| Object:Retrospective analyzing the clinic features and accessoryexaminations of extramedullary infiltration (EMI) at diagnosis in childrenwith acute lymphoblast leukemia (ALL).To summarize the characteristicsof EMI of children with ALL and identify the relationship between EMIand recurrence of ALL and get early intervention, avoid relapsing andimprove long-term event free survival rate.Methods:1.Research objects: Retrospective analyzed247cases of clinical dataof children aged1year and3months to15years and6months with ALLdiagnosed by MICM classification in Children's Hospital of ChongqingMedical University from January2012to November2013.ALL247patients were divided into two groups, the number of patients with EMI(theexperiment group) was152, the number of patients without EMI(thecontrol group) was95.2.Retrospective analyzing the clinic characteristics and accessory examinations of children with ALL at diagnosis,including age,gender,bloodroutine examination,immune phenotype,refusion gene,risk standard,boneradiography,CT findings of chest and abdomen,CT or MR findings ofhead,ultrasound of reproductive system,condition of cerebrospinal fluid andthe result of remission.Data from different groups divided byage,gender,white blood cell count, immune phenotype and risk standardwere compared between EMI with and without EMI.3.Statistical analysis:The clinical data was analyzed by the statisticalsoftware SPSS19.0.The qualitative data was tested by chi-square test(whentotal case <40or theoretical frequency <1,Fisher exact probability), and thequantitative data was expressed ?vąS, and tested by t-test,.Themeasurement data was tested by ?2-test,Kruskal-Wallis test or Wilcoxontest.P<0.05means that there was a statistical significant difference.Results:1. Of all247cases of ALL in children,138cases were male and109cases were female. The male to female ratio was1.27:1.2. The minimum age was1year and3months,the maximum age was15years and6months, mean age of onst was4years and8months.133cases were1~5years old,71cases were5-10years old and43cases were>10years old.3.26cases (10.6%) were T-ALL,4cases (1.6%) were Pro-B ALL,51cases (20.6%) were Pre-B ALL,159cases (64.4%) were C-B ALL,7cases (2.8%) were M-B ALL.4.207cases out of all patients underwent fusion gene inspection,171cases showed negative,36cases showed positive.12cases were BCR/ABL,1case was MLL/AF4,1case was MLL/ENL,13cases were TEL/AML,3cases were HOX11,5cases were E2A/PBX1,1case was AML/ETO1.5.128cases(51.%) belonged to standard risk group,86cases (34.8%)belonged to intermediate risk group and33cases (13.4%) belonged to highrisk group.6. Of all the247patients,152(61.5%) showed EMI,95(38.5%)without EMI at diagnosis.7. In patients with EMI,98patients had one organ infiltration,41patients had two organs infiltration,13patients had three organs infiltration,4patients had four organ infiltration,1patients had five organs infiltration.8.235organs were infiltrated by leukemia cell of152patients withEMI.Bone involvement was the most common at diagnosis of EMI ofchildren with ALL, followed by infiltration of kidney, pleura,pericardium,parotid gland,mediastinum,salivary gland,CNS and testicle.Enlargement of pancreas and uterus has also been seen.13cases out of all26patients with T-ALL had mediastinal mass,9cases were male and4cases were female.9.3cases of Pro-B ALL,30cases of Pre-B ALL,91cases of C-BALL,7cases of M-B ALL and21cases of T-ALL had EMI. 10.65cases of standard risk group,61cases of intermediate riskgroup and26cases of high risk group had EMI.11. The minimum of peripheral WBC count of the experimentalgroup was1.01×109/L, the maximum was753.53×109/L, the average was65.82×109/L. The minimum of peripheral WBC of the control group was0.3×109/L, the maximum was221.51×109/L, the average was18.21×109/L.12. The peripheral WBC count of152cases of the experimentalgroup was less than10×109/L,56cases were10~50×109/L,17cases were50~100×109/L,28cases were>100×109/L. The peripheral WBC count of58cases of the control group was less than10×109/L,27cases were10~50×109/L,8cases were50~100×109/L,2cases were>100×109/L.13. The WBC count of patients with4organs infiltration successivelywas32.89×109/L?138.85×109/L?335.33×109/L and350×109/L.14. Five children had CNS infiltration at diagnosis.4cases wereCNS-2,1cases was CNS-3.2cases quited therapy,3cases of CNS-2adhered to chemotherapy, their continued complete remission timesuccessively was15+months,14+months and9+months by March2014.15. Five children had testis infiltration at diagnosis.2cases werediscovered through physical examination,3cases through ultrasound.2cases quited therapy. Only2cases did biopsy, the results showed theinfiltration of leukemic cell. Their CCR time successively was13+monthsand15+months by March2014.One child diagnosed as ALL and TL had bone marrow relapse4months later.16.77cases had ostealgia, the bone x-ray of23children withostealgia had special change,such as pathologic fracture and leukemicbelt,et al.170cases had no ostealgia,26cases of bone x-ray had specialchange.17.114patients adhered to chemotherapy out of the experimentalgroup, after induction therapy,2patients died,3cases had no remission,1case had incomplete remission,108cases had complete remission. Inpatients with complete remission,2cases died of complication,20casesquited therapy,79cases had EFS,2cases had bone marrow relapse,3caseshad CNS relapse,1cases had testis relapse and1cases had intraocularrelapse.73patients adhered to chemotherapy out of the control group, afterinduction therapy, all patients had complete remission. In the73patients,3cases died of complication,2cases quited therapy,65cases had EFS,1case had bone marrow relapse.Conclusion:1. Consistent with the literature?the amount of male patients is largerthan the female ones in this group with peak age1-5.2. For those patients who have bone pain at diagnosis?we suggestthat they have a bone radiography in order to early dectection and treatmentregardless if their blood routine examination is normal or not.Hematological malignancy should be considered when bone pain as the first manifestation but other disease can't explain, bone puncture should beadopted when necessary.3. CNS infiltration with ALL at diagnosis was uncommon. Withadhering to chemotherapy, strengthen intrathecal injection and applyingHD-MTX, patients with CNS infiltration at diagnosis can had CCR also.4. Testis infiltration with ALL at diagnosis was rare. Ultrasound ofreproductive system was recommended to patients with normal physicalexamination. Biopsy was recommended to patients with abnormal outcomeof ultrasound of reproductive system to detect occult testicular leukemiaearlier and avoid early bone marrow relapse.5. Parotid gland, salivary gland, skin, pancreas and uterus wouldreturn to normal soon after chemotherapy, isolated relapse of those sites arenot observed, correlating to good prognosis. Isolated kidney relapse wasreported, the relationship between enlargement of kidney and prognosiswas not that clear. Taking CT of abdomen is recommend to patients withALL at diagnosis.6. Patients with EMI had a higher initial WBC count. The higher ofWBC count, the more sites infiltration will happen.Overall assessmentshould be taken to patients with hyperleukocytic leukemia.7. Common-B ALL and standard risk ALL were more common inour study, correlating to good prognosis.8. Mature-B ALL and T-ALL likely developed2and more than2 organs infiltration, high risk and intermediate risk likely developed EMI inour study, correlating to bad prognosis.9. Remission rate of children without EMI is higher than EMI onesafter induction chemotherapy.There is no correlation between infiltrationorgans quantity and remission condition.10. CNSL and TL relapse are the most common extramedullaryrelapse site?bone marrow relapse may follow if the patient is not treated ontime.Patients with ALL or TL relapse should adopt relapse chemotherapyprotocols.11. Full chemotherapy relapse protocol together with localradiotherapy to the affected eye should be adopted to patients withintraocular relapse... |
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