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

Iimpawu zeklinikhi:

- Ukuxilongwa: T-cell lymphoblastic lymphoma / leukemia

NgoMatshi ka-2020: Inikezelwe ngokhohlokhohlo lwe-paroxysmal kunye nobunzima be-mediastinal, iqinisekise i-T-cell lymphoblastic lymphoma nge-mediastinal puncture biopsy.

- Ufumene imijikelo ye-8 ye-chemotherapy kunye neeseshoni ezingaphezu kwe-20 ze-radiotherapy, okukhokelela ekunciphiseni okukhulu kobunzima be-mediastinal.

- NgoJanuwari 16, 2021: Ukukhula kweentlungu kwilungu elisezantsi lasekunene.

- Inkqubo yegazi: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- I-morphology yomongo wethambo: i-95.5% ye-lymphoblasts yamandulo.

- I-cytometry ye-bone marrow flow: I-91.77% yeeseli yayiyi-T-cell lymphoblasts engakafiki.

-Ulandelelwano lwemfuza: Utshintsho kwi-NOTCH1, IL7R, ASXL2 iijini zichongiwe.

- Kufunyenwe irejimeni ye-Hyper-CVAD/B, irejimeni ye-ESHAP emva koko, zombini ayisebenzi ngefiva eqhubekayo.

- NgoFebruwari 18, 2021: Wangeniswa esibhedlele.

- Ukunikezelwa ngomkhuhlane, isifuba CT sabonisa inyumoniya.

- Inkqubo yegazi: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Iiseli zegazi ezingagqibelelanga: 90%

- I-Bone marrow morphology: I-Hypercellular (ibakala le-IV), i-85% ye-lymphoblasts yamandulo.

- I-Immunophenotyping: I-87.27% yeeseli zazinobungozi be-T-cell lymphoblasts.

- Uhlalutyo lweChromosomal: 46,XX [24]; ezintathu ezongezelelekileyo karyotypes ezingaqhelekanga.

-Ufuzo olutshintshileyo:

1. I-IL7R T244_I245inARCPL uguqulo lulungile

2. NOTCH1 E1583_Q1584dup uguqulelo oluhle

3. ASXL2 Q602R inguqu entle

- Ukuhlolwa kofuzo lwe-leukemia: Kubi

- Iziphumo ze-PET / CT: Akukho nto ibalulekileyo ye-hypermetabolic tumor foci kwi-skeleton yonke kunye nomnkantsha wethambo.

Unyango:

- Iqaliswe i-VP yerejimeni ye-chemotherapy, echazwe ngolu hlobo lulandelayo: I-Vincristine (VDS) i-3mg kanye, i-Dexamethasone (i-Dex) i-7mg nganye iiyure ze-12 kwiintsuku ze-9, kunye nonyango oluchasene ne-infective.

- Matshi 1: Iiseli zegazi ezingavuthiweyo ze-peripheral zehliswe ukuya kwi-7%.

- Matshi 4: Iqokelelwe i-autologous lymphocytes ye-CD7-CAR T cell culture.

- Matshi 8: Kuqaliswe irejimeni ye-VLP edityaniswe nonyango lwe-Sida benzamine.

- Matshi 14: Ifunyenwe i-FC regimen chemotherapy (i-Fludarabine 0.35g kwiintsuku ze-3, i-Cyclophosphamide 45mg iintsuku ze-3).

- Matshi 17 (ukufakwa kwangaphambili kweeseli):

- I-Bone marrow residual immunophenotyping: Iiseli ze-15.14% zivakalisa i-CD7 ekhanyayo, i-CD3 dim, i-cytoplasmic CD3, i-T cell receptor restricted delta (TCRrd), i-partial expression ye-CD99, ebonisa iiseli ze-T ezinobungozi.

- Matshi 19: Ifakwe iiseli ze-CD7-CAR T ze-autologous (1 x 10 ^ 6 / kg).

- Imiphumo echaphazelekayo ye-CAR-T: IBanga le-1 CRS (umkhuhlane), akukho neurotoxicity.

- Epreli 6 (Usuku lwe-17): I-Bone marrow morphology ibonise ukuxolelwa, ukuhamba kwe-cytometry ayizange ibone iiseli ezinobungozi ezimbi.