Acute Lymphoblastic Leukemia(T-ALL)-03

MamelloTlhaloso: Huang XX

Bong: Monna

Lilemo: lilemo tse 42

Naha: Sechaena

TlhahloboAcute Lymphoblastic Leukemia (T-ALL)

Iteanye le rona

Case Features:

- Tlhahlobo: Acute T-cell lymphoblastic leukemia

- Tšimoloho le Matšoao: Mmesa 2020, e hlahisitsoe ke molikoalikoane, mokhathala le lintlha tse tsoang maling a letlalo. E fumanoa ka acute T-cell lymphoblastic leukemia ka tlhahlobo ea masapo a MICM.

- Kalafo ea Pele: E fihletsoe ka ho feletseng (CR) ka mor'a VDCLP regimen chemotherapy, e lateloa ke li-cycle tsa 2 tsa chemotherapy e matlafalitsoeng.

- Phupu 19, 2020: E amohetse allogeneic hematopoietic stem cell transplantation ho tsoa ho mofani oa mosali (HLA 5/10 A donor A). Mokhoa oa ho boloka maemo o ne o kenyelletsa mahlaseli a 'mele kaofela (TBI), cyclophosphamide (CY), le etoposide (VP-16). Lisele tsa "peripheral stem" li ile tsa kenngoa ka la 24 Phupu, 'me granulocyte e hlaphoheloa ka letsatsi +10 le platelet engraftment ka letsatsi +13. Ka mor'a moo, ho lateloa ha bakuli ba ka ntle khafetsa.

- Hlakola 25, 2021: Ho khutla ha 'mele oa masapo ho fumanoe nakong ea tlhahlobo.

- Kalafo: Ho qadile ka kalafo ya molomo ya thalidomide.

- La 8 Hlakubele: O amohetsoe sepetleleng sa rona.

- Bone Marrow Morphology: 61.5% e phatloha.

- Karolo ea Mali ea Peripheral: 15% ea ho phatloha.

- Immunophenotyping: 35.25% lisele tse hlalosang CD99, CD5, CD3dim, CD8dim, CD7, cCD3, CD2dim, HLA-ABC, cbcl-2, CD81, CD38, e bontšang malignant immature T lymphocyte.

- Tlhahlobo ea Chromosome: 46, XX [9].

- Leukemia Fusion Gene: SIL-TAL1 fusion gene positive; tekanyo ea bongata: SIL-TA.

- Phetoho ea Tumor ea Mali: E mpe.

- Chimerism Analysis (post-HSCT): Lisele tse nkiloeng ho bafani li na le karolo ea 45.78%.

- La 11 Hlakubele: Pokello ea autologous peripheral blood lymphocyte bakeng sa setso sa lisele tsa CD7-CART.

- Kalafo: VILP (VDS 4mg, IDA 10mg, L-asparaginase 10,000 IU qd x 4 matsatsi, Dex 9mg q12h x 9 matsatsi) mokhoa o kopantsoeng le thalidomide ho laola hlahala.

- March 19: FC regimen chemotherapy (Flu 50mg x 3 matsatsi, CTX 0.4gx matsatsi a 3).

- March 24 (pele ho infusion): Bone marrow morphology e bontšitse hyperplasia ea sehlopha sa V, e nang le ho phatloha ha 22%.

- Bone Marrow Flow Cytometry: 29.21% lisele (tsa lisele tse nang le nucleated) tse hlalosang CD3, CD5, CD7, CD99, karolo ea cCD3 e hlalosang, e bontšang lisele tsa T tse kotsi tse sa hōlang.

- Quantitative SIL-TAL1 Fusion Gene: 1.913%.

Kalafo:

- La 26 Hlakubele: Infusion ea autologous CD7-CART cell (5*10^5/kg)

- Litlamorao tse Amanang le CAR-T: Sehlopha sa 1 sa CRS (feberu), ha ho na neurotoxicity

- La 12 Mmesa (Letsatsi la 17): Ts'ebetso e bonts'itse morphology ea lesapo phokolong, ha ho na lisele tse mpe tse sa pheleng tse bonoang ke flow cytometry, le SIL-TAL1 (STIL-SCL) fusion gene quantification ho 0