Acute Lymphoblastic Leukemia(T-ALL)-03

Patient: Huang XX

Gender：Male

Age: 42 years old

Nationality: Chinese

Diagnosis:Acute Lymphoblastic Leukemia(T-ALL)

Case Features:

- Diagnosis: Acute T-cell lymphoblastic leukemia

- Onset and Symptoms: April 2020, presented with dizziness, fatigue, and skin bleeding points. Diagnosed with acute T-cell lymphoblastic leukemia through bone marrow MICM examination.

- Initial Treatment: Achieved complete remission (CR) after VDCLP regimen chemotherapy, followed by 2 cycles of intensified chemotherapy.

- July 19, 2020: Received allogeneic hematopoietic stem cell transplantation from a female donor (HLA 5/10 A donor A). Conditioning regimen included total body irradiation (TBI), cyclophosphamide (CY), and etoposide (VP-16). Peripheral stem cells were infused on July 24, with granulocyte recovery by day +10 and platelet engraftment by day +13. Regular outpatient follow-ups thereafter.

- February 25, 2021: Bone marrow relapse detected during follow-up.

- Treatment: Started oral thalidomide therapy.

- March 8: Admitted to our hospital.

- Bone Marrow Morphology: 61.5% blasts.

- Peripheral Blood Classification: 15% blasts.

- Immunophenotyping: 35.25% cells expressing CD99, CD5, CD3dim, CD8dim, CD7, cCD3, CD2dim, HLA-ABC, cbcl-2, CD81, CD38, indicating malignant immature T lymphocytes.

- Chromosome Analysis: 46, XX [9].

- Leukemia Fusion Gene: SIL-TAL1 fusion gene positive; quantitative measurement: SIL-TA.

- Blood Tumor Mutation: Negative.

- Chimerism Analysis (post-HSCT): Donor-derived cells accounted for 45.78%.

- March 11: Collection of autologous peripheral blood lymphocytes for CD7-CART cell culture.

- Treatment: VILP (VDS 4mg, IDA 10mg, L-asparaginase 10,000 IU qd x 4 days, Dex 9mg q12h x 9 days) regimen combined with thalidomide to control the tumor.

- March 19: FC regimen chemotherapy (Flu 50mg x 3 days, CTX 0.4g x 3 days).

- March 24 (pre-infusion): Bone marrow morphology showed grade V hyperplasia, with 22% blasts.

- Bone Marrow Flow Cytometry: 29.21% cells (of nucleated cells) expressing CD3, CD5, CD7, CD99, partially expressing cCD3, indicating malignant immature T cells.

- Quantitative SIL-TAL1 Fusion Gene: 1.913%.

Treatment:

- March 26: Infusion of autologous CD7-CART cells (5*10^5/kg)

- CAR-T Related Side Effects:CRS grade 1 (fever), no neurotoxicity

- April 12 (Day 17): Follow-up showed bone marrow morphology in remission, no malignant immature cells detected by flow cytometry, and SIL-TAL1 (STIL-SCL) fusion gene quantification at 0