Leukemia ba'an oo Lymphoblastic ah (T-ALL) -03

Bukaan: Huang XX

Jinsiga: lab

Da'da: 42 jir

Jinsiyad: Shiine

ogaanshahaLeukemia ba'an oo Lymphoblastic ah (T-ALL)

Nala soo xidhiidh

Astaamaha Kiiska:

- ogaanshaha: Unugyada T-cell lymphoblastic leukemia ba'an

- Bilawga iyo Calaamadaha: Abriil 2020, oo lagu soo bandhigay dawakhaad, daal, iyo dhibcaha dhiigbaxa maqaarka. Lagu ogaadey T-cell lymfoblastic leukemia oo ba'an iyadoo loo marayo baaritaanka MICM ee dhuuxa lafta.

- Daawaynta Bilowga ah: La gaarey cafis dhammaystiran (CR) ka dib habka daaweynta kemotherabi ee VDCLP, oo ay ku xigto 2 wareeg oo kiimoterabi oo la xoojiyay.

- Luuliyo 19, 2020: Waxaa la helay tallaalka unugyada unugyada dhiigga ee allogeneic hematopoietic oo laga helay deeq bixiye dhedig (HLA 5/10 A ku deeqaha A). Nidaamka qaboojinta waxaa ka mid ah wadarta shucaaca jirka (TBI), cyclophosphamide (CY), iyo etoposide (VP-16). Unugyada asliga ee ku xeeran ayaa la galiyay Juulay 24, iyadoo granulocyte ay soo kabsanayso maalinta +10 iyo ku-abuurka platelet maalintii +13. Dabagal joogto ah oo bukaan-socod ka dib.

- Febraayo 25, 2021: Soo noqoshada dhuuxa lafta ayaa la ogaaday intii lagu jiray dabagalka.

-Daawaynta: Waxay bilaabatay daawaynta thalidomide afka.

- Maarso 8: Waxa la dhigay cusbitaalkayaga.

- Marofolojiyada Dhuuxa lafta: 61.5% qaraxyada.

- Kala soocidda Dhiigga Wareegga: 15% qaraxyo.

- Immunophenotyping: 35.25% unugyo muujinaya CD99, CD5, CD3dim, CD8dim, CD7, cCD3, CD2dim, HLA-ABC, cbcl-2, CD81, CD38, taasoo muujinaysa T lymphocytes aan qaangaarin.

- Falanqaynta Chromosome: 46, XX [9].

- Hida-wadaha Fusion ee Leukemia: SIL-TAL1 hidde-sideyaasha isku-dhafka ah; cabbirka tirada: SIL-TA.

- Blood Buro Beddelka: Negative.

- Falanqaynta Chimerism (post-HSCT): Unugyada deeq-bixiyeyaashu waxay xisaabiyeen 45.78%.

- Maarso 11: Uruurinta lymphocytes ee dhiigga ee iswada ee dhaqanka unugyada CD7-CART.

- Daawaynta: VILP (VDS 4mg, IDA 10mg, L-asparaginase 10,000 IU qd x 4 days, Dex 9mg q12h x 9 days) nidaam lagu daro thalidomide si loo xakameeyo burada.

- Maarso 19: daweynta kemotherabi ee FC (Flu 50mg x 3 maalmood, CTX 0.4gx 3 maalmood).

- March 24 (kahor faleebo): Qaab-dhismeedka dhuuxa lafta ayaa muujisay heerka V hyperplasia, oo leh 22% qaraxyo.

- Qulqulka Dhuuxa Lafta Cytometry: 29.21% unugyada (unugyada nukleed) oo muujinaya CD3, CD5, CD7, CD99, qayb ahaan muujinaya cCD3, taas oo muujinaysa unugyada T ee aan qaan-gaarin.

- Tirada SIL-TAL1 Fusion Gene: 1.913%.

Daaweynta:

- Maarso 26: Faleebo unugyada CD7-CART ee iswada leh (5*10^5/kg)

- Saamaynnada Dhinacyada La Xidhiidha CAR-T:CRS fasalka 1 (qandho), ma laha neurotoxicity

- Abriil 12 (Maalinta 17): Dabagalku wuxuu muujiyay qaab-dhismeedka dhuuxa lafta ee cafiska, ma jiraan unugyo aan qaan-gaarin oo xun oo lagu ogaaday cytometry socodka, iyo SIL-TAL1 (STIL-SCL) qiyaasta hidda-socodka 0