| Objective:To analyze and study the clinical characteristics,biological characteristics and related factors that affect the prognosis of acute lymphoblastic leukemia(ALL)in children in our hospital in the past 7 years,Summarize the diagnosis and treatment experience and provide a reference for improving the survival rate of children with ALL.Methods:A total of 192 children diagnosed with ALL who were admitted to the First Affiliated Hospital of Nanchang University from March 2012 to February 2019 were collected.Among them,2 cases were missing data and 5 patients gave up all the chemotherapy cases in our hospital.185 cases were included in statistics and analysis,and the follow-up deadline was February 2020.The general data of the children and the results of early test data were analyzed retrospectively.All data were statistically analyzed using SPSS 23.0 statistical software.Kaplan-Meier method was used to calculate 5-year overall survival(OS)and event free survival(EFS).Log-Rank test was used Comparison of survival curves.Respectively the age,newly diagnosed white blood cell count,newly diagnosed platelet count,newly diagnosed lactate dehydrogenase value,newly diagnosed bone marrow naive cell ratio,immune phenotype,related fusion genes(BCR/ABL,MLL,TEL/AML,SIL/TALI),chromosome,Univariate analysis of prednisone pre-treatment trial response,induction of minimal residual disease(MRD)for 15 days and induction treatment of minimal residual disease(MRD)for 33 days,To further establish the COX risk proportional regression model for the factors that affect the prognosis for multi-factor analysis.Results:1.Clinical data: 185 cases of ALL children,male to female ratio 1.85: 1(120/65),median age 48 months(6-180 months);4 cases younger than 1 year old(2.2%),38 cases older than or equal to 10 years old(20.5%),143 patients(77.3%)aged 1-10 years old;white blood cell count ≥100 × 109 / L accounted for 17.3%(32/185);platelet count ≥100 × 109 / L accounted for 29.7% at initial diagnosis(55/185);at the time of initial diagnosis,the proportion of naive bone marrow cells ≥90% accounted for 37.8%(70/185);at the time of initial diagnosis,the lactate dehydrogenase count ≥1000U / L accounted for 29.2%(54/185);The immunophenotype is dominated by B-cell phenotype,accounting for 80.0%(148/185);131 cases(70.8%)with normal karyotypes on chromosome examination,and 41 cases(22.2%)with structural abnormalities among the abnormal karyotypes;A total of 59 cases(31.9%)of children detected fusion genes,and among the abnormal genes detected,15 cases(8.1%)had the highest ratio of TEL / AML1;2.Early treatment status and risk stratification: prednisone good response(PGR)was the main prednisone pre-treatment experiment,with 178 cases(96.2%).At the 15 th day of induction treatment,131 patients(70.8%)had minimal residual lesions ≥10-4.There were 22 cases(11.9%)with minimal residual lesions ≥10-4 on the 33 rd day of induction treatment.According to risk stratification,50 cases(27.0%)of them were in the risk group,105 cases(56.8%)in the middle risk group,and 30 cases(16.2%)in the high risk group.3.Analysis of recurrence and death: of the 185 cases of ALL children,There were 19 cases(65.5%)with early recurrence and 10 cases(34.5%)with late recurrence;29(15.7%)had recurrence,including 15(51.7%)with bone marrow alone,6(20.7%)with central nervous system alone,2(6.9%)with testicular alone,and 6(20.7%)with combined recurrence.The recurrence rates of the low,medium and high risk groups were 6.0%(3/50),15.2%(16/105)and 33.3%(10/30),respectively.4.Survival analysis: The overall 5-year OS rate of children with ALL was(82.2 ± 2.63)%,and the 5-year EFS rate was(67.6 ± 3.29)%;the 5-year OS of the standard-risk group,middle-risk group,and high-risk group were(90.5 ± 3.84)%,(71.8 ± 3.89)%,(64.7 ± 8.35)%,the difference between LR and IR and HR were statistically significant(P = 0.029,P=0.009),and the difference between IR and HR was not statistically significant(P = 0.256).The 5-year EFS years were(83.1 ± 4.23)%,(67.5 ± 4.27)%,and(56.7 ± 8.70)% respectively.The differences between LR and IR and HR were statistically significant(P = 0.048,P = 0.017),but there was no difference between IR and HR.Statistical significance(P = 0.198);5-year OS rates of children with early and late relapse were(22.5 ± 11.30)% and(57.3 ± 9.60)%,respectively,and the difference was statistically significant(P = 0.007).5.Gender,platelet count at first diagnosis,lactate dehydrogenase value at first diagnosis,bone marrow naive cell ratio at first diagnosis,immunophenotype,TEL / AML,SIL-TALI,D15 MRD were not significantly associated with long-term OS and EFS;while age,white blood count,Chromosome,MLL fusion gene,BCR / ABL fusion gene,prednisone induction test response,D33 MRD,presence or absence of recurrence,risk stratification to the OS of children with ALL(P values are 0.000、0.047、0.04、0.000、0.022、0.033、0.029、0.000、0.009)and EFS(P values are 0.002,0.043,0.026,0.000,0.014,0.015,0.037,0.013,0.024).Multivariate COX regression analysis showed that age(P = 0.006),recurrence(P = 0.000)and risk grouping(P = 0.029)were independent risk factors that affected the prognosis.Conclusion:1.The overall expected 5-year OS rate for children with ALL in this center is(82.2 ± 2.63)%,and the 5-year EFS rate is(67.6 ± 3.29)%.Both the OS and EFS of children’s ALL gradually decrease with increasing risk;2.ALL children age,both the white blood cell count,chromosome,MLL fusion gene,BCR/ABL fusion gene,prednisone induced reaction test,D33 MRD,recurrence,risk stratification for prognostic factors,including age and risk groups for the independent risk factors influencing the prognosis and recurrence,can be used as an important basis for guiding risk stratification treatment.3.In ALL children,early relapse was more than late relapse.Bone marrow recurrence is the most common recurrence site,with a proportion of up to 51.7%,followed by central nervous system recurrence accounting for 20.7%,and testicular recurrence at least accounting for 6.9%. |
PDF Full Text Request