, 2020: dhuuxa lafta ayaa soo noqnoqonaysa mar kale.

La helay 2 daawaynta unugga ee CD19-CAR-T iyo 2 allogeneic CD19-CAR-T daawaynta unug gudaha 2020, midna cafis laguma helin.

Oktoobar 26, 2020: Waxa la dhigay cusbitaalkayaga.

Natiijooyinka Shaybaadhka:

Joogtada dhiigga: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Unugyada aan qaan-gaarin ee dhiigga ku wareegsan: 63%

Qaab-dhismeedka dhuuxa lafta: Hypercellular (fasalka II), 96% lymphoblasts aan qaan-gaarin.

Immunophenotyping: Unugyadu waxay muujinayaan CD19, cCD79a, CD38dim, CD10bri, CD34, CD81dim, CD24, HLA-DR, TDT, CD22, CD72; muujinta qayb ka mid ah CD123. Loo aqoonsaday inuu yahay B lymfoblast oo aan qaan-gaarin.

Blood tumor mutation: Negative.

Hiddaha isku dhafka leukemia: NUP214-ABL1 hidde-sideyaasha fiyuuska oo togan.

Falanqaynta Chromosome: 46, XX, t(1;9)(p34;p24), kudar(11)(q23)[4]/46, XX, t(1;9)(p34;p24), kudar(11) (q23) x2 [2]/46, XX[3]

Chimerism: Unugyada ku-deeqaha-deeqaha ayaa xisaabiya 7.71%.

Daaweynta:

- VDS, DEX, daawaynta kimoterabiga LASP ayaa la maamulaa.

- Noofambar 20: Unugyada aan qaan-gaarin ee ku wareegsan dhiigga 0%.

-Ururinta lymphocytes dhiigga ee durugsan ee CD19/22 labada dhaqan ee unugyada CAR-T.

- Noofembar 29: daawaynta kimikalka ee FC (Flu 50mg x 3, CTX 0.4gx 3).

- Diseembar 2 (kahor faleebada unugyada CAR-T):

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

- Qaab-dhismeedka dhuuxa lafta: Hypercellular (fasalka IV), 68% lymphoblasts aan qaan-gaarin.

- Qiimaynta tirada ee NUP214-ABL1 hidda-wadaha fusion: 24.542%.

- Sitometry socodka: 46.31% unugyadu waxay muujinayaan CD38dim, CD22, BCL-2, CD19, CD10bri, CD34, CD81dim, CD24, cCD79a, taasoo muujinaysa B lymfoblasts aan qaan gaadhin.

- Diseembar 4: Faleebo iswada CD19/22 unugyo CAR-T ah (3 x 10^5/kg).

- Waxyeellooyinka CAR-T ee la xidhiidha: Fasalka 1 CRS, qandho maalinta 6 oo leh Tmax ee 40 ° C, qandho la xakameynayo maalinta 10. Wax neurotoxicity ah lama arag.

Diseembar 22 (Qiimaynta Maalinta 18): Dhafnaanta dhammaystiran ee maskaxeed ee dhuuxa lafta, ma jiraan unugyo aan qaan-gaarin oo lagu ogaado cytometry socodka. Qiimaynta tirada NUP214-ABL1 hidda-wadaha fusion: 0%.