| Objective:Through the statistical analysis of clinical data,biological characteristics,treatmentresponse and prognosis of infant leukemia(IL)children,it provides a reference for the tre-atment of infant leukemia in the future.Methods:The clinical data of 87 cases of infant leukemia in four centers were retrospectively analyzed,and their gender,age,blood routine at the initial diagnosis,biological characteristics,and efficacy and prognosis were discussed and analyzed.The chi-square test was used to test the difference between sample rates,and kaplan-meier curve was used to analyze the survival status of the children.Results:1.Type,sex and age distribution of infant leukemia.Among the 87 infants with acute leukemia(IAL),53 were infantile acute lymphoblast leukemia(IALL),all of which were B-lineage,accounting for 60.92%,and 34 were acute myeloid cells in infants.Infant acute myeloid leukemia(IAML),accounting for 39.08%,more M5 and M4.49 males,accounting for 56.32%,38 females,43.68%.Among the 53 IALL children,31 were male(58.49%)and 22 were female(41.51%);34 of IAML were male 18(52.94%)and female 16(47.06%),and the sex was lymphoid and myeloid Grouped(P=0.611).Of the 87 patients with IL,the age was 238(172,335)days.Among the 53 children with IALL,the age was 238(158,331)days.In 34 cases of IAML,the age was 239(199,344)days,and the age group was divided into four groups according to 0-3,3-6,6-9,and 9-12 months.The age distribution in the lymphoid and myeloid leukemia was compared(P=0.847).2.Comparison of routine blood tests at first diagnosis between IALL and IAML.Among the 87 cases,the peripheral White blood cells count of 47 cases was less than 100×109/L at first diagnosis,accounting for 54.02%,there were 23 cases of IALL and 24 cases of IAML,and that of 40 cases was more than 100×109/L,accounting for 45.98%,there were 30 cases of IALL and 10 cases of IAML.According to the grouping of lymphoid and medullary systems,the peripheral White blood cells count of IALL children was higher at first diagnosis(P=0.013).63 cases(72.41%)had peripheral hemoglobin<90g/L,there were 43 cases of IALL and 20 cases of IAML,and 24 cases(27.59%)had peripheral hemoglobin>90g/L,there were 10 cases of IALL and 14 cases of IAML.The hemoglobin of IALL children was lower at first diagnosis(P=0.023),according to the grouping of lymphoid system and medullary system.39 cases of peripheral blood platelets<5O×109/L,accounting for 44.83%,there were 31 cases of IALL and 8 cases of IAML.48 cases of peripheral blood platelets>50×109/L,accounting for 55.17%,there were 22 cases of IALL and 26 cases of IAML.Similarly,according to the lymphoid and medullary system,the platelet count of IALL children at first diagnosis was lower(P=0.001).3.Cytogenetics and molecular biology results.(1)Bone marrow chromosome.Among the 87 cases of IL,8 cases were not successful in bone marrow chromosome examination.79 patients underwent bone marrow chromosomal examination,26 cases of normal karyotype(32.91%),53 cases of karyotype abnormality(67.09%),including 43 pseudo-diploids,10 cases of super-diploid,there were 30 cases of IALL and 23 cases of IAML,grouped by lymphoid system and myeloid system,There was no difference in the karyotype of bone marrow chromosomes between the two groups(P=0.280).(2)Gene detection.A total of 84 children underwent fusion gene examination,and the proportion of patients with mixed leukocytic leukemia rearranged(MLL-R)was higher,41 cases(48.81%)and E2A/PBX1 3 cases(3.57%),3 cases(3.57%)of CBFp/MYH11,1 case(1.19%)of EVI1,and 1 case(1.19%)of HOX11.Compared with the MLL partner gene in children with IALL and IAML,it was found that the positive rate of MLL-AF4 in IALL was higher(66.67%),The difference was statistically significant(P=0.010).(3)The relationship between MLL gene and clinical features.Fusion gene examination,84 cases underwent MLL-R positive 41 cases,MLL-R negative 43 cases,according to the MLL-R gene positive and the negative group,the two groups of children with leukemia type,gender,age,liver and spleen enlargement,peripheral blood routine and chromosome karyotype compared to begin with,found that the MLL-R gene is higher in the IALL(P=0.012),MLL-R gene in children with six to nine months in higher positive rate(P=0.025),liver and spleen enlargement see more(P=0.032),Peripheral blood leukocyte count was higher in children with MLL-R gene positive(P=0.017),and chromosomal karyotype was more(P=0.004).4.Efficacy and prognosis.Of 87 cases of IL,33 gave up treatment.In 54 patients received chemotherapy,34 patients(62.96%)with IALL,and 20 patients(37.04%)with IAML.According to the MLL-R gene positive and negative group,IALL and IAML were compared in terms of remission rate,recurrence rate and mortality.It was found that there was no statistically significant difference between IALL and IAML(The IALL P values are 1.000,0.201,1.000.The IAML P values are 0.549,0.354,0.613).The results of event free survival(EFS)and overall survival(OS)were analyzed in children with IAL,IALL,and IAML.The 3 year EFS results were(37.4±9.7)%、(39.4±11.8)%、(34.3± 16.6)%,the 3 year OS results were(53.0±9.3)%、(51.6± 11.6)%、(56.1 ± 15.6)%,respectively.Conclusion:1.In initial diagnosis,patients with IAL often have high peripheral White blood cells count,low hemoglobin and low platelet count,and there are differences between IALL and IAML,which are more obvious in children with IALL.2.According to the FAB classification,there are more M4 and M5 in IAML.3.The positive rate of MLL-R in IALL was significantly higher than that in IAML.MLL-AF4 subtype is most common in IALL.4.Compared with MLL-R negative,MLL-R positive patients were more frequently found in children aged 6-9 months,with more hepatosplenomegaly;higher peripheral blood white blood cell count,and more abnormal chromosome karyotypes in bone marrow.5.The 3-year EFS and OS of IALL and IAML in this paper were lower than abroad,suggesting that our IL treatment level needs to be further improved. |
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