The Clinical Analysis Of29Relapse Acute Leukemia In Children

ObjectiveTo explore predictive clinical risk factors aiming to reducerecurrence、detective early and monitor relapse of childhood leukemiabetter by analyzing clinical characteristics of relapse acute leukemia.Methods1. The study group was29patients with relapse acute leukemia from2007to2013. The control group was forty sufferers randomly chosen fromthose in complete remission (CR) after whole chemotherapy. And the agedistribution and gender ratio were equivalent to the study group.2. The statistical analysis was got by using SPSS17.0software andthe data was analyzed with t-test、chi-square test、variance analysis orKruskal-Wallis Test according to specific consideration.(The significancelevel was set at P<0.05).Results1. Out of29relapse children, there were25bone marrow relapse,2cases of central nervous system relapse and2cases of testicular relapse.Time to relapse after initial chemotherapy was from3to42months and17months was the average relapse time. 2. The age distribution and gender ratio between the relapse and CRgroup had no significant difference (P>0.05). In the relapse group,19patients were male while10were female,19patients were1to10years oldand10patients were older than10years. In the control group,25patientswere male while15were female,31patients were1to10years old while9patients were older than10years. The two groups have the majority of onesfrom1to10years.3. Before chemotherapy, the serum LDH level between the relapsegroup and CR group is significant different (P<0.01), and post-treatmentthe two groups had no statistic significance (P>0.05). But after relapse, theserum LDH is much higher than that in complete remission (P<0.05).4. The serum LDH level before treatment is positively related to thenumber of peripheral blood leukocytes(r=0.362，P<0.01) within69cases,but there was no significant correlation between LDH and the percentage ofmarrow immature cells (r=0.084，P>0.05).5. The WBC count before treatment between the relapse and CRgroup was significant different (P<0.05), the average WBC count in relapseand CR group was94.50×109/L and16.31×109/L respectively. The lowestWBC after each stage of chemotherapy between the relapse and CR grouphad no statistic significance (P>0.05).6. The chromosome number abnormalities within ALL hadsignificant difference between the two groups (P<0.05), but there was no difference within AML (P>0.05).7. The chromosome structural abnormalities (fusion genes) betweenthe relapse and CR group had no significant difference (P>0.05).8. The CSF(WBC、Protein、β2-MG、IgG) during treatment betweenthe relapse and CR group had no significant difference(P>0.05). The CSFinvestigation including WBC and protein between non-CNS relapse, beforerelapse and CNS relapse is significant different (P <0.05), while β2-MGand IgG had no statistical significance (P>0.05).9. The chemotherapy duration in ALL relapse group is longer than inCR group (P<0.05), and the average duration within the relapse group was27.28days but21.76days in CR group. There was no difference withinAML. The bone marrow suppression duration between the relapse and CRgroup had no significant difference (P>0.05).10. Among the different risk groups, the amount of blood transfusionbetween the relapse and CR group had no significant difference both inALL and AML (P>0.05).11. The cytokines administer time between the relapse and CR grouphad no significant difference in ALL and AML (P>0.05).12. All of the29relapse child cases of relapse AL,23patients gaveup treatment,6patients received more intensive re-induction chemotherapy.Among the6cases administered with more intense chemotherapy,4caseswere failure,1case relapsed again and1case is still under chemotherapy. ConclusionsPeripheral blood WBC count is to a relatively important prognosisfactor in childhood acute leukemia. Higher WBC count presents a poorprognosis and high relapse rate. Serum LDH level reflects the tumor loadseverity and has a certain correlation to leukemia cell load. LDH levelsmay decrease to normal after remission but rise up again when relapse. Theprognosis of AL with hyper-diploids is better than those with normalchromosome and lower relapse rate. Increased WBC count in cerebrospinalfluid routine detects needs to be mindful of the relapse in central nervoussystem. The longer interval duration of chemotherapy blocks in relapsegroup suggests that adhering to the standardized chemotherapy treatment isan important guarantee to minimize the probability of relapse.