| Objective: Using the method of retrospective cohort study, to collect theinformation of children with childhood acute lymphoblastic leukemia(ALL),such as clinical symptoms, signs, laboratory examination results and thesurvival condition. According to the statistical analysis of22researchindicators, to calculate event-free survival rate of the ALL, to explore theeffect of22research indicators on event-free survival time, remission rate,recurrence rate and mortality rate. To provide a theoretical basis to the morescientific judgments of prognosis of children with ALL, more correctassessment of childhood ALL with the risk degree, reasonable selection of theindividualized chemotherapy regimens.Methods: With the retrospective cohort method, about132cases withALL who initially diagnosed from January1,2006to January1,2012in thepediatric hematology professional group of the second hospital of HebeiMedical University were carried out.1,Inclusion criteria:①The cases with ALL aged less than or equal to14years old.②T he cases with ALL met the standards of diagnosis. Thediagnostic standards were based on "The recommendations about diagnosisand treatment to children with acute lymphoblastic leukemia (Third RevisedDraft)-2006" or "The clinical path for the children with acute lymphoblasticleukemia (2010Edition)". Exclusion criteria: the cases were not initiallydiagnosed, initially treated, or the treatment was shorter than a chemotherapytreatment.2,Designed the table for case excerpts, we collected the informationabout the cases with ALL, such as sex, age, WBC, HGB, PLT and blasts in theperipheral blood, the central nervous system leukemia (CNSL) or testisleukemia at newly diagnosed, immunophenotype, molecular genetics (BCR/ABL), the enlargement liver, the enlargement spleen, the enlargementlymph nodes, response to prednisone, prolymphocyte percent in bone marrow(BM) on the19th day, prolymphocyte percent in BM on the33th day,infection, chemotherapy-induced liver disease, chemotherapy-induced lungdisease, blood transfusion, compliance, LDH and treatment protocols.3,With the follow-up table, we got the survival conditions of the caseswith ALL, and calculated the survival time.4,We got the classification of each prognostic factor,such as sex (male;female), age at diagnosis(<1years old or>10years old;1years old to10years old), initial WBC (<50×10~9/L;(50to100)×10~9/L;>100×10~9/L),initial HGB(<60g/L;≥60g/L), initial PLT(<20×10~9/L;≥20×10~9/L),blasts in the peripheral blood (no; yes), immunophenotype (B-ALL;T-ALL),molecular genetics(BCR/ABL)(negative; positive), CNSL or testicularleukemia (no; yes), the enlargement liver(distance under the costal margin)(<5cm;≥5cm), the enlargement spleen (distance under the costal margin)(<5cm;≥5cm), the enlargement lymph node (untouched; neck, armpit oringuinal lymph nodes could be touched), response to prednisone (useful;useless), prolymphocyte percent in BM on the19th day (the number of theprimitive lymphocytes+naive lymphocytes)(<5%;≥5%), prolymphocytepercent in BM on the33th day (the number of the primitive lymphocytes+naive lymphocytes)(<5%;≥5%), infection (no; yes),chemotherapy-induced liver disease (no; yes), chemotherapy-induced lungdisease (no; yes), blood transfusion (no; yes), compliance (bad; good),LDH (<240u/L;≥240u/L) and treatment protocols(2006therapeuticschedule; clinical pathway; special treatment).5,Statistical analysis methods:We chose SPSS17.0statistical software toanalyze all the data. We used the Kaplan-Meier method to calculate3-yearevent-free survival and5-year event-free survival; We used Log-Rank test tocompare survival curves;We used the single COX regression model to screeneffective factors, then establish the multivariate COX regression model to dothe analysis of multiple factors; We used logistic regression analysis to do the analysis of effect that the research indicators had on remission rate,recurrence rate or mortality rate; the mean of measurement data was calculatedby t-test; P <0.05indicated that the difference was statistically significant.Results: A total data of132cases was collected, including105patientswho were event free survival (2cases without remission after inductiontherapy, reached remission later),19patients who relapsed and8patients weredeath. Remission rate was98.48%, recurrence rate was14.39%and mortalityrate was6.07%.3-year event-free survival rate was(74.9±0.05)%,5-yearevent-free survival rate was (63.3±0.07)%. We divided the cases intolow-risk group, middle-risk group and high-risk group.3-year event-freesurvival rate of the52cases in the low-risk group was(87.2±0.06)%, and it ofthe42cases in middle-risk group was(67.6±0.10)%, while it of the38casesin high-risk group wa(s63.1±0.10)%.5-year event-free survival rate of casesin the low-risk group wa(s71.5±0.10)%, and it of cases in middle-risk groupwas(67.6±0.10)%, while it of cases in high-risk group was(50.5±0.14)%.The cases with ALL belonged to different risk groups had the differentsurvival rates (P=0.023). In other words, the higher risk group cases withALL belonged to, the lower survival rate they had. The result of the singleCOX regression model showed: immunophenotype (P=0.005) andcompliance (P=0.046) of cases with ALL had an effect on the event freesurvival time, the other20research indicators did not affect the event freesurvival time. The result of the COX regression multivariate analysis showed:immunophenotype (P=0.005) and compliance (P=0.045) were effectiveprognostic factors for cases with ALL. The result of Logistic analysis showedthat: blood transfusion in the treatment (P=0.040) improved remission rate,molecular genetics(BCR/ABL)(P=0.004) increased recurrence rate, and22research indicators had no effect on mortality rate. Infection rate of the132cases with ALL was34.09%. The cases with respiratory tract infection took amain part of cases with ALL in chemotherapy treatment.4cases with seriousinfection resulted in death, and in the cases died, they accounted for half. Conclusion:1,The higher risk group children with ALL belong to, the lower survivalrate they have.2,Immunophenotype and compliance are independent prognostic factorsfor children with ALL. Compared with the children with T-ALL, the event freesurvival rate of the children with B-ALL is significantly higher.It is animportant guarantee for a good prognosis to adhering to the standardizedtreatment.3,The recurrence rate of children who have the molecular genetics(BCR/ABL) is higher than it of the others.4,It could improve the remission rate for children with ALL to haveblood transfusion in the treatment.5,The children with respiratory tract infection take a main part ofchildren infected with ALL in chemotherapy treatment.The children withserious infection result in death easily. |
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