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

Izici Zomtholampilo:

- Ukuxilongwa: I-Acute T-cell lymphoblastic leukemia

- Ukuqala: Ekupheleni kuka-March 2018

- Izimpawu zokuqala: Ukwanda kwama-lymph node amaningi angaphezulu emzimbeni wonke

- Umjikelezo wokuqala wegazi: WBC: 39.46*10^9/L, Hb: 129g/L, PLT: 77*10^9/L

- I-Bone marrow morphology: 92% ukuqhuma

I-cytometry yokugeleza: 95.3% amaseli angavamile aveza

TdT+CD99+CyCD3+CD7stCd5DdimCD4-CD8-mCD3-CD45dim

- Izakhi zofuzo ze-Fusion: Negative

- Ukuguqulwa kofuzo: NOTCH1 ukuguqulwa kofuzo kutholiwe

- Ukuhlaziywa kweChromosome: I-karyotype evamile

Umlando Wokwelapha:

- Ephreli 3, 2018: Ukwelashwa kokungeniswa ngohlelo lwe-VDCP

- Ephreli 18, 2018: Ukuqhuma komnkantsha kuhlanganisa u-96%

- Ephreli 20, 2018: Kufinyelelwe ukukhululwa ngemva kohlobo lwe-CAG

- Meyi 18, 2018: Ukwelashwa kokuhlanganisa ngohlelo lwe-CMG+VP

- Juni 22, 2018: Ukuqhuma komnkantsha kukhuphuke kwafinyelela ku-40%, ukuphindeka kwe-leukemia

- Julayi 25, 2018: Imithi ye-CLAM (clarithromycin+cyclophosphamide+amikacin)

- Ukufakelwa kwe-hematopoietic stem cell kusuka kuzelamani ehambisana ne-HLA kusetshenziswa isimo se-FLU+BU ngo-Agasti 14

- Ukuqapha ngemuva kokufakelwa: Ukukhululwa kwe-morphology yomnkantsha enyangeni engu-1, izinyanga ezi-3, izinyanga eziyisi-6, izinyanga eziyi-9 nezinyanga eziyi-11

- I-Bone marrow morphology ibonise ukukhululeka ezinyangeni eziyi-16 ngemuva kokufakelwa, ne-flow cytometry yembula ama-lymphocyte angama-malignant angama-0.02%

- Novemba 13, 2020: I-peripheral blood chimerism evela kumthombo womnikeli yayingu-97.9%

- Amaseli egazi angama-peripheral: 20%

- Disemba 18, 2020: I-morphology yomnkantsha wamathambo: 60.6% ukuqhuma

- I-cytometry yokugeleza: ama-lymphocyte angama-T angama-30.85% amabi

- Ukuhlaziywa kweChromosome: 46, XY (20)

- Uthole ukwelashwa ngamakhemikhali kwe-DA ngoJanuwari 19, 2021

- I-Bone marrow morphology ngoJanuwari 19, 2021: I-hyperplasia yeBanga lesi-III, ukuqhuma okungu-16%

- Ukuhlaziywa kwe-chromosome karyotype: 46, XY (20)

- I-Flow cytometry: 7.27% wamaseli (phakathi kwamaseli enuzi) aveze i-CD99bri, i-CD13, i-CD38, i-cbcl-2, i-cCD3, i-HLA-ABC bri, i-CD7bri, ne-CD5dim evezwe kancane, ekhombisa ama-lymphocyte e-T ayingozi

- Ukuhlolwa kofuzo lwe-leukemia fusion: Kubi

- Ukuhlaziywa kokuguqulwa kwesimila segazi (izinhlobo ezingama-86):

1. PHF6 K299Efs*13 ukuguqulwa okuhle

2. I-RUNX1 S322* inguquko enhle

3. Ukuguqulwa kwe-FBXW7 E471G kulungile

4. I-JAK3 M511I inguquko enhle

5. NOTCH1 Q2393* ukuguqulwa okuhle

Ukwelashwa:

- Januwari 22: Ukuqoqwa nesiko lama-autologous peripheral lymphocyte e-CD7-CART

- Ngaphambi kokufakwa kwe-CD7-CART, isiguli sathola i-VLP (vincristine, l-asparaginase, prednisone) kanye ne-bortezomib chemotherapy.

- February 3: FC regimen chemotherapy (Flu 50mg izinsuku ezingu-3 + CTX 0.45g izinsuku ezingu-3)

- February 5 (pre-infusion): I-Bone marrow morphology ibonise ukuqhuma okungama-23%.

- I-Flow cytometry yembule amaseli angu-4.05% aveza i-CD99bri, CD5dim, CD7bri, TDT, cCD3, ebonisa ama-lymphocyte e-T angalungile.

- Ukuhlaziywa kweChromosome: 46, XY (20)

- Ukuhlaziywa kwe-Chimerism (post-HSCT): Amaseli atholakala kumnikeli abalwe ku-52.19%.

- Februwari 7: Ukufakwa kwamaseli e-CD7-CART e-autologous ngethamo elingu-5*10^5/kg.

- Febhruwari 15: Amangqamuzana egazi angavuthiwe afinyelela ku-2%.

- February 19 (Day 12 post-infusion): Isiguli saqala umkhuhlane, owathatha izinsuku ezingu-5 ngaphambi kokulawulwa kwezinga lokushisa.

- Mashi 2: Ukuhlolwa komnkantsha wamathambo kubonise ukukhululwa okuphelele kwe-morphological, ne-flow cytometry engatholanga amaseli amadala ayingozi.