| Objiective: Using the method of retrospective cohost study, to collect the information of children with childhood with novo acute myeloid leukemia(AML), such as biological characteristics, clinical symptoms and the survival condition. According to the statistical analysis of collected information, to explore the effect and prognostic factors of medium/high dose cytarabine consolidation therapy for childhood with novo acute myeloid leukemia(AML).Methods: With the retrospective cohort method, about 40 cases with AML who initially treated from December 1, 2004 to January 1, 2015 in the pediatric hematology professional group of the second hospital of He Bei Mediical University were carried out.1 Inclusion criteria: ①The cases with AML aged less than or equal to 14 years old. ②The cases with AML met the standars of diagnosis. The diagnostic standards were based on “ The recommendation about diagnosis and treatment to children with novo acute myeloid leukemia-2006. Exclusion criteria: ①The cases with acute promyelocytic leukemia(APL). ②The cases were not initially treated. ③The cases were not treated by high/medium dose cytarabine consolidation(HD/ID-Ara C).2 Designed the table for case excerpts, we collected the information about the cases with AML, such an sex, age, FAB substyle, induction protocol and induction course, the time from illness onset to chemotherapy finished, initial WBC, initial HGB, initial PLT, the time from the myelosuppression started to finished, the adverse reactions, blasts in the peripheral blood and so on.3 With the follow-up table, we got the survival conditions of the cases with AML, and calculated the survival time.4 We got the classification of information with AML, such as sex(male; femal), age at diagnosis(≤2years old; 2 years old to 10 years old; >10 years old),FAB substyle(M2, M4, M5, M6), M2 substyle includes M2 b and non M2 b, status(condinued complete remission, recurrence, died, lost), induction protocol(DAE, DA, HA), induction courses(CR1, CR2, CR3), adverse reactions(myelosuppression; drug fever; rash; neurotoxicity; gastrointestinal adverse reaction; heart, liver, kidney hurt and else), infections(pneumonia, bronchitis, upper respiratory infection, lung damage, sepsis, fungal infection and else), initial WBC(<10x109/L;(10 to 30)x109/L;(30 to 100)x109/L; ≥100x109/L), initial HGB(<60g/L; ≥60g/L), initial PLT(<20x109/L; ≥100 x109/L).5 Statistical analysis methods: We chose SPSS13.0 statistical software to analyze all the data. We used frequency analysis method to calculate remission rate, loss rate, mortality, recurrence rate, adverse reaction after chemotherapy; We used the Kaplan-Meier method to calculate 1-year event-free survival and disease-free survival, 2-year event-free survival and disease-free survival, 3-year event-free survival and disease-free survival. We used chi-square test to compare rates of different sex, ages, FAB subtype, initial WBC, initial HGB, initial PLT with AML. P<0.05 indicated that the difference was statistically significant.Results: A total data of 40 cases was collected, including 26 patients had completed the entire process of chemotherapy and chemotherapy completion rate was 65%; 5 patients had completed 5 courses of chemotherapy and 4 patients had completed 4 courses of chemotherapy, he complete remission rate of 1 course(CR1) was 85%, CR2 rate was 95%, CR3 rate was 100%, and the median time for 19(15 to 35) days. 1-year event-free survival rate was(88.6±0.05)% and disease-free survival rate was(85.7±0.06)%, 2-year event-free survival rate was(71.93±0.08)% and disease-free survival rate was(71.8±0.06)%, 3-year event-free survival rate was(66.8±0.09)% and disease-free survival rate was( 65.6±0.07) %. 5 patients lost after chemotherapy, loss rate was 12.5%; 8 patients relapsed, recurrence rate was 20%, the most relapsed in one year after remission, the majory relapsed in bone marrow. There were 8 patients relapsed, including 6 cases died and 2 cases achieved continued complete remission after chemotherapy again with high-risk treatment. 7 patients died and death rate was 17.5%, including 1 death case was associated with infection. This group dose include cumulative cases of AML with ID/HD-Ara-C was 166, the all cases complicated with myelosuppression, the period of bone marrow was from 9 to 26 days(medium time was 11.7 days). The infective cases was 97, infection rate was 58.43%, the most infection cases were respiratory tract, besides crystalli, pulmonary tuberculosis, fungal infection and else. Results: Besides 1 case death because of chicken pox infection induced multiple organ failure and given up, other cases controlled by adequate, broad-spectrum antibiotics and antifungal treatment. The adverse reactions included gastrointestinal adverse reaction, rash, drug fever, neurotoxicity, liver damage and else expect infection, then they returned to normal by symptomatic treatment. To compared 1 course complete ression(CR1) rate of sex, ages, initial WBC, initial HGB, initial PLT with AML between groups were no significant(P>0.05), and CR1 rate of subtype M2 with other FAB subtype(M4 M5 M6), were also no significant(P>0.05).Conclusions: 1 A total data of 40 cases was collected, the chemotherapy completion rate was 65%(26/40), more than half, the treatment compliance was good.2 The complete ression rate of 1 course(CR1) was 85%, some reported that was 90%, they were close.3 3-year event-free survival rate and disease-free survival rate were higher 65%, the efficacy of cytarabine had been affirmed.4 The recurrence rate of cases with AML was 20%, higher recurrence rate was main factor which threaten the long-term disease-free survival with AML.5 Most patients can through the period of myelosuppression safely and tolerate chemotherapy with high/medium dose cytarabine by positively preventive measures for complication of chemotherapy.6 The sex, age, initial WBC, initial HGB and initial PLT had no effect on the rate of CR1; and so did between subtyle M2 with other FAB subtypes. |
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