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Ocular melanoma (qalong), e lateloa ke lihlahala tsa sebete tsa metastatic-02

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Kankere ea prostate ea boemo bo holimo e tsamaeang le metastase ea masapo a mangata-05

Acute Lymphoblastic Leukemia(B-ALL)-03

Mamello: Monghali. Lu

Bong: Monna

Lilemo: lilemo tse 39

Naha: Sechaena

TlhahloboAcute Lymphoblastic Leukemia (B-ALL)

Iteanye le rona

Case Features:

- E fumanoe ka acute B-cell lymphoblastic leukemia qetellong ea Mots'eanong 2020.

- Kemiso ea mali: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- Sebopeho sa 'mele oa masapo: Hypocellular e nang le 67% ea li-lymphocyte tsa khale.

- Flow cytometry: 82.28% ea lisele tse hlalosang CD38, HLA-DR, CD19, CD10, CD105, TDT, CD22, cCD79a, karolo ea CD9 e hlalosang ka mokhoa o fokolang, e fokolang CD13.

- Fusion gene screening negative; WT1 57,3%; ha ho liphatsa tsa lefutso tse amanang le PH tse amanang le ALL tse fumanoeng.

- FISH: TP53 phetoho e ntle.

- 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].

- E amohetse mofuta oa VCDLP bakeng sa lithuto tse 2 ntle le tšoarelo.

- Mokhoa oa CAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) ka la 22 Phupu 2020, e ntse e se na tšoarelo.

- Bone marrow flow cytometry ka la 25 Loetse 2020: 7.35% ea lisele li hlahisa CD81, CD19, CD10, CD38, CD33, CD20, CD45.

- Tlhahlobo ea phetoho ea tumor ea mali: phetoho ea TP53.

- Li-chromosomes: 46, XY[20].

- E qalile kalafo ea CD19-CART.

- FC regimen (FLU 62.7mg x 4 matsatsi, CTX 1045mg x 2 matsatsi) chemotherapy.

- La 1 Mphalane 2020: Autologous CD19-CART cell infusion ka 4.7x10^7/kg.

- Sehlopha sa 2 sa CRS se nang le neurotoxicity ea sehlopha sa 1, se ntlafalitsoe kamora kalafo e tšehetsang.

- La 29 Mphalane 2020: Ts'oarelo e felletseng ho morphology ea moko oa masapo, ha ho na lisele tse mpe tsa khale ho cytometry ea phallo.

- La 31 Tšitoe 2020: Ho khohlela ho omileng, ho nyekeloa ke pelo, ho hlatsa, bofokoli bo akaretsang.

- Tloaelo ea mali: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- Takatso ea moko oa masapo e bontšang ho khutlela mokhoeng.

- La 2 Pherekhong 2021: O amohetsoe sepetleleng sa rona.

- Tloaelo ea mali: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

- Creatinine 134umol/L, mohato oa 3 oa khatello ea mali, nalane ea bongaka ea lilemo tse 4.

- Sehlopha sa mali se pota-potileng: 62% ea lisele tsa pele.

- Immunophenotyping: 28.48% ea lisele (lisele tsa nucleated) li hlahisa CD10, CD38dim, HLA-DR, CD20dim, CD24, CD81, cCD79a, CD22, CD268dim, CD58, CD123, TDT, ha e hlahise CD34, CD19 , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, e bontšang malignant primitive B lymphocyte.

- Tlhahlobo ea phetoho ea tumor ea mali: TP53 R196P phetoho e ntle.

Kalafo:

- E amohetse VLP chemotherapy, hammoho le kalafo ea khatello ea mali, phokotso ea creatinine, le hydration alkalinization.

- La 19 Pherekhong: Kemiso ea mali e bonts'a WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Sehlopha sa mali sa peripheral: Ha ho li-lymphocyte tsa khale.

- Bone marrow morphology: Hypercellularity (V grade), libaka tse tsepamisitsoeng tsa sehlopha sa IV, tse nang le 42% ea li-lymphocyte tsa khale.

- Flow cytometry: 13.91% ea lisele tse hlalosang CD10, cCD79a, CD38, CD81, CD22, ha li hlahise CD20, CD34, CD19, tse bontšang lisele tse kotsi tsa pele tsa B.

- karyotype ea chromosomal:

- 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,eketsa(1)(q42),- 2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].

- January 20: Li-lymphocyte li bokelloa bakeng sa setso sa lisele tsa CD22-CART.

- 21 January: Ho phunya lumbar ho etsoa, chemotherapy ea intrathecal e tsamaisoang ho thibela leukemia ea tsamaiso ea methapo ea bohareng; tlhahlobo ea cerebrospinal fluid ha ea ka ea bontša ho se tloaelehe.

- 22 January: E amohetse Arac, 6MP, L-ASP chemotherapy, le FC (Flu 50mg x 3, CTX 0.5gx 3) chemotherapy.

- Hlakola 7 (pele ho tšeloa): Morpholoji ea moko oa masapo e bontšitse 93% ea li-lymphocyte tsa khale.

- Flow cytometry: 76.42% ea lisele tse hlalosang CD38, cCD79a, CD22, cbcl-2, CD123, CD10bri, CD24, CD81, ha li hlahise CD4, CD3, CD13 +33, CD34, CD20, CD19, CD279 (PD1), CD274 (PDL1), e leng sesupo sa lisele tse bolaeang tsa pele tsa B.

- Tšoaetso ea letlalo le lisele tse bonolo tse nang le feberu; e ntlafala ka mor'a phekolo ea lithibela-mafu.

- February 9: Autologous CD22-CART cell infusion (5x10 ^ 5 / kg).

- Litla-morao tse amanang le CAR-T: CRS grade 1, feberu ka Letsatsi la 6 le Tmax 40 ° C, mocheso o laoloang ka Letsatsi la 10; ha ho na neurotoxicity.

- La 11 Hlakubele: Tlhahlobo ea moko oa masapo e bonts'itse phokotso e felletseng ea morphological, cytometry ea phallo e bonts'a lisele tse mpe tsa khale.