| Target : Discuss the factors resulting in the recurrence of acute lymphoblastic leukemia(ALL) among children by the research on the clinical manifestation during preliminary diagnosis, biological characteristics, reaction during early treatment and other factors of recurrent children patient with ALL.Method:1. The research group was the 20 recurrent children patients of acute lymphoblastic leukemia who had received treatment in the Affiliated Hospital of Medical College, Qingdao University in 2010-2014, while the control group was 40 randomly selected B- ALL children patients without recurrence; the age distribution of both groups was the same. Collect relevant clinical data for analysis, including the gender of children patient, the specific age at the time of preliminary diagnosis, the WBC counting, the LDH level, chromosome and gene,response during inductive treatment, minimal residual disease(MRD), etc.2. Take use of the SPSS21.0 software to analyze and collect data and use X2 inspection, t test and other methods to analyze related data, if P<0.05, there is certain statistical meaning.Results2. Clinical characteristic analysis at first visit(1) Gender and age: among the 20 cases of pediatric patients in recurrence group, 11 cases are boys and 9 cases are girls, with the mean age of 3.75 years old; among the 40 cases of pediatric patient in control group, 22 cases are boys and 19 cases are girls, with the mean age of 4.17 years old. There is no statistical difference between the two groups(P>0.05 for both).(2) Immunophenotyping: The expression of CD79 a of pediatric patients in recurrence group is significantly higher than that of control group(P=0.043), while there are no statistical differences between expressions of other CD molecules in two groups(P>0.05 for both).(3) Chromosome karyotype: Hypo-diploid karyotype pediatric patients in recurrence group are significantly higher than those in the control group, while hyper-diploid karyotype is significantly lower than that in the control group(P=0.042).(4) Fusion gene: In recurrence group, the expression of t(12; 21)(TEL/AML1) fusion gene is significantly lower than that in the control group(P=0.037), without statistical differences in expressions of other fusion genes between the two groups(P>0.05 for both).(5) Peripheral blood cell: There is no statistical meaning between the difference of two groups(P>0.05 for both).(6) Level of lactate dehydrogenase(LDH): There is no statistical meaning between the difference of two groups(P>0.05 for both).2. Response to induced relieving treatment(1) Prednisone sensitive test shows that 3 pediatric patient cases(15%) and 2 cases(5%)are insensitive to prednisone in recurrence group and the control group respectively. There is no statistical difference between the two groups(P=0.058).(2) 33 MRD monitoring shows that Pediatric patients with MRD≥10-2 after induced relieving treatment in recurrence group is significantly higher than those in the control group(P=0.037).(3) d33 bone marrow condition: There is no statistical difference between the two groups(P>0.05).3. Monitoring of adverse effects related to chemotherapy and relevant indicators after chemotherapy(1) Hyperglycemia related to chemotherapy in induced relieving phase: There is no statistical difference between the two groups(P=0.357).(2) Absolute neutron count(ANC) after induction: There is no statistical difference between these two groups(P=0.175).(3) Level of IL-17 in consolidation phase:The level IL-17 of recurrence group is significantly lower than that of control group(P=0.047).(4) Infusion of blood products: There is no statistical difference between the two groups(P>0.05 for both).4. Analysis of related factors in induced relieving phase, consolidation phase and delayed enhancement phase(1) Times of infection during chemotherapy: The infection times of pediatric patients in consolidation phase in recurrence group are significantly more than those in control group(P=0.046), without statistical differences between the two groups in the other two phases(P>0.05 for both).(2) Duration of bone marrow suppression: There is no statistical difference between these two pediatric patient groups in duration of bone marrow suppression(P>0.05 for both).(3) Time of chemotherapy: Delayed enhancement phase in recurrence group is significantly longer than that in control group(P=0.039), without statistical differences between the two groups in the other two chemotherapy phases(P>0.05 for both).Conclusion1. The expression of CD79 a increases, expression of t(12; 21)(TEL/AML1) fusion gene decreases, the number of patients with hypo-diploid karyotype increases and the number of patients with hyper-diploid karyotype decreases in pediatric patients in recurrence group.2. The MRDs of pediatric patients in recurrence group are still higher after induced relieving treatment and most of them are no less than 10-4.3. In recurrence group, the expression of IL-17 decreases, while the incidence of infection increases in pediatric patient consolidation phase, and the length of the delayed enhancement phase significantly prolongs. |
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