Aisan lukimia Lymphoblastic nla (T-ALL) -03

Alaisan: Huang XX

abo: Okunrin

Ọjọ ori: 42 ọdun atijọ

Orilẹ-ede: Kannada

Aisan ayẹwoAisan lukimia Lymphoblastic (T-ALL)

Pe wa

Awọn ẹya ara ẹrọ ọran:

- Ayẹwo: Ẹjẹ-ẹjẹ-ẹjẹ-ẹjẹ-ẹjẹ T-cell

- Ibẹrẹ ati Awọn aami aisan: Oṣu Kẹrin Ọjọ 2020, ti a gbekalẹ pẹlu dizziness, rirẹ, ati awọn aaye ẹjẹ awọ ara. Ti ṣe ayẹwo pẹlu aisan lukimia lymphoblastic T-cell nla nipasẹ idanwo MICM ọra inu egungun.

- Itọju Ibẹrẹ: Aṣeyọri idariji pipe (CR) lẹhin kimoterapi ijọba VDCLP, atẹle nipasẹ awọn akoko 2 ti kimoterapi ti o pọ si.

- Oṣu Keje Ọjọ 19, Ọdun 2020: Ti gba isọdọmọ sẹẹli hematopoietic hematopoietic lati ọdọ oluranlọwọ obinrin (HLA 5/10 A oluranlọwọ A). Ilana imudara to wa pẹlu itanna gbogbo ara (TBI), cyclophosphamide (CY), ati etoposide (VP-16). Awọn sẹẹli sẹẹli agbeegbe ni a fi sii ni Oṣu Keje Ọjọ 24, pẹlu imularada granulocyte nipasẹ ọjọ +10 ati imudara platelet nipasẹ ọjọ +13. Awọn atẹle alaisan deede lẹhinna.

- Oṣu Kẹta Ọjọ 25, Ọdun 2021: Ipadasẹyin ọra inu egungun rii lakoko atẹle.

- Itọju: Bibẹrẹ itọju ailera thalidomide ẹnu.

- Oṣu Kẹta Ọjọ 8: Ti gba wọle si ile-iwosan wa.

- Egungun Ẹkọ-ara: 61,5% bugbamu.

- Agbeegbe Ẹjẹ Classification: 15% blasts.

- Immunophenotyping: 35.25% awọn sẹẹli ti n ṣalaye CD99, CD5, CD3dim, CD8dim, CD7, cCD3, CD2dim, HLA-ABC, cbcl-2, CD81, CD38, ti n tọka si awọn lymphocytes T ti ko dagba.

- Chromosome Analysis: 46, XX [9].

- Aisan lukimia Fusion Gene: SIL-TAL1 fusion gene rere; pipo wiwọn: SIL-TA.

- Ẹjẹ Tumor Iyipada: Odi.

- Itupalẹ Chimerism (post-HSCT): Awọn sẹẹli ti o jẹ oluranlọwọ ṣe iṣiro fun 45.78%.

- Oṣu Kẹta Ọjọ 11: Ikojọpọ ti awọn lymphocytes agbeegbe ẹjẹ ti ara ẹni fun aṣa sẹẹli CD7-CART.

- Itoju: VILP (VDS 4mg, IDA 10mg, L-asparaginase 10,000 IU qd x 4 ọjọ, Dex 9mg q12h x 9 ọjọ) ilana ni idapo pẹlu thalidomide lati ṣakoso awọn tumo.

- Oṣu Kẹta Ọjọ 19: Kimoterapi ijọba FC (Flu 50mg x 3 ọjọ, CTX 0.4gx 3 ọjọ).

- Oṣu Kẹta Ọjọ 24 (iṣaaju-idapo): Mofoloji ọra inu egungun fihan hyperplasia ipele V, pẹlu awọn bugbamu 22%.

- Cytometry Marrow Flow: 29.21% awọn sẹẹli (ti awọn sẹẹli iparun) ti n ṣalaye CD3, CD5, CD7, CD99, ti n ṣalaye ni apakan cCD3, ti o nfihan awọn sẹẹli T ti ko dagba.

- Pipo SIL-TAL1 Fusion Gene: 1.913%.

Itọju:

- Oṣu Kẹta Ọjọ 26: Idapo awọn sẹẹli CD7-CART autologous (5*10^5/kg)

- Awọn ipa ẹgbẹ ti o jọmọ CAR-T: CRS grade 1 (iba), ko si neurotoxicity

- Oṣu Kẹrin Ọjọ 12 (Ọjọ 17): Atẹle ṣe afihan iṣan-ara iṣan inu eegun ni idariji, ko si awọn sẹẹli ti ko tọ ti a rii nipasẹ cytometry ṣiṣan, ati SIL-TAL1 (STIL-SCL) iwọn jiini idapọmọra ni 0