Maarso 2023: Immune thrombocytopenia (ITP) waa cillad keeni karta nabar iyo dhiig-bax fudud ama xad dhaaf ah. Qiyaastii saddex-meelood laba meel bukaannada ayaa gaadha cafiska ka dib/inta lagu jiro daawaynta safka hore. Si kastaba ha ahaatee, qaybta kale ee bukaanku ma gaadhi karaan cafis waarta ama xitaa diidmada daaweynta bilowga ah. Kiisaskaas, oo loo yaqaanno soo noqoshada/dib-u-celinta difaaca jirka ee thrombocytopenia (R/R ITP), waxay maraan culayska culus ee cudurka kaas oo hoos u dhigaya tayada nolosha. Qaar badan oo cudur-sidaha ah ayaa ka qayb qaata dhacdada R/R ITP, midda ugu muhiimsanna waa burburinta difaaca jirka ee dhexdhexaadka ah. Ilaa hadda inta la og yahay, autoantibodies platelet ee bini'aadamka waxaa inta badan soo daaya unugyada balasmaha, gaar ahaan unugyada balaasmaha ee cimriga dheer. Cilmi-baarayaashu waxay rabaan inay sahamiyaan in BCMA CAR-T ay caawin karto bukaannada R/R ITP inay kordhiyaan tirada platelet, hoos u dhigista qaybaha dhiig-baxa iyo qiyaasta daawooyinka isku-dhafan.
Tijaabo: Anti-BCMA CAR T-unugyada faleebo R/R ITP bukaanada ayaa aqbali doona faleebo ka hortag-BCMA autologous CAR T-unugyada wadar ahaan 1.0-2.0×10e7/Kg. Bukaannada ayaa la socon doona 6 bilood ka dib CAR T-cell therapy.
Nafley: autologous anti-BCMA Unugyada T-ceybaha ee kimeric antigen
Lymphoadenodepletion chemotherapy oo leh FC (fludarabine 30mg/ m2 3 maalmood oo isku xigta iyo cyclophosphamide 300mg/m2 3 maalmood oo isku xigta) ayaa la siin doonaa maalinta -5, -4 iyo -3 kahor CAR T-unugyada faleebo. Wadarta 1.0-2.0×10e7/Kg autologous anti-BCMA CAR T-unugyada waxaa lagu dari doonaa qiyaasta-kordhinta ka dib daaweynta kemoadenodepletion ka dib. Qiyaasta CAR T-unugyada are allowed to be adjusted according to the severity of cytokine sii daayo syndrome.
Shuruudaha
Shuruudaha ka mid noqoshada:
- Dib-u-soo-celinta ITP waxaa lagu qeexay iyadoo loo eegayo shuruudaha dhawaan la isku raacay ('Hagaha Shiinaha ee ogaanshaha iyo maareynta thrombocytopenia aasaasiga ah ee difaaca jirka ee qaangaarka (nooca 2020)'), ama soo noqoshada ITP ee lagu qeexay bukaannada ITP ee ka jawaabay daaweynta safka hore (glucocorticoids ama immunoglobulins) iyo anti-CD20 monoclonal antibody, laakiin ma ilaalin karo jawaabta.
- Da'da 18-65 sano lagu daro.
- Helitaanka xididdada ku filan ee apheresis ama venous dhiiga iyo ma jiraan wax kale oo lid ku ah leukocytosis.
- Kooxda Iskaashatada Oncology ee Bari (ECOG) heerka waxqabadka 0-2.
- Mawduucyadu waa inay lahaadaan awood buuxda oo anshaxa madaniga ah, fahmaan macluumaadka lagama maarmaanka ah, saxeexa foomka oggolaanshaha la wargeliyey si ikhtiyaari ah, oo ay yeeshaan shirkad wanaagsan oo leh nuxurka borotokoolka cilmi-baarista.
Shuruudaha Ka-saarista:
- Sare ITP.
- Bukaanka leh tariikh la yaqaan ama hore looga helay xinjirowga dhiigga halbowlaha (sida xinjirowga maskaxda, wadnaxanuun myocardial, iwm.), ama isku-dhafka xididdada xididdada dhiigga (sida xinjirowga dhiigga ee qoto dheer, sambabada sambabada), ama isticmaalaya daawada xinjirowga lidka / antiplatelet bilowga ee maxkamadaynta.
- Bukaanka leh taariikh la yaqaan ama hore loo ogaadey cudur halis ah ee wadnaha iyo xididdada dhiigga.
- Bukaanka qaba infekshanka aan la xakameynin, cilladda xubnaha ama cillad kasta oo caafimaad oo firfircoon oo aan la xakameynin taas oo ka hortagaysa ka qaybgalka sida lagu qeexay.
- Bukaanka qaba malignant ama taariikhda malignant.
- Tijaabada ballaarinta unugga T ee guuldareystay.
- Inta lagu jiro baaritaanka, hemoglobin <100g/L; qiimaha saxda ah ee tirinta neutrophils <1.5×10^9/L.
- Inta lagu jiro baaritaanka, serum creatinine fiirsashada> 1.5x xadka sare ee xadka caadiga ah, wadarta bilirubin> 1.5x xadka sare ee xadka caadiga ah, alanine aminotransferase iyo aspartate aminotransferase> 3x xadka sare ee heerka caadiga ah, bidix ee ejection jajabka ventricular ≤ 50% by echocardiography, Shaqada sambabada ≥ fasalka 1 dyspnea (CTCAE v5.0), saturation oxygen dhiiga<91% iyada oo aan la neefsan oksijiin.
- Waqtiga Prothrombin (PT) ama saamiga prothrombin-time-international normalized ratio (PT-INR) ama qayb firfircoon oo thromboplastin ah (APTT) oo ka badan 20% qiyaasta tixraaca caadiga ah; ama taariikh aan caadi ahayn oo xinjirowga ah oo aan ahayn ITP.
- Mid ka mid ah antibody HIV ama waraabowga antibody waa togan; Cagaarshowga C antibody waa togan oo ogaanshaha HCV-RNA wuu dhaafaa tijaabada shaybaarka xadka tixraaca sare; Cagaarshowga B dushiisa antigen waa togan oo ogaanshaha HBV-DNA wuu dhaafaa shaybaarka xadka tixraaca sare.
- Ka qaybqaatay daraasado caafimaad oo kale 3 bilood ka hor faleebo unug CAR-T ah.
- Bukaanka ayaa uur leh ama naaska nuujinaya, ama qorsheynaya uur.
- Bukaanku waa bacrin, baaruhuna wuxuu go'aamiyaa in kiisku aanu habboonayn in laga qaybqaato.
- Taariikhda xasaasiyadda daran ee daroogada ama xasaasiyadda caanka ah ee daawaynta CAR-T ee daawooyinka la xidhiidha.
- Laga shakisan yahay ama la aasaasay khamriga, daroogada ama daroogada.
- Baaruhu waxa uu xukumay in aanay ku haboonayn in laga qayb qaato maxkamadayntan.
