Acute Lymphoblastic Leukemia(T-ALL)-01

Likarolo tsa tleliniki:

- Tlhahlobo: T-cell lymphoblastic lymphoma/leukemia

- Hlakubele 2020: E hlahisitsoe ka khohlela ea paroxysmal le boima ba mediastinal, e netefalitsoeng ke T-cell lymphoblastic lymphoma ka biopsy ea boima ba mediastinal.

- E amohetse li-cycle tse 8 tsa chemotherapy le linako tse fetang 20 tsa radiotherapy, e leng se ileng sa fella ka ho fokotseha ho hoholo ha boima ba mediastinal.

- La 16 Pherekhong 2021: Ho ba le bohloko bo ka tlase ho leoto le letona.

- Kemiso ea mali: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- Morpholoji ea moko oa masapo: 95.5% ea li-lymphoblasts tsa pele.

- Cytometry ea phallo ea masapo: 91.77% ea lisele e ne e le T-cell lymphoblasts e sa tsitsang.

- Tatelano ea liphatsa tsa lefutso: Liphetoho ho NOTCH1, IL7R, ASXL2 liphatsa tsa lefutso li fumanoe.

- E amohetse mofuta oa Hyper-CVAD/B, mofuta oa ESHAP hamorao, ka bobeli ha e sebetse ka feberu e sa feleng.

- Hlakola 18, 2021: O amohetsoe sepetleleng sa rona.

- E hlahisoa ka feberu, sefuba sa CT se bontšitse pneumonia.

- Kemiso ea mali: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Lisele tse sa itekanelang maling: 90%

- Sebopeho sa 'mele oa masapo: Hypercellular (grade IV), 85% ea li-lymphoblasts tsa khale.

- Immunophenotyping: 87.27% ea lisele e ne e le malignant primitive T-cell lymphoblasts.

- Tlhahlobo ea chromosomal: 46,XX [24]; li-karyotype tse ling tse tharo tse sa tloaelehang li hlokometsoe.

- Liphatsa tsa lefutso tse fetotsoeng:

1. IL7R T244_I245insARCPL phetoho e ntle

2. NOTCH1 E1583_Q1584dup phetoho e ntle

3. ASXL2 Q602R phetoho e ntle

- Tlhahlobo ea lefutso la leukemia fusion: e mpe

- Liphetho tsa PET / CT: Ha ho na foci ea bohlokoa ea hypermetabolic tumor foci eohle ea skeleton le moko oa masapo.

Kalafo:

- E qalile VP regimen chemotherapy, e qaqileng ka tsela e latelang: Vincristine (VDS) 3mg hang, Dexamethasone (Dex) 7mg lihora tse ling le tse ling tsa 12 bakeng sa matsatsi a 9, hammoho le phekolo e khahlanong le tšoaetso.

- La 1 Hlakubele: Lisele tse sa itekang tsa mali li fokotsehile ho isa ho 7%.

- La 4 Hlakubele: Ho bokelletse li-lymphocyte tsa autologous bakeng sa setso sa lisele tsa CD7-CAR T.

- La 8 Hlakubele: Ho qala kalafo ea VLP e kopantsoeng le kalafo ea Sida benzamine.

- March 14: E amohetse FC regimen chemotherapy (Fludarabine 0.35g bakeng sa matsatsi a 3, Cyclophosphamide 45mg bakeng sa matsatsi a 3).

- La 17 Hlakubele (infusion ea pele ho sele):

- Bone marrow residual immunophenotyping: 15.14% lisele li hlahisa CD7 e khanyang, CD3 dim, cytoplasmic CD3, T cell receptor restricted delta (TCRrd), polelo e sa fellang ea CD99, e bontšang lisele tsa T tsa khale tse kotsi.

- 19 March: E kentse lisele tsa CD7-CAR T tsa autologous (1 x 10 ^ 6 / kg).

- Litla-morao tse amanang le CAR-T: Sehlopha sa 1 CRS (feberu), ha ho na neurotoxicity.

- 6 April (Letsatsi la 17): Morpholoji ea 'mele oa masapo e bontšitse phokolo, cytometry ea phallo ha ea ka ea lemoha lisele tse mpe tsa khale.