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

Izici zomtholampilo:

- Ukuxilongwa: T-cell lymphoblastic lymphoma/leukemia

- Mashi 2020: Kwethulwa ngokukhwehlela kwe-paroxysmal nesisindo se-mediastinal, kuqinisekiswe i-T-cell lymphoblastic lymphoma nge-mediastinal puncture biopsy.

- Ithole imijikelezo engu-8 ye-chemotherapy kanye neseshini engaphezu kuka-20 ye-radiotherapy, okuholele ekuncipheni okukhulu kwesisindo se-mediastinal.

- Januwari 16, 2021: Ukuthuthukiswa kobuhlungu esithweni esingakwesokudla esingezansi.

- Umjikelezo wegazi: WBC 122.29 x 10^9/L, HGB 91 g/L, PLT 51 x 10^9/L

- I-Bone marrow morphology: 95.5% i-lymphoblasts yakudala.

- I-cytometry yokugeleza komnkantsha: I-91.77% yamaseli ayengama-T-cell lymphoblasts angavuthiwe.

- Ukulandelana kofuzo: Kutholwe ukuguqulwa kofuzo NOTCH1, IL7R, ASXL2.

- Kutholwe uhlobo lwe-Hyper-CVAD/B, uhlobo lwe-ESHAP kamuva, kokubili alusebenzi nomkhuhlane ongapheli.

- Februwari 18, 2021: Wangeniswa esibhedlela sethu.

- Yethulwa ngomkhuhlane, isifuba CT sabonisa inyumoniya.

- Umjikelezo wegazi: WBC 2.89 x 10^9/L, HGB 57.7 g/L, PLT 14.9 x 10^9/L

- Amaseli egazi angavuthiwe: 90%

- I-Bone marrow morphology: I-Hypercellular (ibanga le-IV), i-85% ye-lymphoblasts yakudala.

I-Immunophenotyping: I-87.27% yamaseli ayengama-T-cell lymphoblasts ayingozi.

- Ukuhlaziywa kweChromosomal: 46,XX [24]; ama-karyotypes amathathu engeziwe angajwayelekile abonwa.

- Izakhi zofuzo eziguquliwe:

1. IL7R T244_I245insARCPL ukuguqulwa kube positive

2. NOTCH1 E1583_Q1584dup ukuguqulwa okuhle

3. Ukuguqulwa kwe-ASXL2 Q602R kuhle

- Ukuhlolwa kofuzo lwe-leukemia fusion: Kubi

- Imiphumela ye-PET/CT: Ayikho i-hypermetabolic tumor foci ebalulekile kuwo wonke uhlaka lwamathambo nomnkantsha wethambo.

Ukwelashwa:

- Iqale ukwelashwa ngamakhemikhali kohlobo lwe-VP, inemininingwane kanje: I-Vincristine (VDS) 3mg kanye, i-Dexamethasone (Dex) 7mg njalo emahoreni angu-12 izinsuku ezingu-9, kanye nokwelashwa okulwa namagciwane.

- Mashi 1: Amaseli egazi angavuthiwe afinyelela ku-7%.

- Mashi 4: Kuqoqwe i-autologous lymphocyte yesiko lamaseli e-CD7-CAR T.

- Mashi 8: Kuqalwe uhlobo lwe-VLP oluhlanganiswe nokwelashwa kwe-Sida benzamine.

- Mashi 14: Ithole i-FC regimen chemotherapy (i-Fludarabine 0.35g izinsuku ezingu-3, ​​i-Cyclophosphamide 45mg izinsuku ezingu-3).

- Mashi 17 (ukufakwa kwangaphambi kweseli):

- I-immunophenotyping ye-bone marrow residual: amaseli angu-15.14% aveza i-CD7 ekhanyayo, i-CD3 dim, i-cytoplasmic CD3, i-T cell receptor restricted delta (TCRrd), ukubonakaliswa okuyingxenye kwe-CD99, okubonisa amangqamuzana e-T asekuqaleni ayingozi.

- Mashi 19: Kufakwe amaseli e-CD7-CAR T azenzakalelayo (1 x 10^6/kg).

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

- Ephreli 6 (Usuku 17): I-morphology yomnkantsha wamathambo ibonise ukukhululeka, i-cytometry yokugeleza ayizange ithole amaseli amadala ayingozi.