I-Acute Lymphoblastic Leukemia(T-ALL)-02

Iimpawu zoNyango:

- Ukuxilongwa: I-Acute T-cell lymphoblastic leukemia

- Ukuqala: ngasekupheleni kukaMatshi 2018

- Iimpawu zokuqala: Ukwandiswa kwe-lymph node ezininzi emzimbeni wonke

- Inkqubo yokuqala yegazi: WBC: 39.46*10^9/L, Hb: 129g/L, PLT: 77*10^9/L

- I-morphology yomongo wethambo: 92% ukuqhuma

-I-cytometry ye-Flow: I-95.3% yeeseli ezingaqhelekanga ezivakalisa

TdT+CD99+CyCD3+CD7stCd5DdimCD4-CD8-mCD3-CD45dim

- Fusion genes: Negative

-Utshintsho lwemfuza: NOTCH1 ukuguqulwa kofuzo kufunyenwe

- Uhlalutyo lweChromosome: Karyotype eqhelekileyo

Imbali yoNyango:

- ngo-Aprili 3, 2018: Unyango lwe-Induction kunye ne-VDCP regimen

Ngomhla we-18 ku-Epreli, i-2018: Ukuqhuma kwamathambo kuqulethwe kwi-96%

- Epreli 20, 2018: Ukuxolelwa okufezekisiweyo emva kwerejimeni ye-CAG

- Meyi 18, 2018: Unyango lokudibanisa kunye ne-CMG + VP regimen

NgoJuni 22, 2018: Ukuqhushumba komnkantsha kwanda ukuya kwi-40%, ukubuyiswa kwe-leukemia

- Julayi 25, 2018: Irejimeni ye-CLAM (clarithromycin+cyclophosphamide+amikacin)

-I-Hematopoietic stem cell transplantation ukusuka kwi-HLA ehambelana nomntakwabo usebenzisa i-FLU + BU conditioning ngo-Agasti 14

- Ukubeka iliso emva kokutshintshwa: Ukuxolelwa kwe-morphology yomongo kwinyanga enye, iinyanga ezi-3, iinyanga ezi-6, iinyanga ezili-9 kunye neenyanga ezili-11

- I-Bone marrow morphology ibonise uxolelo kwiinyanga ezili-16 emva kokutshintshwa, kunye ne-cytometry ejikelezayo ebonisa i-0.02% ye-lymphocytes engalunganga

NgoNovemba 13, 2020: I-peripheral blood chimerism evela kumthombo wabaxhasi yayiyi-97.9%

- Iiseli zegazi zokuqala: 20%

-Disemba 18, 2020: Imo yomongo wethambo: 60.6% uqhushumbo

- I-cytometry yokugeleza: I-30.85% i-lymphocyte ye-T engalunganga engafanelekanga

- Uhlalutyo lweChromosome: 46, XY (20)

-Yafumana irejimeni ye-DA ichemotherapy nge-19 kaJanuwari, ngo-2021

- I-morphology yomongo wethambo ngoJanuwari 19, 2021: I-hyperplasia yeBakala III, i-16% yokuqhushumba

- Uhlalutyo lwekhromosome karyotype: 46, XY (20)

- I-cytometry ejikelezayo: I-7.27% yeeseli (phakathi kweeseli zenyukliya) ibonakaliswe i-CD99bri, i-CD13, i-CD38, i-cbcl-2, i-cCD3, i-HLA-ABC bri, i-CD7bri, kunye ne-CD5dim ebonakaliswe ngokuyinxenye, ebonisa i-lymphocytes ye-T enobungozi.

- Ukuhlolwa kofuzo lwe-leukemia: Kubi

- Uhlalutyo lokuguqulwa kwethumba legazi (iintlobo ezingama-86):

1. PHF6 K299Efs*13 uguqulelo olulungileyo

2. I-RUNX1 S322* inguqulelo entle

3. FBXW7 E471G inguqu entle

4. JAK3 M511I inguquko entle

5. NOTCH1 Q2393* utshintsho olulungileyo

Unyango:

NgoJanuwari 22: Ukuqokelela kunye nenkcubeko ye-autologous peripheral lymphocytes yegazi ye-CD7-CART

- Ngaphambi kokufakwa kwe-CD7-CART, isigulane safumana i-VLP (vincristine, l-asparaginase, prednisone) kunye ne-bortezomib chemotherapy.

- NgoFebruwari 3: I-FC regimen chemotherapy (Flu 50mg iintsuku ze-3 + CTX 0.45g iintsuku ze-3)

- NgoFebruwari 5 (ngaphambi kokufakelwa): I-Bone marrow morphology ibonise i-23% yokuqhuma.

- I-cytometry ejikelezayo ibonakalise i-4.05% yeeseli ezibonisa i-CD99bri, i-CD5dim, i-CD7bri, i-TDT, i-cCD3, ebonisa i-lymphocytes ye-T enobungozi.

- Uhlalutyo lweChromosome: 46, XY (20)

- Uhlalutyo lwe-Chimerism (i-post-HSCT): Iiseli eziphuma kubaxhasi zibalelwa kwi-52.19%.

- NgoFebruwari 7: Ukufakwa kweeseli ze-CD7-CART ezizenzekelayo kwi-dose ye-5 * 10 ^ 5 / kg.

- ngoFebruwari 15: Iiseli zegazi ezingavuthiweyo ze-peripheral zehlisiwe ukuya kwi-2%.

- NgoFebruwari 19 (Usuku lwe-12 emva kokunyuswa): Isigulane sihlakulela umkhuhlane, oye wahlala iintsuku ezi-5 ngaphambi kokuba ulawulo lokushisa luphunyezwe.

- Matshi 2: Uvavanyo lomongo wethambo lubonise ukuxolelwa okupheleleyo kwe-morphological, kunye ne-flow cytometry engaboni iiseli ezinobungozi ezinobungozi.