| ObjectiveAdmitted to the Department of Hematology in Zhengzhou Children’s Hospital in 2006 to 2013 in 500 cases of children with acute leukemia in children with clinical data were retrospective summary and analysis, and summarize the clinical characteristics of acute leukemia in local area, clinical features, laboratory features and therapeutic effect evaluation, provide a reference for the treatment in children with acute leukemia.MethodsCollected 2006 May 1 to 2013 December 31,500 children who have diagnosised acute leukemia in the hematology as the observation object, the research diagnostic criteria in accordance with the 2006 Chinese medical subspecialty blood study group to develop the "in children with acute lymphoblastic leukemia diagnosis and treatment recommendations (the three revised draft)" and "children with acute myeloid leukemia cells treatment recommendations." Statistics and analysis of the clinical data of all the children in the onset age, sex, clinical manifestations, and children to develop appropriate treatment programs and to evaluate the therapeutic effect.Result1. In 500 patients, there are 361 ALL patients, 139 AML patients. In 361 ALL cases, there are male 200 cases, female 161 cases; in 139 cases of AML patients, there are male 74 cases, female 65 cases. In 361 cases of children with acute lymphoblastic leukemia, minimum age of onset for 28 days, maximum is 16 years old, peak incidence between 3-7 years old, average age of onset (3.3±0.8) years; in 139 cases of children with AML, the age of onset of the minimum for 3 months and 16 days, a maximum of 16 years old, there is no obvious incidence peak, Ping Junfa disease age (7.3±1.2) years old, the average age of onset of acute lymphoblastic leukemia (all) to significantly lower than children with AML (P<0.05).2. Type and characteristics of MICM(1) Cell morphology:Al patients according to FAB classification: there are 361 cases of acute lymphoblastic leukemia (all),amount of them, there are 254 cases can do, accounting for 70.36%, which male 144 cases,110 cases were female,37 cases of L1,208 cases of L2, L3 type in 9 cases; there are 139 cases of children with AML to types of 97 cases, accounting for 69.78%, which 53 male,44 female patients,3 cases of M1 type,35 cases of M2 type,33 cases of M3 type,6 cases of M4 type,11 cases of M5, M6 type in 6 cases, the M7 3 cases.(2) The immune phenotype:there are 361 cases of children with acute lymphoblastic leukemia all measured the immunophenotype of bone marrow, the type B acute lymphoblastic leukemia (B-ALL) have 309 cases, T acute lymphocytic leukemia (T-ALL) have 52 cases; there are 139 cases of AML, all measured the immunophenotype of bone marrow, which 30 APL patients, 109 patients with AML non M3 with. Non AML patients with M3 CD34, CD 19 and HLA-DR expression rate was significantly higher than that of the APL patients (P< 0.05) and CD33, MPO expression rate was significantly lower than that of APL patients (P< 0.05).(3) Fusion gene:there are gene fusion detection of 212 cases, amount of them,detection fusion gene were 59 cases, accounted for 27.83%, were not detected in 153 patients with fusion gene and 72.17% accounted for. there are 1 212 cases of Al patients, all 154 cases, accounted for 72.64%; there are 154 cases of children with acute lymphoblastic leukemia fusion gene detection results:46 cases were positive, accounted for 29.87% 46/154, the Tel/AML1 most, 23 cases; BCR/ABL times, have 9 cases; E2A/PBX14 cases; MLL/ENL there are 2 cases; not detected Hox11, PML/rar alpha and EVI1 gene expression. Secondly, 58 cases of children with AML fusion gene detection results:10 cases were positive, 17.24%, respectively), which in the PML/rar alpha most in 7 cases, APL; EVI1 times,3 cases were not detected Tel/AML1, BCR/ABL, E2A/PBX1, SIL/TAL1, MLL/ENL gene expression.3. Clinical manifestations:fever:there are 500 cases of A1 patients got a fever, a total of 391 cases, accounted for 78.20%; 361 cases of children with acute lymphoblastic leukemia, a total of 285 cases of fever, accounting for 78.95%,139 cases of AML patients, a total of 106 cases of fever, accounting for 76.26%; Ⅱ hemorrhage: 500 cases of Al patients, a total of 384 Cases of bleeding, (76.80%; 361 cases of children with acute lymphoblastic leukemia, a total of 281 cases of bleeding, accounted for 77.84%,139 cases of AML patients, a total of 103 cases of hemorrhage, accounting for 74.10%.3 infiltration: 500 cases of A1 patients, a total of 377 cases of leukemia cell infiltration, accounted for 75.40%, infiltrative sites occurred in the liver, spleen, lymph nodes, central nervous system (CNS); 361 cases of children with acute lymphoblastic leukemia, a total of 256 cases of leukemia cell infiltration, accounting for 70.91%,139 cases of AML patients, a total of 121 cases of leukemia cell infiltration accounted for 87.05%. AML children with leukemia cell infiltration was significantly higher than that in patients with ALL (P< 0.05).4. Laboratory examination: routine: there are 500 cases, routine blood test, appear naive or primitive cells with 409 cases (81.80%), elevated white blood cell count in children with 314 cases (62.80%); at the same time, we found that when the elevated white blood cell count, naive or primitive cell positive rate, with the highest 282 cases (89.81%), and the white blood cell count is normal, naive or primitive cells with 99 cases (88.39%). With respect to the red cells and platelets, most of the patients had different degrees of reduction, reduce red blood cell in children with 480 cases (96.00%), thrombocytopenia in children with a 436 cases (87.20%). Blood biochemical:500 cases of children with liver function test found that acute lymphoblastic leukemia (all) of aspartic acid transaminase (AST), alanine aminotransferase (ALT), Gu Bingxian turn peptidase (GGT) and alkaline phosphatase (ALP) levels were significantly higher than those of children with AML (P< 0.05). Albumin concentration in APL group was significantly higher than that in all and AML m3 patients (P< 0.05), in children with acute lymphoblastic leukemia (all) and APL globulin concentration to significantly lower than AML m3 patients (P< 0.05).5. Treatment response:361 cases of children with acute lymphoblastic leukemia,328 patients completed the first course of chemotherapy. Other 33 for personal reasons to give up treatment (B-ALL. There are 13 cases gave up treatment, children with T-ALL has 20 cases gave up treatment). After 328 patients in first remission induction therapy, Cr 314 cases (there are 281 cases of complete remission induction in children with B-ALL was first, accounted for 97.23%, T-ALL first induces complete remission have 33 cases, accounted for 84.62%), accounted for 95.73%, PR in 14 cases, accounting for 4.27%. 109 cases of AML m3 patients,87 cases of children completed the first course of chemotherapy were treated with DAE regimen, Cr in 27 cases, accounted for 31.03%, 9 cases of PR, 10.34%, the total efficiency of 41.64%. In 29 patients with APL, 21 cases of children completed the first course of chemotherapy, the ARTA single induction scheme in 12 cases, accounted for 57.14%, Cr in 10 cases, accounted for 83.33%, PR in 1 case, 8.33%, the total efficiency of 91.67%. There were 1 children died in the first chemotherapy, 4 cases were due to personal reasons for not completing the first chemotherapy.6. The influencing factors of treatment efficiency of children with acute lymphoblastic leukemia (all):according to the induction of remission after the end of treatment as a result of the treatment, the patient’s sex, age of onset, clinical symptoms, the hemogram, liver enzymes and protein targets, the immunophenotype of bone marrow and peripheral blood leukemic cell percentage, bone marrow leukemic blood cell percentage of eight factors by multivariate logistic analysis, results show, peripheral blood leukemic cell percentage is effect of children with acute lymphoblastic leukemia treatment effect factors, gender and bone marrow leukemic blood cell ratio is affecting the AML m3 treatment in children with the effect of factors.Conclusion:1. In this region, children with acute leukemia incidence age, type, clinical symptoms and laboratory indicators was similar to other reports, but sex incidence rates in males, the ratio of male to female is higher than that of other domestic reports.2. The sex incidence rates of ALL and AML in males is more than females, the mean age of onset of ALL was significantly lower than that of AML. FAB type, AML type and M3 with M2, ALL with L2 type. MICM type, ALL were mainly B-ALL, AML were mainly AML-M3. Al patients mainly fever, bleeding, anemia, as the main clinical manifestations and AML patients occurred medullary infiltration ratio was significantly higher than that in acute lymphoblastic leukemia (ALL).3. Outer peripheral blood leukemia cells percentage is effect of children with acute lymphoblastic leukemia treatment effect factors, gender and bone marrow leukemic blood cell ratio is affecting the AML m3 treatment in children with effect factors. |
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