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

Isiguli: Huang XX

Ubulili:Owesilisa

Ubudala: Iminyaka engu-42

Ubuzwe: isiShayina

UkuxilongwaI-Acute Lymphoblastic Leukemia (T-ALL)

Xhumana nathi

Izici zekesi:

- Ukuxilongwa: I-Acute T-cell lymphoblastic leukemia

- Ukuqala Nezimpawu: Ephreli 2020, kwethulwe ngesiyezi, ukukhathala, namaphuzu okopha esikhunjeni. Kuhlonzwe nge-acute T-cell lymphoblastic leukemia ngokuhlolwa komnkantsha we-MICM.

- Ukwelashwa Kwasekuqaleni: Kufinyelelwe ukukhululwa okuphelele (CR) ngemva kokwelashwa ngamakhemikhali kwerejimeni ye-VDCLP, kulandelwa imijikelezo engu-2 yokwelashwa ngamakhemikhali okuqinisiwe.

- Julayi 19, 2020: Kutholwe ukufakelwa i-allogeneic hematopoietic stem cell kusuka kumnikeli wesifazane (HLA 5/10 A donor A). I-conditioning regimen yayihlanganisa i-total body irradiation (TBI), i-cyclophosphamide (CY), ne-etoposide (VP-16). Amaseli we-peripheral stem afakwa ngoJulayi 24, nokululama kwe-granulocyte ngosuku +10 kanye nokufakwa kweplatelet ngosuku +13. Ukulandelela iziguli ezilaliswayo njalo ngemva kwalokho.

- Februwari 25, 2021: Kutholwe ukuphindeka komnkantsha wamathambo ngesikhathi sokulandelela.

- Ukwelashwa: Kuqalwe ukwelashwa ngomlomo nge-thalidomide.

- Mashi 8: Ungeniswa esibhedlela sethu.

- I-Bone Marrow Morphology: 61.5% ukuqhuma.

- I-Peripheral Blood Classification: 15% ukuqhuma.

- I-Immunophenotyping: amaseli angu-35.25% aveza i-CD99, CD5, CD3dim, CD8dim, CD7, cCD3, CD2dim, HLA-ABC, cbcl-2, CD81, CD38, ekhombisa ama-lymphocyte e-T ayingozi.

- Ukuhlaziywa kweChromosome: 46, XX [9].

- I-Leukemia Fusion Gene: I-SIL-TAL1 fusion gene positive; isilinganiso sobuningi: SIL-TA.

- Ukuguqulwa Kwezimila Zegazi: Kubi.

- Ukuhlaziywa Kwe-Chimerism (post-HSCT): Amaseli atholakala kumnikeli abalwe ku-45.78%.

- Mashi 11: Ukuqoqwa kwe-autologous peripheral lymphocyte yegazi yesiko lamaseli e-CD7-CART.

- Ukwelashwa: I-VILP (VDS 4mg, IDA 10mg, L-asparaginase 10,000 IU qd x 4 days, Dex 9mg q12h x 9 days) uhlobo lomuthi oluhlanganiswe ne-thalidomide ukulawula isimila.

- Mashi 19: I-FC regimen chemotherapy (Umkhuhlane 50mg x 3 izinsuku, CTX 0.4gx izinsuku ezingu-3).

- Mashi 24 (pre-infusion): I-Bone marrow morphology ibonise i-hyperplasia yebanga V, nokuqhuma okungama-22%.

- I-Cytometry Yokugeleza Kwamathambo: Amaseli angu-29.21% (amaseli ane-nucleated) aveza i-CD3, i-CD5, i-CD7, i-CD99, i-cCD3 eveza ingxenye, ebonisa amaseli e-T angalungile.

- I-Quantitative SIL-TAL1 Fusion Gene: 1.913%.

Ukwelashwa:

- Mashi 26: Ukufakwa kwamaseli e-CD7-CART azenzakalelayo (5*10^5/kg)

- Imiphumela Emibi Ehlobene Ne-CAR-T: Ibanga 1 le-CRS (umkhuhlane), akukho neurotoxicity

- Ephreli 12 (Usuku 17): Ukulandelela kubonise i-morphology yomnkantsha ekuxolelweni, awekho amaseli amadala ayingozi atholwe yi-flow cytometry, kanye ne-SIL-TAL1 (STIL-SCL) ukulinganisa kofuzo kwe-fusion ku-0