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

Umonde: Huang XX

Isini: Indoda

Ubudala: iminyaka engama-42 ubudala

Ubuzwe: IsiTshayina

UxilongoI-Acute Lymphoblastic Leukemia (T-ALL)

Qhagamshelana nathi

Case features:

- Ukuxilongwa: I-Acute T-cell lymphoblastic leukemia

-Ukuqala kunye neempawu: ku-Epreli 2020, kunikezelwa ngesiyezi, ukudinwa, kunye namanqaku okopha eluswini. Ufunyanwe nge-acute T-cell lymphoblastic leukemia ngovavanyo lomongo we-MICM.

- Unyango lokuqala: Ukufumana ukuxolelwa okupheleleyo (CR) emva kwe-VDCLP yerejimeni ye-chemotherapy, ilandelwa yimijikelezo ye-2 ye-chemotherapy eqinisiweyo.

- Julayi 19, 2020: Kufunyenwe i-allogeneic hematopoietic stem cell transplantation evela kumnikeli wesifazane (HLA 5/10 A donor A). I-conditioning regimen yayiquka i-total body irradiation (TBI), i-cyclophosphamide (CY), kunye ne-etoposide (VP-16). Iiseli ze-peripheral stem zafakwa ngoJulayi 24, kunye nokubuyiselwa kwegranulocyte ngemini +10 kunye neplatelet engraftment ngosuku +13. Ulandelelo lwezigulane ezingalaliswayo rhoqo emva koko.

- NgoFebruwari 25, 2021: Ukuphindaphinda kwamathambo kufunyenwe ngexesha lokulandelwa.

- Unyango: Kwaqalwa ngonyango lwe-thalidomide yomlomo.

- Matshi 8: Walaliswa esibhedlele.

- I-Bone Marrow Morphology: 61.5% ukuqhuma.

- Ulwahlulo lwegazi lwe-Peripheral: 15% ukuqhuma.

- I-Immunophenotyping: Iiseli ze-35.25% ezibonisa i-CD99, i-CD5, i-CD3dim, i-CD8dim, i-CD7, i-cCD3, i-CD2dim, i-HLA-ABC, i-cbcl-2, i-CD81, i-CD38, ebonisa i-lymphocytes ye-T enobungozi.

- Uhlalutyo lweChromosome: 46, XX [9].

- I-Leukemia Fusion Gene: i-SIL-TAL1 i-fusion gene positive; umlinganiselo wobungakanani: SIL-TA.

- Ukuguquguquka kweTumor yegazi: Okungalunganga.

- Uhlalutyo lwe-Chimerism (i-post-HSCT): Iiseli eziphuma kubaxhasi zibalelwa kwi-45.78%.

- Matshi 11: Ukuqokelelwa kwee-autologous peripheral lymphocytes zegazi lenkcubeko ye-CD7-CART.

- Unyango: I-VILP (VDS 4mg, IDA 10mg, L-asparaginase 10,000 IU qd x iintsuku ze-4, i-Dex 9mg q12h x iintsuku ze-9) irejimeni edibeneyo kunye ne-thalidomide ukulawula i-tumor.

- Matshi 19: FC regimen chemotherapy (Flu 50mg x 3 iintsuku, CTX 0.4gx iintsuku ze-3).

- Matshi 24 (pre-infusion): I-Bone marrow morphology ibonise i-hyperplasia ye-grade V, kunye ne-22% yokuqhuma.

- I-Cytometry ye-Bone Marrow Flow: I-29.21% iiseli (zeeseli ze-nucleated) ezibonisa i-CD3, i-CD5, i-CD7, i-CD99, i-cCD3 echaza ngokuyinxenye, ebonisa iiseli ze-T ezinobungozi.

- Ubungakanani be-SIL-TAL1 Fusion Gene: 1.913%.

Unyango:

- Matshi 26: Ukufakwa kweeseli ze-CD7-CART ezizenzekelayo (5 * 10 ^ 5 / kg)

I-CAR-T eNxulumene neempembelelo eziPhambili: ibakala le-CRS 1 (umkhuhlane), akukho neurotoxicity

Ngomhla we-12 ku-Epreli (Umhla we-17): Ulandelelwano lubonise i-morphology yamathambo ekuxoxweni, akukho ziseli ezinobungozi ezingabonakaliyo ezifunyenwe yi-cytometry yokuhamba, kunye ne-SIL-TAL1 (STIL-SCL) i-fusion gene quantification kwi-0