Leukemia ba'an ee Lymphoblastic (B-ALL) -02

Astaamaha Kiis:

- Meey 19, 2019: Waxaa lagu ogaadey ba'an B-cell lymphoblastic leukemia (B-ALL)

- Lagu soo bandhigay tiro badan oo maqaarka madaxa ah iyo lymphadenopathy

- Joogtada dhiigga: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, limfosaytis aan caadi ahayn 4%

- Qaab-dhismeedka dhuuxa lafta: 80.2% lymphoblasts aan qaan-gaarin (qaraxyo)

- Immunophenotyping: 74.19% unugyadu waa unugyo horudhac u ah B-lineage malignant oo muujinaya CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, qayb ahaan muujinaya cIgM. Cilad-sheegid: B-ALL (marxaladda B ka-hor)

Hidde-sidaha Fusion: MLL-ENL togan, Philadelphia koromosoom u eg (Ph-like) shaashadda taban

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

- Dawaynta kemotherabi ee VDLD ayaa markii hore lagu gaadhay cafis difaac 1 bil ka dib, MLL-ENL tirada PCR 0.026%

- Kemotherabi oo sii socota sida ku cad borotokoolka carruurta, MLL-ENL tirada PCR 0 ka dib wareegga 4aad. Kiimoterabi dheeraad ah ayaa sii socday.

- Maarso 2020: Cudurka haraa ee dhuuxa lafta difaaca jirka 0.35%, MLL-ENL tirada PCR 0.53%, taasoo muujinaysa isbeddel ku wajahan soo noqoshada. Qoyska ayaa diiday in la beero. Kiimoterabiga oo sii socda 3 wareeg.

- Luulyo 2020: dhuuxa lafta ayaa dib u soo noqday si guud.

- Noofembar 11, 2020: Daaweynta kiimikaad intrathecal, CSF haraaga difaaca jirka 66%, laga helay leukemia habka dhexe ee neerfayaasha. Kemotherabi intrathecal ayaa lagu celceliyay laba jeer, CSF waxay noqotay diidmo.

- Diseembar 31, 2020: Waxa la dhigay cusbitaalkayaga.

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

- Tirada qaraxa dhiigga ee ku wareegsan: 69%

- Qaab-dhismeedka dhuuxa lafta: 90% lymphoblasts aan qaan-gaarin (qaraxyo)

- Immunophenotyping: 84.07% unugyadu waxay muujinayaan CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, qayb ahaan cad CD24, CD15dim, taasoo muujinaysa B lymphoblasts aan qaan gaadhin.

Hidde-sidaha isku-dhafka ah: MLL-ENL hidda-wadaha isku-dhafka ah ee togan, tirada PCR 44.419%

- Isbeddellada hidda-socodka: KMT2D isbeddelka togan (asalka jeermiga)

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

- PET-CT: Kororka dheef-shiid kiimikaadka oo dhan ee lafaha lafaha iyo dhuuxa lafta, shakiga sare ee dib u soo noqoshada leukemia; splenomegaly oo leh dheef-shiid kiimikaad kordhay, oo ay u badan tahay inay ku lug leedahay leukemia.

- Waxaa la sameeyay daloolin lumbar ah iyo kiimoterabi intrathecal hal mar, wax aan caadi ahayn oo laga helay imtixaanada CSF la xiriira.

Daaweynta:

-Laba toddobaad oo daaweynta kiimikaad ee VLP, dhiig-baxyada durugsan 5% Janaayo 18.

- Janaayo 25: Qaraxyada dhiigga ee hareeraha 91%, oo lagu daaweeyay CTX, Ara-C, 6-MP chemotherapy.

-February 3: Qaraxyada dhiigga ee ku xeeran 22%.

-February 4: Uruurinta 50ml oo ah dhiiga iswada ee dhaqanka unugyada CD19-CART.

- MTX 1g, FC chemotherapy (Flu 15mg maalin kasta x 3 maalmood, CTX 0.12g maalin kasta x 3 maalmood).

- Febraayo 13 (kahor faleebo): Qaab-dhismeedka dhuuxa lafta ayaa muujinaya 87.5% qarax, cytometry socodka ayaa muujinaya 79.4% qaraxyada halista ah.

- Falanqaynta tirada hidda-wadaha isku-dhafka MLL-ENL: 42.639%.

- Febraayo 14: Faleebo unugyada CART ee qiyaasta 5 x 10 ^ 5 / kg.

- Saamaynta xun ee CAR-T ee la xiriirta: Fasalka 1 CRS (qandho), ma laha neurotoxicity.

-Maalinta 20 ka dib faleebo: Dhiiga smear wuxuu muujinayaa kororka buro, saamiga unugyada CART 0.07%.

- Daaweynta unugyada CART ee aan waxtar lahayn.

- Maarso 8, 2021: Joogtada dhiigga: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- Qaraxyada dhiigga ee agagaarka: 83%. Dhiigga durugsan ee iswada leh ayaa laga soo ururiyay 60ml CD19/CD22 labada unug ee dhaqanka CART.

- Waxaa lagu daaweeyaa cytarabine iyo dexamethasone si loo xakameeyo culeeska burada.

- Maarso 18: FC chemotherapy (Flu 15mg maalin kasta x 3 maalmood, CTX 0.12g maalin kasta x 3 maalmood).

- March 22 (kahor faleebo): Joogtada dhiiga: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Qaab-dhismeedka dhiigga ee durugsan: 6% qarax.

- Qaab-dhismeedka dhuuxa lafta: 91% qaraxyada. Haraaga dhuuxa lafta: 88.61% unugyo muujinaya CD38, CD19, cCD79a, CD81, CD22, taasoo muujinaysa B lymphoblasts aan qaan-gaarin.

- Falanqaynta tirada hidda-wadaha isku-dhafka MLL-ENL: 62.894%.

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

- Maarso 23: Faleebo unugyada CART ee qiyaasta 3 x 10 ^ 5 / kg.

-Maarso 26 ka dib: qandho sare oo joogto ah iyo barar nidaamsan.

- Maarso 29: Qaabdhismeedka dhiigga ee ku wareegsan: 92% qaraxyada; transaminases sare iyo bilirubin.

- Abriil 2: Curyaaminta qallalka, oo lagu daaweeyay diazepam.

- Abriil 2 (Maalinta 10): Waxay bilaabatay daawaynta methylprednisolone muddo 3 maalmood ah.

- Falcelinta CRS: Fasalka 3, CRES: Fasalka 3.

- Abriil 8 (Maalinta 16): Qiimaynta dhuuxa lafuhu waxay muujinaysaa cafis qaabaysan oo dhammaystiran, cytometry qulqulka oo taban qaraxyada xun; Falanqaynta tirada hidda-wadaha isku-dhafka MLL-ENL: 0.