Childhood Acute Lymphoblastic Leukemia Prognostic Survival Study

We have conducted a retrospective study on 234 eases of childhood acute lymphoblasstic leukemia(ALL) which aged less than 15 years and diagnosed between Jan 1, 1990 and Dec 30, 1995 in Suzhou children hospital. The censor time is Jun 30, 2000. We obtained 164 valid follow-up cases. The failure follow-up rate is 29. 1%. Its remission rate is 75. 9% and 5 year EFS is 15. 9% ±2. 9%. For 164 valid cases, 64 cases were defined as hyper-risk ALL(HR-ALL), its remission rate is 69.8%, 5-EFS is 9.4%±3. 6%;and 100 cases were defined as standard-risk ALL (SR-ALL), its remission rate is 88.1%, 5-EFS is 20.0%±4.0%.In SR-1LL groups, multivariate COX model analysis show that FAB morphology classification(RR=1.84,P=0.05) . medistinal mass(RR=2.67,P=0.004). cumulative therapeutic scores (TSL) (RR=0.51, P0.012) have statistical significance.In HR-ALL group, multivariate COX model analysis show that WBC count (50×109/L,RR2.14,P=0.036) prolymphocyte percent in BM(>78%, RR=2.40. P=0.0 16). enlarged lever (≥ 5cm,RR=2.21,P=0.056) cumulative TS1 (RR=0.31,P=0.033) TS1 in prophylaxis injection(RR=3.99, P=0.055). Chinesemedical herbs(RR=0. 39, P=0. 005)havethestatisticalsignificance.In overall group, multivariate analysis in COX model show that the cumulative TS1(RR~0.55,P~0.004Y. TS1 inprophylaxis injection(RR=3. 95, P=0.004),TS1 instageof induction can come into the multivariate model with other prognostic factors WBC counts~ prolymphocyte percent inBM. enlarged spleen or enlarged lever,which show that the cumulative TSL TS1 in prophylaxis injection,TS in stage ofinduction aremuch importantprognostic factors.IIIftMultivariate analysis adjusted with factors age.. VIBC counts . enlarged spleen show that factors the cumulative TS( X2=71.65,P<0.000 ) TS in prophylaxis injection( x2=62.20,P<0.000),TS in induction(x2=l0. 76,P<0.006), TS in stage of consolidation treatment(x2=57.41, P<0. 000) have significance. The relative risks of ALL children contrast to the TS counts. The more the TS are, the less the risk is. It tell us that the more the child receives in treatment, the RR is less, the better the outcome is.The COX additive model analysis show that the relative risks of age. cumulative TS and TS in prophylaxis injection prsent the non-linear variation.In our conclusion, 1. WBC counts maybe the most important independent prognostic factors for childhood ALL; prolymphocyte percent in BM and blasts percent in peripheral blood maybe the important factors for the long-outcome Enlarged lever and enlarged spleen are dependant prognostic factors, but have some values in the clinical treatment. 2. Treatment regimens are important factors for ALL ehildren.The appropriate treatment regimens and the resonable intensive doses level of therapeutic drugs may be lead to a better longtime-outcome for children.China medical herbs is a positive prognostic factor for HR-ALL. 3. TS-applicat ion may be helpful in guiding treatment, evaluating the prognisis and predicting relapse.Postgraduate student:Lee QinxueDirected by Prof. Zhongliu Tang.