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

Izici zekesi:

- Kutholakale ukuthi une-acute B-cell lymphoblastic leukemia ekupheleni kukaMeyi 2020.

- Umjikelezo wegazi: WBC 5.14x10^9/L, HGB 101.60g/L, PLT 6x10^9/L.

- I-Bone marrow morphology: I-Hypocellular enama-67% ama-lymphocyte akudala.

- I-cytometry egelezayo: 82.28% wamaseli aveza i-CD38, i-HLA-DR, i-CD19, i-CD10, i-CD105, i-TDT, i-CD22, i-cCD79a, i-CD9 eveza kancane, i-CD13 iveza kancane.

- Fusion gene screening negative; WT1 57.3%; awekho amajini okuhlanganisa ahlobene ne-PH ahlobene KONKE.

- INHLANZI: TP53 ukuguqulwa okuhle.

- Ama-Chromosomes: 63-58, XXY, +Y, +1, +del(1)(q41q42), -2, -3, +6, -7, +8, -9, +10, -12, -13 , +14, +15, -17, +18, -20, +22(cp16)/46, XY[4].

- Ithole uhlobo lwe-VCDLP lwezifundo ezi-2 ngaphandle kokuxolelwa.

- Uhlobo lwe-CAM-VL (CTX 2gx2, Arac 200mgx6, 6-MP 100mgx14, VDS 4mgx2, L-ASP 10,000 IUx7) ngoJulayi 22, 2020, namanje ngaphandle kokuxolelwa.

- I-cytometry yokugeleza komnkantsha ngoSepthemba 25, 2020: U-7.35% wamaseli aveza i-CD81, i-CD19, i-CD10, i-CD38, i-CD33, i-CD20 ebuthakathaka, i-CD45.

- Ukuhlaziywa kokuguqulwa kwesimila segazi: Ukuguqulwa kwe-TP53.

- Ama-Chromosomes: 46, XY[20].

- Iqale ukwelashwa kwe-CD19-CART.

- Uhlobo lwe-FC (FLU 62.7mg x 4 days, CTX 1045mg x 2 days) ukwelashwa ngamakhemikhali.

- Okthoba 1, 2020: I-Autologous CD19-CART cell infusion ku-4.7x10^7/kg.

- I-CRS grade 2 ene-neurotoxicity yebanga loku-1, ithuthukisiwe ngemva kokwelashwa okusekelayo.

- Okthoba 29, 2020: Ukukhululwa okuphelele ku-morphology yomnkantsha, awekho amaseli adala ayingozi ku-flow cytometry.

- Disemba 31, 2020: Ukukhwehlela okomile, isicanucanu, ukuhlanza, ubuthakathaka obujwayelekile.

- Umjikelezo wegazi: WBC 15.53x10^9/L, HGB 134g/L, PLT 71x10^9/L.

- Ukulangazelela komnkantsha okubonisa ukuphindeka.

- Januwari 2, 2021: Wangeniswa esibhedlela sethu.

- Umjikelezo wegazi: WBC 20.87x10^9/L, HGB 118.30g/L, PLT 58.60x10^9/L.

I-Creatinine 134umol/L, isigaba sesi-3 somfutho wegazi ophezulu, umlando wezokwelapha weminyaka emi-4.

- Ukuhlukaniswa kwegazi okujikelezayo: amaseli angama-62% okuqala.

- I-Immunophenotyping: 28.48% wamaseli (amaseli ane-nucleated) aveza i-CD10, i-CD38dim, i-HLA-DR, i-CD20dim, i-CD24, i-CD81, i-cCD79a, i-CD22, i-CD268dim, i-CD58, i-CD123, i-TDT, ayivezi i-CD34 MPO, i-CD19 , CD13, CD33, CD11b, clgM, CD79b, CD7, cCD3, kappa, lambda, ekhombisa ama-lymphocyte adala angama-B abulalayo.

- Ukuhlaziywa kokuguqulwa kwesimila segazi: TP53 R196P ukuguqulwa okuhle.

Ukwelashwa:

- Ithole i-VLP chemotherapy, kanye nokwelashwa kwe-hypertension, ukunciphisa i-creatinine, kanye ne-hydration alkalinization.

- Januwari 19: Umjikelezo wegazi ubonisa i-WBC 1.77x10^9/L, HGB 71g/L, PLT 29.8x10^9/L.

- Ukuhlukaniswa kwegazi kwe-peripheral: Awekho ama-lymphocyte akudala.

- I-Bone marrow morphology: I-Hypercellularity (ibanga le-V), izindawo ezigxilwe kuzo zebanga le-IV, nama-lymphocyte angama-42% akudala.

- I-Flow cytometry: 13.91% wamaseli aveza i-CD10, i-cCD79a, i-CD38, i-CD81, i-CD22, awavezi i-CD20, i-CD34, i-CD19, ebonisa amaseli a-B akudala amabi.

- I-karyotype ye-chromosomal:

- 35,XY,-2,-3,-4,-5,-7,-9,-12,-13,-16,-17,-20[8]/35,XY+X,-2 ,-3,-4,-5,-7,-9,-10,-12,-13,-16,-17,-20[1]/36,XY,add(1)(q42),- 2,-3,-4,-7,-9,-12,-13,-16,-17,-20[1]/46,XY[20].

- Januwari 20: Ama-lymphocyte aqoqwa ukuze enze isiko lamaseli e-CD22-CART.

- Januwari 21: Ukubhoboza kwe-Lumbar kwenziwa, i-intrathecal chemotherapy ilawulwa ukuvimbela i-central nervous system leukemia; ukuhlolwa kwe-cerebrospinal fluid akuzange kubonise ukungavamile.

- Januwari 22: Kutholwe i-Arac, 6MP, L-ASP chemotherapy, ne-FC (Flu 50mg x 3, CTX 0.5gx 3) ukwelashwa ngamakhemikhali.

- February 7 (ngaphambi kokumnika): I-Bone marrow morphology ibonise ama-lymphocyte angama-93% okuqala.

- I-Flow cytometry: 76.42% wamaseli aveza i-CD38, i-cCD79a, i-CD22, i-cbcl-2, i-CD123, i-CD10bri, i-CD24, i-CD81, i-CD4, i-CD3, i-CD13+33, i-CD34, i-CD20, i-CD19, i-CD279 (PD1), i-CD274 (PDL1), inkomba yamaseli adala B ayingozi.

- Ukutheleleka kwesikhumba kanye nezicubu ezithambile ezinomkhuhlane; ngcono ngemva kokwelashwa ngama-antibiotic.

- Febhruwari 9: I-Autologous CD22-CART infusion cell (5x10^5/kg).

- Imiphumela emibi ehlobene ne-CAR-T: I-CRS grade 1, imfiva ngoSuku 6 nge-Tmax 40 ° C, izinga lokushisa elilawulwayo ngoSuku lwe-10; akukho neurotoxicity.

- Mashi 11: Ukuhlolwa komnkantsha wamathambo kubonise ukukhululwa okuphelele kwe-morphological, ukugeleza kwe-cytometry akuzange kubonise amaseli amadala ayingozi.