| Objective:This study is aimed to explore the impact of initial diagnosis conditions,such as white blood cell count,age,fusion gene,on minimal residual disease(MRD)and prognosis in intermediate-risk(IR)children with acute lymphoblastic leukemia(ALL).Through this study,we try to provide theoretical evidence to the more scientific stratification treatment and improve the overall survival(OS)of children with ALL.Methods:We collected clinical data of children newly diagnosed ALL from January 1,2015 to June 30,2019 in Qilu Hospital.A total of 82 patients were enrolled.According to the initial diagnosis conditions,all of the children were divided into 5 groups.They are the WBC group,the Age group,the Ph group,the T-ALL group,the rest which is not in conformity with the low risk or high risk group.According to the numbers of the conditions,they were divided into 15 groups..Statistical analysis was performed on the MRD values at day 19 and day 46,the time of MRD negative transition,whether there was recurrence or death at the end of the follow-up period.We analyzed retrospectively and compared the prognostic value of different initial diagnosis conditions.All data were statistically analyzed using SPSS25.0 statistical software.Results:1.General InformationOf the 82 cases,11(13.41%)were Ph positive and 71(86.59%)were negative,and the ratio of Ph+ALL to Ph-ALL was 1:6.45.At the time of initial diagnosis,the mean peripheral blood white blood cell count was 135.33×109/L,with the median of 76.40×109/L.There were 49 cases(59.76%)with the white blood cell count greater than 50×109/L and less than 300×109/L,and 33 cases(40.24%)with the white blood cell count less than or equal to 50×109/L and greater than 300×109/L,with the ratio of 1.48:1.There were 27 cases ofT-ALL(32.93%)and 55 cases of B-ALL(67.07%),and the ratio of T-ALL to B-ALL was about 1:2.04.The average age at the initial diagnosis was 7.94 years old,and the median age was 7.92 years old.There were 29 cases(35.37%)of the children with the initial diagnosis age greater than or equal to 6 months and less than 1 year old and the first diagnosis age greater than 10 years old,and 53 cases(64.63%)of the children with the first diagnosis age less than 6 months or more than 1 year old and less than 10 years old,with a ratio of 1:1.83.There was 1 case(1/82,1.22%)of children in the high-risk group who were younger than 6 months and had a white blood cell count less than 300×109/L.There was 1 case(1/82,1.22%)of children in the low-risk group who had a t(1,19)chromosome mutation.2.The effects of different initial diagnosis conditions on MRD and prognosis Single factor analysis showed that the immune typing of children in the ALL group was statistically significant with the MRD at day 19(P<0.05),and was not statistically significant with the MRD at day 46(P<0.05).Age and MRD Yin conversion time were statistically significant(P<0.05).There was no statistical significance in Ph chromosome,peripheral blood leukocyte count,age,immune typing,recurrence rate and mortality.3.The effect of the number of initial diagnosis conditions on MRD and prognosis In children with Ph+ALL combined with other initial diagnosis conditions,the mortality rate increased and there was no significant effect on MRD.The number of WBC count combination and initial diagnosis conditions was statistically significant with the MRD on day 19(P<0.05),and was not statistically significant with the MRD,MRD days,recurrence rate and mortality on day 46.The number of t-all combined initial diagnosis conditions was not statistically significant with the number of MRD at day 19,MRD at day 46,the number of negative days,the recurrence rate and the death rate.There was a statistically significant difference in the number of MRD on the 19th day between the age of two other initial diagnosis conditions and that of one combined initial diagnosis condition(P<0.05).There was no statistical difference in the number of combined initial diagnosis conditions and the number of MRD,MRD negative transition time,recurrence rate and mortality on the 46th day.4.The effect of MRD at day 19 on prognosisAmong the 82 children with MRD≥0.01 on day 19,there were 39 cases,3 cases of recurrence and 10 cases of death,and 43 cases of children with MRD<0.01 on day 19,4 cases of recurrence and 8 cases of death,with no statistically significant difference between the two groups.Conclusion:1.Generally speaking,with the increase of the combined primary diagnosis criteria,the MRD value increased and the prognosis became worse in the middle-risk group.3.T-all was an independent risk factor for MRD on day 19 of ALL in the middle-risk group,and age was an independent risk factor for MRD Yin conversion time in the middle-risk group.4.Treatment-related death was the leading cause of death of ALL in the middle-risk group.5.There was no significant difference in the causes of death among children with different initial diagnosis conditions. |
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