Sabalalisa i-B-cell lymphoma(DLBCL) enkulu -03

NgoMashi 2021, uMnu. Wang (igama elingelona iqiniso) wavele wezwa ubuhlungu obungezansi besisu, ekuqaleni wenza iphutha ngokuphatheka kabi emathunjini, futhi akazange afune usizo lwezokwelapha ngokushesha. Ezinyangeni ezimbili ezalandela, wabhekana ngokuphindaphindiwe nezimpawu zobuhlungu besisu esingezansi kwesokudla, okwamenza wafuna ukubonisana nodokotela esibhedlela sendawo. I-CT scan yembula ukungahambi kahle kukholoni kanye nokwandiswa kwama-lymph nodes e-retroperitoneal.

Odokotela batusa i-colonoscopy kanye ne-biopsy ukuze kuxilongwe okwengeziwe, okuqinisekisile ukuthi "kusabalalisa i-B-cell lymphoma enkulu," isimila esiyingozi esaziwa kakhulu ngokuthi i-lymphoma. I-PET-CT iphinde yaqinisekisa izilonda ze-nodular hypermetabolic ezisabalele kuwo wonke umzimba wakhe, ngesilinganiso esikhulu kunazo zonke esingu-4.3 * 4.1 * 4.5cm.

Ngokusekelwa umndeni wakhe, uMnu. Wang wathola imijikelezo emine ye-R-CHOP yokwelapha ngamakhemikhali. Ukulandelela kwe-PET-CT ngemva kokwelashwa ngamakhemikhali kubonise ukukhululwa okuyingxenye.

Nokho, ukwelapha okwalandela kwaholela ezinkingeni ezinzima kuMnu. Odokotela abahlinzayo emathunjini kanye nodokotela ababekhona babambisana ohlelweni lokuhlinza, benza i-colon resection kanye ne-drainage, eceleni kokunakekelwa okusekela izimpawu, ukulawula ngokuphumelelayo izimpawu zakhe zesisu.

Ukuskena okwalandela kwe-PET-CT kwembula ukwanda kwezilonda zesimila nosayizi. Ukuze baqede kangcono amangqamuzana esimila, odokotela balungisa uhlobo lokwelapha ngamakhemikhali oluqinisiwe futhi batusa ukufakelwa kwe-hematopoietic stem cell.

Ebhekene nochungechunge lwezinkinga, uMnu. Wang wabhekana nokuhlupheka okukhulu ngokomzimba nangokomzwelo njengoba isimo sakhe sasiba sibi kakhulu. Ukungena kwe-tumor kwabonwa ezindaweni eziningi, nezilonda ezisanda kuthuthukiswa ze-multifocal nodular hypermetabolic ezikhulisa kakhulu indawo yomdlavuza. Ngenxa yezimila kuwo wonke umzimba wakhe, uMnu. Wang wahlushwa ubuhlungu obungapheli besistimu, okwenza kube nzima kuye ukuba alale acashe futhi alale ngenxa yobuhlungu.

Ephelelwe ithemba, uMnu. Wang wafunda ngokwelashwa kwe-CAR-T, inoveli ye-CAR-T cell immunotherapy eyenzelwe ngokukhethekile iziguli ezine-B-cell lymphoma ebuyele emuva noma ephikisayo.

Ngaphambi kokwelashwa kwe-CAR-T, i-lymph node biopsy endaweni engakwesokudla ye-inguinal yabonisa ukuthi i-CD19 ne-CD20 positivity, ihlinzeka ngezinhloso eziqondile zokwelashwa kweseli ye-CAR-T. USolwazi u-Yu uhlele ukuhlolwa okuphelele komzimba okuphelele, okuholele ekuthuthukisweni kohlelo lokwelapha lwe-CAR-T lomuntu ngamunye lukaMnu Wang.

Ngomhla zingama-25 kuJulayi, 2022, uMnu. Wang wathola ukufakwa kweseli ye-CD19/20 CAR-T esibhedlela, inqubo ihamba kahle. Ukuqapha okuseduze kanye nokunakekelwa okuqinile okusekelayo kulawula ukusabela okungekuhle ngemva kokumnika ngaphandle kwezinkinga ezisongela ukuphila.

Esikhathini esingaphansi kwezinyanga ezintathu, ngo-Okthoba 10, 2022, ukuskena kwe-PET-CT kokulandelela kwaqinisekisa ukukhululwa okuphelele, nokuhlola okuphelele okubonisa ukuthuthuka okuphawulekayo esimweni sakhe sezempilo.

Phakathi nokulandelela okwalandela, uMnu. Wang wayevame ukwenza ama-CT, i-MRI, noma ama-PET-CT scan, konke okuqinisekisa isimo sakhe sokuxolelwa okuphelele. Kuze kube manje, impilo yakhe isalokhu iyinhle, idlula isikhathi sokuxolelwa okuphelele esingaphezu kwezinyanga eziyi-14.