Leukemia ba'an ee Lymphoblastic (B-ALL) -03

Astaamaha Kiiska:

- Waxaa lagu ogaadey ba'an B-cell lymphoblastic leukemia dhamaadka May 2020.

- Joogtada dhiigga: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- Qaab-dhismeedka dhuuxa lafta: Hypocellular leh 67% lymphocytes asaasiga ah.

- Sitometry socodka: 82.28% unugyadu waxay muujinayaan CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, qayb ahaan waxay muujiyaan CD9, si liidata u muujiyaan CD13.

- Baadhitaanka hidda-wadaha Fusion ee xun; WT1 57.3%; ma jiro PH-sida DHAMMAAN hiddo-wadaha isku-dhafka la xiriira oo la ogaaday.

- KALUUNKA: TP53 isu beddelka togan.

- Chromosomes: 63-58, XXY, +Y, +1, +del(1)(q41q42), -2, -3, +6, -7, +8, -9, +10, -12, -13 , +14, +15, -17, +18, -20, +22(cp16)/46, XY[4].

- Heshay nidaamka VCDLP ee 2 koorso oo aan cafis lahayn.

- CAM-VL nidaamka (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) July 22, 2020, weli aan cafis lahayn.

- Sitometry socodka dhuuxa lafta Sebtember 25, 2020: 7.35% unugyadu waxay muujinayaan CD81, CD19, CD10, CD38, CD33, si liidata u muujinaya CD20, CD45.

- Falanqaynta isbeddelka burada dhiigga: TP53 mutation.

- Chromosomes: 46, XY[20].

- Bilowday daawaynta CD19-CART

- habka FC (FLU 62.7mg x 4 days, CTX 1045mg x 2 days) kiimoterabi.

- Oktoobar 1, 2020: Faleebo unug ah oo otomaatig ah CD19-CART oo ah 4.7x10^7/kg.

- CRS fasalka 2 oo leh fasalka 1 neurotoxicity, oo la hagaajiyay ka dib daawaynta taageerada.

- Oktoobar 29, 2020: Ka cafis dhammaystiran ee qaab-dhismeedka dhuuxa lafta, ma jiraan unugyo xun xun oo ku jira cytometry socodka.

- Diseembar 31, 2020: Qufac qallalan, lallabbo, matag, daciifnimo guud.

- Joogtada dhiigga: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- Hamiga dhuuxa lafta oo tilmaamaya soo noqoshada.

- Janaayo 2, 2021: Waxa la dhigay cusbitaalkayaga.

- Joogtada dhiigga: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

Creatinine 134umol/L, heerka 3 hypertension, taariikhda caafimaad ee 4 sano.

- Kala soocidda dhiigga ku wareegsan: 62% unugyada asaasiga ah.

- Immunophenotyping: 28.48% unugyada (unugyada nukliyeerka) waxay muujinayaan CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, qayb ahaan CD123, TTD, CD-ga ha muujin, CD34, 7 MP11 , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, oo muujinaya malignant primitive B lymphocytes.

- Falanqaynta isbeddelka buro-dhiigga: TP53 R196P mutation togan.

Daaweynta:

- Hemotherapy VLP, oo ay weheliso daaweynta dhiig-karka, creatinine-yaraynta, iyo alkalinization fuuqbaxa.

- Janaayo 19: Joogtada dhiigga waxay muujisay WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Kala soocidda dhiigga ku wareegsan: Ma jiraan lymphocytes hore.

- Qaab-dhismeedka dhuuxa lafta: Hypercellularity (Vgrade), meelaha xudunta u ah fasalka IV, oo leh 42% lymphocytes asaasiga ah.

- Sitometry socodka: 13.91% unugyadu waxay muujinayaan CD10, cCD79a, CD38, CD81, CD22, ma muujiyaan CD20, CD34, CD19, oo tilmaamaya unugyada hore ee B malignant.

Chromosomal karyotype:

-35,XY,-2,-3,-4,-5,-7,-9,-12,-13,-16,-17,-20[8]/35,XY+X,-2 ,-3,-4,-5,-7,-9,-10,-12,-13,-16,-17,-20[1]/36,XY, add(1)(q42),- 2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].

- Janaayo 20: Lymphocytes oo loo ururiyay CD22-CART dhaqanka unugyada.

- Janaayo 21: Dulitaanka lumbar oo la sameeyay, kiimoterabiga intrathecal ayaa la maamulaa si looga hortago leukemia habka dhexe ee neerfayaasha; Baaritaanka dareeraha maskaxda ma muujin wax aan caadi ahayn.

- Janaayo 22: La helay Arac, 6MP, L-ASP chemotherapy, iyo FC (Flu 50mg x 3, CTX 0.5gx 3) kiimoterabi.

- Febraayo 7 (kahor faleebo): Qaab-dhismeedka dhuuxa lafta ayaa muujisay 93% lymphocytes asaasiga ah.

- Sitometry socodka: 76.42% unugyadu waxay muujinayaan CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, ha muujin CD4, CD3, CD13+33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), oo tilmaamaya unugyada hore ee B-ka.

- maqaarka oo kobcay iyo caabuq unug jilicsan oo qandho leh; la hagaajiyay ka dib daaweynta antibiyootiga.

- Febraayo 9: faleebo unug CD22-CART oo iswada leh (5x10^5/kg).

- Waxyeellooyinka CAR-T ee la xiriira: CRS fasalka 1, qandho maalinta 6 oo leh Tmax 40°C, heerkulka la xakameeyey maalinta 10; ma laha neurotoxicity.

-Maarso 11: Qiimaynta dhuuxa lafta ayaa muujisay cafis qaabaysan oo dhammaystiran, cytometry socodka ma muujin unugyo hore oo xun.