Acute Lymphoblastic Leukemia(B-ALL)-02
Litšobotsi tsa Boemo:
- La 19 Motšeanong 2019: E fumanwe a e-na le acute B-cell lymphoblastic leukemia (B-ALL)
- E hlahisoa ka bongata ba letlalo la hlooho le lymphadenopathy
- Ts'ebetso ea mali: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, li-lymphocyte tse sa tloaelehang 4%
- Morpholoji ea moko oa masapo: 80.2% ea li-lymphoblasts tse sa tsoakoang (ho phatloha)
- Immunophenotyping: 74.19% ea lisele ke lisele tse kotsi tsa pele tsa B-lineage tse hlalosang CD45dim, CD19, CD9, CD22, CD81, CD58, cCD79a, CD38, HLA-DR, karolo ea cIgM e hlalosang karolo e itseng. Tlhahlobo: B-ALL (Sethala sa Pele ho B)
- Fusion gene: MLL-ENL positive, Philadelphia chromosome-like (Ph-like) skrineng ha e mpe
- Chromosome: 46, XX, t(11;19)(q23;p13), del(20)(q12) [3]/46, XX [7]
- VDLD regimen chemotherapy qalong e fihletse tšoarelo ea immunology ka mor'a khoeli e le 'ngoe, MLL-ENL quantitative PCR 0.026%
- Chemotherapy e tsoelang pele ho latela protocol ea bana, MLL-ENL quantitative PCR 0 ka mor'a potoloho ea 4th. Kalafo e eketsehileng ea lik'hemik'hale e ile ea tsoela pele.
- Hlakubele 2020: Bone marrow immunological residual disease 0.35%, MLL-ENL quantitative PCR 0.53%, e bonts'ang mokhoa oa ho khutlela mokhoeng. Lelapa le ile la hana ho fetisoa. Chemotherapy e tsoelang pele bakeng sa lipotoloho tse 3.
- Phupu 2020: Mongobo oa masapo o ile oa khutla ka botlalo.
- La 11 Pulungoana 2020: Intrathecal chemotherapy, CSF immunological residual disease 66%, e fumanoeng e na le leukemia ea tsamaiso ea methapo e bohareng. Intrathecal chemotherapy e phetoa habeli, CSF e ile ea fetoha e mpe.
- La 31 Tšitoe 2020: O amohetsoe sepetleleng sa rona.
- Kemiso ea mali: WBC 3.99 x 10^9/L, HGB 66 g/L, PLT 57 x 10^9/L
- Palo ea ho phatloha ha mali: 69%
- Morpholoji ea 'mele oa masapo: 90% ea li-lymphoblasts tse sa sebetseng (ho phatloha)
- Immunophenotyping: 84.07% ea lisele li hlahisa CD38, CD19, CD81dim, cCD79a, HLA-DR, cIgM, CD22, CD123, karoloana e hlalosang CD24, CD15dim, e bontšang malignant immature B lymphoblasts.
- Fusion gene: MLL-ENL fusion gene positive, PCR e ngata 44.419%
- Phetoho ea liphatsa tsa lefutso: KMT2D phetoho e ntle (tšimoloho ea likokoana-hloko)
- Chromosome karyotype: 46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3), eketsa( 14)(q34), -17, +mar [7]/46, idem, t(3;16)(p21;p13.3) [1]/46, XX [13]
- PET-CT: Phatlalatsa keketseho ea metabolic karolong eohle ea skeletal le moko oa masapo, lipelaelo tse phahameng tsa ho khutla ha leukemia; splenomegaly e nang le metabolism e eketsehileng, mohlomong e kenyelletsa leukemia.
- O entse ho phunya lumbar le chemotherapy ea intrathecal hang, ha ho na lintho tse sa tloaelehang tse fumanoang litekong tse amanang le CSF.
Kalafo:
- Libeke tse peli tsa VLP chemotherapy, mali a peripheral a phatloha ka 5% ka la 18 Pherekhong.
- January 25: Mali a phefumolohang a phatloha 91%, a phekoloa ka CTX, Ara-C, 6-MP chemotherapy.
- Hlakola 3: Ho phatloha ha mali ka peripheral 22%.
- La 4 Hlakola: Pokello ea mali a peripheral a 50ml bakeng sa setso sa lisele tsa CD19-CART.
- MTX 1g, FC chemotherapy (Flu 15mg letsatsi le letsatsi x matsatsi a 3, CTX 0.12g letsatsi le letsatsi x matsatsi a 3).
- February 13 (pele ho infusion): Morpholoji ea masapo a masapo e bontša ho phatloha ha 87.5%, ho phalla ha cytometry ho bontša 79.4% ea ho phatloha ho kotsi.
- MLL-ENL fusion fusion quantitative analysis: 42.639%.
- February 14: Ho kenngoa ha lisele tsa CART ka tekanyo ea 5 x 10 ^ 5 / kg.
- Litlamorao tse mpe tse amanang le CAR-T: Sehlopha sa 1 CRS (feberu), ha ho na neurotoxicity.
- Letsatsi la 20 ka mor'a ho tšeloa: Mali a smear a bontša ho ata ha hlahala, karolo ea CART cell 0.07%.
- Kalafo ea lisele tsa CART e sa sebetseng.
- La 8 Hlakubele 2021: Kemiso ya madi: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.
- Ho phatloha ha mali ho pota-potileng: 83%. Mali a "autologous peripheral" a bokelletse 60ml bakeng sa CD19/CD22 dual CART cell culture.
- E phekoloa ka cytarabine le dexamethasone ho laola boima ba hlahala.
- March 18: FC chemotherapy (Flu 15mg letsatsi le letsatsi x matsatsi a 3, CTX 0.12g letsatsi le letsatsi x matsatsi a 3).
- 22 March (pele ho tšeloa): Kemiso ea mali: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. Pheripheral mali morphology: 6% ho phatloha.
- Morpholoji ea moko oa masapo: 91% ea ho phatloha. Masalla mokong oa masapo: 88.61% lisele tse hlalosang CD38, CD19, cCD79a, CD81, CD22, tse bontšang malignant immature B lymphoblasts.
- MLL-ENL fusion fusion quantitative analysis: 62.894%.
- Tlhahlobo ea karyotype ea Chromosome: 46, XX, del(1)(p36.1), del(11)(q13), t(11;19)(q23;p13.3), eketsa(14)(q34), - 17, +mar [2]/46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3) ), eketsa(14)(q34).
- 23 March: Ho kenngoa ha lisele tsa CART ka tekanyo ea 3 x 10 ^ 5 / kg.
- La 26 Hlakubele ho ea pele: Feberu e matla e sa khaotseng 'me ka mor'a moo ea ba le edema ea systemic.
- La 29 March: Pheripheral mali morphology: 92% ho phatloha; ho eketseha ha bilirubin le transaminase.
- La 2 Mmesa: Ho qala ho ts'oaroa, ho tšoaroa ka diazepam.
- 2 Mmesa (Letsatsi la 10): Ho qala kalafo ea methylprednisolone matsatsi a 3.
- Karabelo ea CRS: Kereiti ea 3, CRES: Kereiti ea 3.
- 8 Mmesa (Letsatsi la 16): Tlhahlobo ea moko oa masapo e bonts'a phokotso e felletseng ea morphological, phallo ea cytometry e mpe bakeng sa ho phatloha ho hobe; MLL-ENL fusion gene quantitative analysis: 0.
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