Child, female, 7 years old. Acute B lymphocytic leukemia/lymphoma (medium risk, CR1), central nervous system leukemia, 1 year of dangerous chemotherapy according to CCLG-15 regimen, right lower jaw enlargement, admission in January

In April 2018, there was no obvious incentive for the right mandible to enlarge, most about 8cm × 5cm × 4cm, with tenderness, high skin temperature, no fever, dizziness, headache and nausea and vomiting. In the local hospital, the anti-infective effect was poor, and no abnormalities were found in the bone marrow and cerebrospinal fluid during repeated review. On May 15th, 2018, the right lower jaw mass was puncture in the external hospital. Pathological biopsy showed that the morphology was consistent with lymphoma, immunohistochemistry: MPO (small minority +), CD20 (scattered +), PAX-5 (diffuse +), TdT+, Ki-67 (approximately 90%+), CD7-, CD3-, consistent with the diagnosis of "B lymphoblastic leukemia/lymphoma". For further diagnosis and treatment, 2018-05-21 was included in our hospital.
PET-CT examination after admission: multiple soft tissues and masses on the right neck, submandibular and clavicle, increased glucose metabolism, (SUV1.2/1.7) consistent with B lymphoblastic lymphoma/leukemia; right mandibular ulna The quality is damaged; the diffuse unevenness of bone marrow glucose metabolism in the whole body is increased, and some soft tissue shadows in the medullary cavity are consistent with the extensive bone infiltration of the tumor.

After 1 year of treatment, PET-CT showed extensive extramedullary recurrence early, suggesting a poor prognosis. After admission, VLD (Dex 20mg/m2×4d+L-ASP 10,000 units×4d+VDS 1mg d1) was given to the induction program. After the tumor was shortened and shortened rapidly, the patients were completely relieved by chemotherapy and had no long-term treatment. The survival probability of the disease is low, and the family members communicate with each other. The family members voluntarily enter the autologous mouse-derived CD19-CART clinical trial. The peripheral blood lymphocytes of the children were collected and the mouse CD19-CART cells were cultured.
2018-05-28 to 2018-06-04 line CART pre-treatment scheme: VLD+IDA+Flud+CTX
2018-06-06 (0d) CD19-CART cells were returned, and the number of cells was 4.28×106/kg.
2018-06-10 (+4d) Fever, the right lower jaw mass increases rapidly, the skin temperature is high, tender, and resists touch.
2018-06-12 (+6d) ALT/AST increased 4 times, body flushing, edema. The right lower jaw mass is progressively enlarged, involving the mandibular body and neck, and compressing the trachea. Give 20 mg of methylprednisolone into the pot to control CRS.
2018-06-14 (+8d) heat, liver function returned to normal, systemic edema disappeared, right lower jaw mass disappeared, CRS grade 2 (see Figure 2-3).
2018-07-09 (+33d) Blood recovery, bone marrow and cerebrospinal fluid assessment: molecular remission status. Imaging evaluation PET-CT (see Figure 4): Multiple hypermetabolic lesions disappeared from the body.
The children underwent 2018-07-13 to 2018-08-03 head skull + total spinal cord + right mandibular local radiotherapy. The family members refused to perform allogeneic hematopoietic stem cell transplantation, and the familial genetic susceptibility gene screening (see Figure 6) indicated no Defining the high-risk genes of the disease, it is planned to return to the hospital on 2018-08-10 to perform autologous humanized CD22-CART cell sorting therapy.