I-Acute Lymphoblastic Leukemia(B-ALL)-03

Case features:

Ufunyanwe une-acute B-cell lymphoblastic leukemia ekupheleni kukaMeyi ka-2020.

- Inkqubo yegazi: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- I-morphology yomongo wethambo: I-Hypocellular ene-67% ye-lymphocytes yokuqala.

- I-cytometry ejikelezayo: I-82.28% yeeseli zivakalisa i-CD38, i-HLA-DR, i-CD19, i-CD10, i-CD105, i-TDT, i-CD22, i-cCD79a, i-CD9 ichaza ngokuyinxenye, i-CD13 ibonakalisa ngobuthathaka.

- Ukuhlolwa kofuzo olungalunganga; WT1 57.3%; akukho PH-efana ZONKE-ezinxulumene nofuzo lwemfuza olufunyenweyo.

I-FISH: TP53 inguquko entle.

- 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].

- Kufunyenwe irejimeni yeVCDLP kwiikhosi ezi-2 ngaphandle kokuxolelwa.

- Irejimeni yeCAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) nge-22 kaJulayi, 2020, ingekaxolelwa.

-I-cytometry yomongo wethambo nge-25 kaSeptemba 2020: 7.35% yeeseli ezibonisa i-CD81, CD19, CD10, CD38, CD33, i-CD20 ebuthathaka, i-CD45.

- Uhlalutyo lokuguqulwa kwethumba legazi: ukuguqulwa kwe-TP53.

- Chromosomes: 46, XY[20].

- Yaqalwa ngonyango lwe-CD19-CART.

- I-FC regimen (i-FLU 62.7mg x iintsuku ze-4, i-CTX 1045mg x iintsuku ze-2) i-chemotherapy.

-Okthobha 1, 2020: Autologous CD19-CART cell infusion kwi 4.7x10^7/kg.

- I-CRS grade 2 kunye ne-neurotoxicity yebakala 1, iphuculwe emva konyango oluxhasayo.

-Okthobha wama-29, 2020: Uxolelo olupheleleyo kwi-morphology yomongo wamathambo, akukho ziseli zimbi zakuqala kwi-flow cytometry.

-Disemba 31, 2020: Ukukhohlela okomileyo, isicaphucaphu, ukugabha, ubuthathaka jikelele.

- Inkqubo yegazi: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- Umnqweno womongo wethambo obonisa ukubuyela kwakhona.

- NgoJanuwari 2, 2021: Wangeniswa esibhedlele.

- Inkqubo yegazi: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

- I-Creatinine 134umol / L, isigaba se-3 soxinzelelo lwegazi, imbali yonyango ye-4 iminyaka.

- Ukuhlelwa kwegazi kweperipheral: i-62% yeeseli zokuqala.

-I-Immunophenotyping: I-28.48% yeeseli (iiseli ze-nucleated) zichaza i-CD10, i-CD38dim, i-HLA-DR, i-CD20dim, i-CD24, i-CD81, i-cCD79a, i-CD22, i-CD268dim, i-CD58, i-CD123, i-TDT, i-CD34, i-CD19 , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, ebonisa i-lymphocyte ye-B yamandulo eyingozi.

- Uhlalutyo lokuguqulwa kwethumba legazi: TP53 R196P ukuguqulwa kwenguqu elungileyo.

Unyango:

-Yamkela i-VLP chemotherapy, kunye nonyango lwe-hypertension, ukunciphisa i-creatinine, kunye ne-hydration alkalinization.

- NgoJanuwari 19: Inkqubo yegazi ibonisa i-WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Ukuhlelwa kwegazi kweperipheral: Akukho lymphocyte zamandulo.

- I-Bone marrow morphology: I-Hypercellularity (i-V grade), imimandla egxininisekile yebakala le-IV, kunye ne-42% ye-lymphocytes yokuqala.

- I-cytometry ehambayo: I-13.91% yeeseli zivakalisa i-CD10, i-cCD79a, i-CD38, i-CD81, i-CD22, ayibonakalisi i-CD20, i-CD34, i-CD19, ebonisa iiseli ezinobungozi ze-primitive B.

-Khromosomal karyotype:

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

- Januwari 20: Lymphocytes eziqokelelwe CD22-CART cell inkcubeko.

NgoJanuwari 21: I-Lumbar puncture yenziwa, i-chemotherapy ye-intrathecal ilawulwa ukukhusela i-central nervous system leukemia; Uvavanyo lwe-cerebrospinal fluid aluzange lubonise ukungaqhelekanga.

- NgoJanuwari 22: Ifunyenwe i-Arac, i-6MP, i-L-ASP i-chemotherapy, kunye ne-FC (i-Flu 50mg x 3, i-CTX 0.5gx 3) i-chemotherapy.

- NgoFebruwari 7 (phambi kokugalelwa): I-Bone marrow morphology ibonise i-93% ye-lymphocytes yokuqala.

- I-cytometry ejikelezayo: i-76.42% yeeseli zivakalisa i-CD38, i-cCD79a, i-CD22, i-cbcl-2, i-CD123, i-CD10bri, i-CD24, i-CD81, i-CD4, i-CD3, i-CD13 + 33, i-CD34, i-CD20, i-CD19, i-CD279 (PD1), i-CD274 (PDL1), ebonisa iiseli ze-B ezinobungozi.

- Ukuphuhliswa kwesikhumba kunye nosulelo lwezicubu ezithambileyo kunye nomkhuhlane; iphuculwe emva konyango lwe-antibiotic.

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

- Imiphumo echaphazelekayo ye-CAR-T: i-CRS grade 1, umkhuhlane kwiSuku 6 kunye ne-Tmax 40 ° C, ubushushu obulawulwayo ngoSuku lwe-10; akukho neurotoxicity.

- Matshi 11: Uvavanyo lomongo wethambo lubonise ukuxolelwa okupheleleyo kwe-morphological, ukuhamba kwe-cytometry akuzange kubonise iiseli ezinobungozi ezimbi.