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

Kutholwe nge-acute B-cell lymphoblastic leukemia ngoNovemba 28, 2017.

Ukwelashwa ngohlelo lwe-VDLP ekuqaleni, kufinyelelwa ukukhululwa kwengxenye yomnkantsha wamathambo (imininingwane ayibikwanga).

Februwari 2018: Shintshela kuhlelo lwe-VLCAM. I-cytometry yokugeleza komnkantsha ibonise amaseli angama-B angama-60.13% amabi.

Mashi 2018: Ubhalise esivivinyweni somtholampilo se-BiTE. Ukukhululwa kwe-morphological emnkantsheni wamathambo, awekho amaseli amadala ayingozi atholwe yi-flow cytometry.

Meyi 8, 2018: Kutholwe uhlobo lwesimo lwe-TBI/CY+VP16 olulandelwa ukufakelwa kwe-allogeneic stem cell kusuka kuzelamani ezifaniswe ngokugcwele (umnikezeli we-AB+ ukuya kumamukeli ongu-A+). Ukubuyiselwa kwe-neutrophil ngosuku +11, ukululama kwe-megakaryocyte ngosuku +12.

Disemba 5, 2018: Ukukhululwa okuphelele kwe-morphological emnkantsheni, awekho amaseli amadala ayingozi atholwe yi-flow cytometry. Kutholwe ukumnika kwe-lymphocyte yomnikeli (i-DLI) kanye nokwelashwa kwe-prophylactic nge-dasatinib ne-imatinib ukuvimbela ukuphindeka.

Februwari 2, 2019: I-Morphology ibonise amaseli angavuthiwe angu-6.5%, i-flow cytometry ibonise u-0.08% wama-lymphoblasts angama-B ayingozi. Uthole ukwelashwa kwe-DLI. Ngomhla zingama-28 kuNdasa, 2019: I-cytometry egelezayo ayizange ibonise ukungavamile.

Agasti 11, 2019: Umnkantsha wamathambo uphinde uphathwe, uphathwe nge-dasatinib.

Septhemba 2, 2019: I-Morphology ibonise amaseli angakavuthwa angu-3%, i-flow cytometry ibonise amaseli amadala angama-0.04%. Ukwelashwa okuqhubekayo nge-dasatinib, kulandelwa imijikelezo ye-2 ye-methotrexate chemotherapy.

Meyi 11, 2020: Umnkantsha wamathambo uyaphinda futhi.

Ithole izindlela zokwelapha zamaseli e-CD19-CAR-T ezingu-2 ezizenzakalelayo kanye nokwelashwa kwamaseli angu-2 allogeneic e-CD19-CAR-T ngo-2020, akukho okuzuzwe ukuthethelelwa.

Okthoba 26, 2020: Wangeniswa esibhedlela sethu.

Imiphumela Yaselabhorethri:

Umjikelezo wegazi: WBC 22.75 x 10^9/L, HGB 132 g/L, PLT 36 x 10^9/L

Amaseli egazi angavuthiwe: 63%

I-Bone marrow morphology: I-Hypercellular (ibanga II), i-96% ye-lymphoblasts engavuthiwe.

I-Immunophenotyping: Amaseli aveza i-CD19, i-cCD79a, i-CD38dim, i-CD10bri, i-CD34, i-CD81dim, i-CD24, i-HLA-DR, i-TDT, i-CD22, i-CD72; ingxenye ye-CD123. Ikhonjwe njengama-malignant B lymphoblasts angavuthiwe.

Ukuguqulwa kwesimila segazi: Kubi.

I-leukemia fusion gene: I-NUP214-ABL1 fusion gene positive.

Ukuhlaziywa kwe-Chromosome: 46, XX, t(1;9)(p34;p24), engeza(11)(q23)[4]/46, XX, t(1;9)(p34;p24), engeza(11) (q23)x2 [2]/46, XX[3]

I-Chimerism: Amaseli asuselwa kumnikeli enza i-7.71%.

Ukwelashwa:

- I-VDS, i-DEX, i-LASP chemotherapy regimen ilawulwa.

- Novemba 20: Amaseli egazi angavuthiwe angu-0%.

- Ukuqoqwa kwe-autologous peripheral lymphocyte yegazi ye-CD19/22 dual CAR-T cell culture.

- Novemba 29: Ukwelashwa ngamakhemikhali kwe-FC (Flu 50mg x 3, CTX 0.4gx 3).

- Disemba 2 (ngaphambi kokufakwa kweseli ye-CAR-T):

- Umjikelezo wegazi: WBC 0.44 x 10^9/L, HGB 66 g/L, PLT 33 x 10^9/L.

- I-Bone marrow morphology: I-Hypercellular (ibanga lesi-IV), i-68% ye-lymphoblasts engavuthiwe.

- Ukuhlolwa komthamo we-NUP214-ABL1 gene fusion: 24.542%.

- I-Flow cytometry: 46.31% wamaseli aveza i-CD38dim, i-CD22, i-BCL-2, i-CD19, i-CD10bri, i-CD34, i-CD81dim, i-CD24, i-cCD79a, ekhombisa ama-lymphoblasts angama-B ayingozi.

- Disemba 4: Ukufakwa kwamaseli e-CD19/22 amabili e-CAR-T e-autologous (3 x 10^5/kg).

- Imiphumela emibi ehlobene ne-CAR-T: Ibanga 1 CRS, imfiva ngoSuku 6 nge-Tmax engu-40 ° C, umkhuhlane olawulwa yi-Day 10. Akukho neurotoxicity ephawuliwe.

- Disemba 22 (ukuhlola kosuku lwe-18): Ukukhululwa okuphelele kwe-morphological kumnkantsha, awekho amaseli amadala ayingozi atholwe yi-flow cytometry. Ukuhlolwa komthamo we-NUP214-ABL1 yofuzo oluhlanganisiwe: 0%.