Ukusasaza i-B-cell lymphoma enkulu (DLBCL) -03
Ngo-Matshi 2021, uMnu. Wang (igama elingaziwa) ngequbuliso weva iintlungu ezisezantsi zesisu, ekuqaleni waphazama ngenxa yokungakhululeki kwesisu, kwaye akazange afune unyango kwangoko. Kwiinyanga ezimbini ezalandelayo, wafumana ngokuphindaphindiweyo iimpawu zentlungu esezantsi yesisu, ebangela ukuba afune ukubonisana nonyango kwisibhedlele sendawo. I-CT scan ibonise ukungahambi kakuhle kwikholoni kunye nokwandisa i-retroperitoneal lymph nodes.
Oogqirha bacebise ukuba i-colonoscopy kunye ne-biopsy ixilongwe ngakumbi, eqinisekisa "i-B-cell lymphoma enkulu," ithumba elibi elidume njenge-lymphoma. I-PET-CT iphinde yaqinisekisa ukusasazeka kwezilonda ze-nodular hypermetabolic kuwo wonke umzimba wakhe, kunye neyona nto inkulu yokulinganisa i-4.3 * 4.1 * 4.5cm.
Ngenkxaso yentsapho yakhe, uMnumzana Wang wafumana imijikelo emine ye-R-CHOP ichemotherapy. Ukulandelwa kwe-PET-CT emva kwe-chemotherapy kubonise ukuxolelwa inxalenye.
Noko ke, unyango olwalandelayo lwakhokelela kwiingxaki ezinzima kuMnu. Oogqirha besisu kunye noogqirha abahambayo babambisana kwisicwangciso sotyando, ukwenza i-colon resection kunye ne-drainage, kunye nokunakekelwa kwenkxaso yeempawu, ukulawula ngokufanelekileyo iimpawu zakhe zesisu.
Uvavanyo olulandelayo lwe-PET-CT lubonakalise ukwanda kwezilonda kunye nobukhulu. Ukuphelisa ngcono iiseli zethumba, oogqirha bahlengahlengisa irejimeni ye-chemotherapy eyandisiweyo kwaye bacebisa utyando lwe-hematopoietic stem cell.
Etyhubela uthotho lweengxaki, uMnumzan’ uWang wabandezeleka kakhulu ngokwasemzimbeni nangokweemvakalelo njengoko imeko yakhe yayisiba mandundu. Ukungena kwe-tumor kwabonwa kwiindawo ezininzi, kunye nezilonda ezisanda kuphuhliswa ze-multifocal nodular hypermetabolic zandisa kakhulu indawo enomhlaza. Ngenxa yamathumba kuwo wonke umzimba wakhe, uMnumzana Wang wabandezeleka ngenxa yeentlungu ezingapheliyo zenkqubo, okwenza kube nzima ukuba alale phantsi kwaye alale ngenxa yeentlungu.
Ngokuphelelwa lithemba, uMnumzana Wang wafunda ngonyango lwe-CAR-T, inoveli ye-CAR-T ye-cell immunotherapy eyenzelwe ngokukhethekileyo izigulane ezine-B-cell lymphoma ephindaphindayo okanye i-refractory.
Ngaphambi kokufumana unyango lwe-CAR-T, i-lymph node biopsy kummandla we-inguinal ochanekileyo ibonise ukuba i-CD19 kunye ne-CD20 positivity, ibonelela ngeethagethi ezichanekileyo zonyango lwe-CAR-T. UNjingalwazi Yu uququzelele uviwo olubanzi lomzimba, olukhokelela ekuphuhlisweni kwesicwangciso sonyango lwe-CAR-T yomntu ngamnye kuMnu Wang.
NgoJulayi 25, 2022, uMnu. Wang wafumana iCD19/20 CAR-T cell infusion esibhedlele, nenkqubo ihamba kakuhle. Ukubeka iliso olusondeleyo kunye nokhathalelo olungqongqo oluxhasayo lulawule ukusabela okungalunganga emva kokufakwa ngaphandle kweengxaki ezisongela ubomi.
Ngaphantsi kweenyanga ezintathu, ngo-Oktobha 10, 2022, i-PET-CT scan yaqinisekisa ukuba uxolelwe ngokupheleleyo, yaye uvavanyo lulonke lubonisa ukuphucuka okuphawulekayo kwimeko yakhe yempilo.
Ngethuba lokulandelwa okulandelayo, uMnu. Wang wayesoloko ephethe i-CT, i-MRI, okanye i-PET-CT scans, zonke eziqinisekisa isimo sakhe sokuxolelwa ngokupheleleyo. Ukuza kuthi ga ngoku, impilo yakhe isahleli ilungile, idlula ixesha loxolelo olupheleleyo olungaphezulu kweenyanga ezili-14.
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