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

Izici zekesi:

- Meyi 19, 2019: Kuhlonzwe nge-acute B-cell lymphoblastic leukemia (B-ALL)

- Kwethulwa ngobuningi be-scalp kanye ne-lymphadenopathy

- Umjikelezo wegazi: WBC 13.3 x 10^9/L, HGB 94 g/L, PLT 333 x 10^9/L, ama-lymphocyte angavamile 4%

- I-Bone marrow morphology: 80.2% ama-lymphoblasts angavuthiwe (ukuqhuma)

- I-Immunophenotyping: Amaphesenti angu-74.19 amaseli angamaseli ayingozi andulela umugqa we-B aveza i-CD45dim, i-CD19, i-CD9, i-CD22, i-CD81, i-CD58, i-cCD79a, i-CD38, i-HLA-DR, iveza ingxenye ye-cIgM. Ukuxilongwa: B-ALL (Pre-B stage)

- Fusion gene: MLL-ENL positive, Philadelphia chromosome-like (Ph-like) screen negative

- I-Chromosome: 46, XX, t(11;19)(q23;p13), del(20)(q12) [3]/46, XX [7]

- Ukwelashwa ngamakhemikhali kwerejimeni ye-VDLD ekuqaleni kwazuza ukukhululwa kwe-immunological ngemva kwenyanga engu-1, i-MLL-ENL quantitative PCR 0.026%

- I-chemotherapy eqhubekayo njengephrothokholi yezingane, i-MLL-ENL quantitative PCR 0 ngemva komjikelezo wesi-4. Ukwelashwa okwengeziwe ngamakhemikhali kwaqhubeka.

- Mashi 2020: Isifo se-bone marrow immunological residual disease esingu-0.35%, i-MLL-ENL quantitative PCR 0.53%, okubonisa ukuthambekela kokubuyela emuva. Umndeni wenqabile ukufakelwa kabusha. I-chemotherapy eqhubekayo imijikelezo emi-3.

- Julayi 2020: Umnkantsha ubuye wabuya ngokuphelele.

- Novemba 11, 2020: I-Intrathecal chemotherapy, i-CSF immunological residual disease 66%, kutholwe ukuthi inomdlavuza we-nervous central. I-Intrathecal chemotherapy iphindwe kabili, i-CSF yaphenduka inegethivu.

- Disemba 31, 2020: Ungeniswe esibhedlela sethu.

- Umjikelezo wegazi: WBC 3.99 x 10^9/L, HGB 66 g/L, PLT 57 x 10^9/L

- Isibalo sokuqhuma kwegazi okuzungezile: 69%

- I-Bone marrow morphology: 90% ama-lymphoblasts angavuthiwe (ukuqhuma)

- I-Immunophenotyping: Amaphesenti angu-84.07 amaseli aveza i-CD38, i-CD19, i-CD81dim, i-cCD79a, i-HLA-DR, i-cIgM, i-CD22, i-CD123, iveza ingxenye ye-CD24, i-CD15dim, ekhombisa ama-lymphoblasts a-B angavuthiwe.

I-Fusion gene: I-MLL-ENL fusion gene positive, quantitative PCR 44.419%

- Ukuguqulwa kofuzo: Ukuguqulwa kwe-KMT2D okuhle (umsuka wegciwane)

- I-Chromosome karyotype: 46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3), engeza( 14)(q34), -17, +mar [7]/46, idem, t(3;16)(p21;p13.3) [1]/46, XX [13]

- I-PET-CT: Ukusabalalisa ukwanda kwe-metabolic kuwo wonke uhlaka lwamathambo nomnkantsha, izinsolo eziphakeme zokuphindaphinda kwe-leukemia; i-splenomegaly ene-metabolism eyandayo, okungenzeka ukuthi ihilela i-leukemia.

- Wenza ukubhoboza i-lumbar kanye ne-intrathecal chemotherapy kanye, akukho okungavamile okutholakala ekuhloleni okuhlobene ne-CSF.

Ukwelashwa:

- Amasonto amabili e-VLP chemotherapy, igazi le-peripheral liqhuma ama-5% ngoJanuwari 18.

- Januwari 25: Igazi le-peripheral liqhuma ama-91%, elashwe nge-CTX, Ara-C, 6-MP chemotherapy.

- Febhruwari 3: Ukuqhuma kwegazi kwe-peripheral 22%.

- Februwari 4: Ukuqoqwa kwegazi elingu-50ml le-autologous peripheral yesiko lamaseli e-CD19-CART.

- MTX 1g, FC chemotherapy (Flu 15mg nsuku zonke x 3 izinsuku, CTX 0.12g nsuku zonke x 3 izinsuku).

- February 13 (pre-infusion): I-Bone marrow morphology ibonisa ukuqhuma okungama-87.5%, i-cytometry yokugeleza ibonisa ukuqhuma okubi okungama-79.4%.

- Ukuhlaziywa kobuningi bofuzo lwe-MLL-ENL: 42.639%.

- February 14: Ukufakwa kwamaseli e-CART ngethamo lika-5 x 10^5/kg.

- Imiphumela emibi ehlobene ne-CAR-T: I-CRS yeBanga loku-1 (umkhuhlane), akukho neurotoxicity.

- Usuku lwama-20 ngemva kokujova: I-blood smear ibonisa ukwanda kwesimila, ingxenye ye-CART cell 0.07%.

- Ukwelashwa kwamaseli e-CART okungasebenzi.

- Mashi 8, 2021: Umjikelezo wegazi: WBC 38.55 x 10^9/L, HGB 65g/L, PLT 71.60 x 10^9/L.

- Ukuqhuma kwegazi okuzungezile: 83%. Igazi le-autologous peripheral liqoqe u-60ml we-CD19/CD22 dual CART cell culture.

- Yelashwa nge-cytarabine ne-dexamethasone ukulawula isimila.

- Mashi 18: I-FC chemotherapy (Umkhuhlane 15mg nsuku zonke x izinsuku ezi-3, i-CTX 0.12g nsuku zonke x izinsuku ezi-3).

- Mashi 22 (pre-infusion): Umjikelezo wegazi: WBC 0.42 x 10^9/L, HGB 93.70g/L, PLT 33.6 x 10^9/L. I-peripheral blood morphology: 6% ukuqhuma.

- I-morphology yomnkantsha: 91% ukuqhuma. Insalela emnkantsheni: 88.61% amaseli aveza i-CD38, i-CD19, i-cCD79a, i-CD81, i-CD22, ekhombisa ama-lymphoblasts angama-B ayingozi.

- Ukuhlaziywa kobuningi be-MLL-ENL ye-fusion gene: 62.894%.

- Ukuhlaziywa kwe-Chromosome karyotype: 46, XX, del(1)(p36.1), del(11)(q13), t(11;19)(q23;p13.3), engeza(14)(q34), - 17, +mar [2]/46, XX, del(1)(p36.1), del(1)(q31q42), del(11)(q13), t(11;19)(q23;p13.3) ), engeza(14)(q34).

- Mashi 23: Ukufakwa kwamaseli e-CART ngethamo elingu-3 x 10^5/kg.

- Mashi 26 kuye phambili: Ukushisa okuphezulu okuqhubekayo futhi kamuva kwavela i-systemic edema.

- Mashi 29: I-peripheral blood morphology: 92% ukuqhuma; ukwanda kwe-bilirubin ne-transaminase.

- Ephreli 2: Ukuqala kokuquleka, ukwelashwa nge-diazepam.

- Ephreli 2 (Usuku 10): Uqale ukwelashwa nge-methylprednisolone izinsuku ezi-3.

- Ukusabela kwe-CRS: IBanga lesi-3, i-CRES: iBanga lesi-3.

- Ephreli 8 (Usuku 16): Ukuhlolwa komnkantsha kubonisa ukukhululwa okuphelele kwe-morphological, i-flow cytometry inegethivu yokuqhuma okubi; Ukuhlaziywa kobuningi bofuzo lwe-MLL-ENL: 0.