I-Acute Lymphoblastic Leukemia(B-ALL)-01

Ufunyanwe nge-acute B-cell lymphoblastic leukemia ngoNovemba 28, 2017.

Unyango ngerejimeni ye-VDLP ekuqaleni, ukufikelela kumongo wethambo ngokuyinxenye (iinkcukacha azixelwanga).

NgoFebruwari 2018: Tshintshela kwirejimeni yeVLCAM. I-cytometry yomongo wethambo ibonise i-60.13% yeeseli ze-B ezinobungozi ezingaguqukiyo.

NgoMatshi 2018: Ubhalise kulingo lwezonyango lwe-BiTE. Ukuxolelwa kwe-Morphological kumongo wethambo, akukho ziseli ezinobungozi ezingabonakaliyo ezifunyenwe yi-flow cytometry.

NgoMeyi 8, 2018: Ifunyenwe i-TBI / CY + VP16 ye-conditioning regimen elandelwa yi-allogeneic stem cell transplant ukusuka kumntakwabo ohambelana ngokupheleleyo (umxhasi we-AB + kummkeli we-A +). Ukubuyiswa kwe-neutrophil ngosuku +11, ukubuyiswa kwe-megakaryocyte ngosuku +12.

NgoDisemba 5, 2018: Gqibezela ukuxolelwa kwe-morphological kumongo wethambo, akukho ziseli ezinobungozi ezingabonakaliyo ezifunyenwe yi-flow cytometry. Ufumene i-donor lymphocyte infusion (DLI) kunye nonyango lweprophylactic kunye ne-dasatinib kunye ne-imatinib ukukhusela ukuphindaphinda.

Nge-2 kaFebruwari, 2019: I-Morphology ibonise i-6.5% yeeseli ezingekavuthwa, ukuhamba kwe-cytometry kubonise i-0.08% ye-lymphoblasts engalunganga ekhulayo. Ufumene unyango lwe-DLI. Ngomhla wama-28 kuMatshi ka-2019: I-cytometry equkuqelayo ibonise ukuba akukho nto ingaqhelekanga.

Nge-11 ka-Agasti, 2019: Umva womongo wamathambo uphinde wanyangwa nge-dasatinib.

Nge-2 kaSeptemba 2019: I-Morphology ibonise i-3% yeeseli ezingekakhuli, i-flow cytometry ibonise i-0.04% yeeseli ezinobungozi. Unyango oluqhubekayo kunye ne-dasatinib, ilandelwa yimijikelezo ye-2 ye-methotrexate chemotherapy.

Nge-11 kaCanzibe, ngo-2020: Umongo wethambo uyaphinda kwakhona.

Kufunyenwe i-2 autologous CD19-CAR-T cell therapies kunye ne-2 allogeneic CD19-CAR-T cell therapies ngo-2020, akukho namnye ofumene uxolelo.

Nge-26 ka-Okthobha, 2020: Wangeniswa esibhedlele.

Iziphumo zeLebhu:

Inkqubo yegazi: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Iiseli zegazi ezingagqibelelanga: 63%

I-Bone marrow morphology: I-Hypercellular (ibakala II), i-96% ye-lymphoblasts engakafiki.

I-Immunophenotyping: Iiseli zivakalisa i-CD19, i-cCD79a, i-CD38dim, i-CD10bri, i-CD34, i-CD81dim, i-CD24, i-HLA-DR, i-TDT, i-CD22, i-CD72; inxenye ye-CD123. Zichongwe njengee-lymphoblasts ze-B ezinobungozi.

Ukuguqulwa kwethumba legazi: Kubi.

I-leukemia fusion gene: i-NUP214-ABL1 i-fusion gene positive.

Uhlalutyo lweChromosome: 46, XX, t(1;9)(p34;p24), yongeza(11)(q23)[4]/46, XX, t(1;9)(p34;p24), yongeza(11) (q23)x2 [2]/46, XX[3]

I-Chimerism: Iiseli ze-Donor-derived-akhawunti ze-7.71%.

Unyango:

- I-VDS, i-DEX, i-LASP ye-chemotherapy regimen ilawulwa.

- Novemba 20: Iiseli zegazi ezingavuthiweyo ze-0%.

- Ukuqokelela autologous peripheral lymphocytes igazi CD19/22 ezimbini CAR-T inkcubeko cell.

- NgoNovemba 29: I-FC regimen chemotherapy (Flu 50mg x 3, CTX 0.4gx 3).

Ngomhla we-2 kuDisemba (ngaphambi kokungeniswa kweseli ye-CAR-T):

- Inkqubo yegazi: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- I-Bone marrow morphology: I-Hypercellular (ibakala IV), i-68% ye-lymphoblasts engakafiki.

- Uvavanyo lobungakanani be-NUP214-ABL1 gene fusion: 24.542%.

- I-cytometry ehambayo: i-46.31% yeeseli zivakalisa i-CD38dim, i-CD22, i-BCL-2, i-CD19, i-CD10bri, i-CD34, i-CD81dim, i-CD24, i-cCD79a, ebonisa i-lymphoblasts ye-B engalunganga.

- Disemba 4: Ukufakelwa kweeseli ze-CD19/22 ze-CD19/22 ezimbini ze-CAR-T (3 x 10 ^ 5 / kg).

- Imiphumo echaphazelekayo ye-CAR-T: IBanga le-1 CRS, i-fever ngoSuku lwe-6 kunye ne-Tmax ye-40 ° C, umkhuhlane olawulwa nguMhla we-10. Akukho neurotoxicity ebonwe.

- Disemba 22 (Uvavanyo lwe-18 yosuku): Ukuxolelwa okupheleleyo kwe-Morphological kumongo wethambo, akukho ziseli ezinobungozi ezingabonakaliyo ezifunyenwe yi-cytometry yokuhamba. Uvavanyo lobungakanani be-NUP214-ABL1 gene fusion: 0%.