| Objective:By analyzing gene expression profiling of acute lymphoblastic leukemia(ALL)patients at preliminary diagnosis,ph-like ALL could be screen out,then we could analyze its gene expression and clinical features and outcome.To establish diagnostic approach of ph-like ALL,and find out its gene expression and clinical characteristics for exploring clinical therapy strategy.Methods:The study cohort was made up of 150 previously untreated children who were admitted to Jiangxi Provincial Children Hospital from Feb 2013 to June 2014.The diagnosis of ALL was according to cytomorphology,immunology,cytochemistry,molecular genetics and cytogenetics.Bone marrows were collected with the consent from all patients.Exclude known common genetic gene positive for children,a total of 20 cases into the group.The subtype of Ph-like leukemia was determined based on gene expression profiles evaluated by Ph-like ALL related fusion gene detection kit.In accordance with the expression pattern,all patients were classified into two groups,Ph-like positive group and negative group.The information of clinical features,therapeutic response and survival time were recorded and analyzed between these two groups.Results:2.1 clinical characteristics:2.1.1: Age: The average age in positive group was 8.01±3.04 years old,negative group was 4.59±2.24 years old,a statistically significant between the two groups(P< 0.05);2.1.2 Gender: 5 cases in positive group,male 3 cases,female 2 cases;15 cases negative group,male 8 cases,female 7 patients,no statistically significant between two groups(p>0.05);2.2 Blood routine test: Higher leucocyte count was observed in positive group(128.61 ± 232.11)*109/L compared to the negative group(27.94±40.25)*109/L;The average level of hemoglobin was(61.50±17.13)g/L in positive group and(78.47±27.48)g/L in negative one;The mean platelet count was(88.16±101.08)* 109 / L in positive group and(67.84±56.60)* 109 / L in negative group;There was no statistically significant difference between the two groups(p>0.05).2.3 The percentage of primitive and immature cells in bone marrow: No statistically significant difference was disclosed between positive group(78.53%±13.95%)and negative group(73.43%±18.09%)(p>0.05);2.4 Karyotype analysis: No abberant karyotype was detected in positive group;2.5 Gene expression characteristics of Ph-like(+): PAX5-JAK2 was identified in 2 cases,ETV6-JAK2 in 1 cases,TPR-JAK2 in 1 cases,and IK6 positive in 1 cases;2.6 Immunophenotype of Ph-like(+): All of the cases were analyzed by immunohistology and flow cytometry,among of which 3 cases were diagnosed as commonB-ALL,1 case as PreB-ALL,and 1 case as T-ALL(20%).2.7 Therapeutic protocol and follow-up: 2 cases of children(40%)receive intermediate-risk treatment and 3 cases(60%)standard-risk treatment in according to risk stratification.3-year follow-up data showed that 2 cases of Ph-like(+)relapsed and 3 cases(60%)survived,which suggested there was no significant difference compared with the Ph-like(-)group(p>0.05);peripheral blood cells were counted on day 8,and bone marrow was observed on day15 and day 33 for evaluating therapy response,Ph-like(+)ALL has a lower remission rate on day15 than Ph-like(-)(P < 0.05).Conclusion:1?It is an efficient scheme that ph-like ALL gene test kit(fluorescence RT-PCR)was used to screen gene expression profiling of ALL children patients.2?The morbidity age of ph-like ALL patients was younger than another group.The rate of original and juvenile cell in bone marrow,and sex was on statistically significant versus normal ALL patients.3?CommonB-ALL is more commonly in ph-like ALL patients.4?JAK2 gene mutation was more frequently detected in ph-like ALL patients.5?It is an independent outcome risk factor in all patients. |
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