Clinical Analysis Of 31 Infantile Acute Leukemia

Objective:The clinical data of 31 infants with acute leukemia admitted to the first affiliated Hospital of Zhengzhou University from January 2010 to December 2016 were retrospectively summarized and analyzed.Prognostic factors,therapeutic responses and so on,provide reference for the treatment of infantile acute leukemia in the future.Methods:The clinical data of 31 children with IAL under 1 year old who were diagnosed and treated in our hospital from January 2010 to December 2016 were analyzed retrospectively to investigate the clinical manifestations,morphological characteristics and treatment reaction of the children undergoing initial treatment.Results:1.Of the 31 children,22 were ALL and 9 were AML.Including 13 male,18female.8 male and 14 female in 22 cases of ALL,5 males and 4 females in 9 AML cases,P=0.326.2.Among the 31 patients with IAL,the mimimum age was 43 days,the maximum was 11₃₀²² months,and the most in 9/12 mont₁h₁s?61.29%?.In 22 cases of ALL,the age of onset was 43 days,the maximum was 11₃₀ months,and the peak of onset was between 9 and 12 months.In 9 cases of AML,the minimum onset age was5m omnothnts has,n dt h1e2 mmaoxnitmhsu.m was 112320 months,and the onset peak was also between 93.The clinical manifestations:?1?Fever:of 31 cases,17 cases?54.84%?had fever,of which 10 cases with ALL,7 cases with AML,P=0.101;?2?Hep-atosplenomegaly:of 31 cases,22 cases?70.97%?had hepatosplenomegaly,16 cases with ALL,of which 6 cases with AML,P=0.736;?3?Lymphadenomegaly:10 cases?32,26%?with lymphadenomegaly in 31 cases,of which 5 cases with ALL,5cases with AML,P=0.076;?4?The central system infiltration:3 cases?9.68%?was found in31cases,of which 3 cases with ALL,no cases with AML,P=0.244.4.Laboratory examination:?1?Total number of white blood cells:12 cases?38.71%?peripheral blood white blood cells were 100×109/L,including 10 cases with ALL and 2 cases with AML;In 19 cases?61.29%?,the total number of white blood cells was 100×109/L,including 12 cases with ALL and 7 cases with AML,P=0.062;?2?12 cases?38.71%?had peripheral blood platelet count?50×109/L,including with ALL and 2 cases with AML;.In 19 cases?61.29%?,the platelet count of peripheral blood was less than 50×109/L,including 12 cases with ALL and 7 cases with AML,P=0.062.5.MICM typing and characteristic:?1?Fab typing were performed in 9 cases of22 cases with ALL?1 case with hemophagocytic syndrome?and 9 cases with AML,of which 2 cases with M1,4 cases with M4,3 cases with M5.?2?The fusion gene was detected inin 22 cases of ALL,5 cases?19.23%?were positive,4 cases?18.18%?of 22cases with ALL,and all of them were positive for MLL/AF4,and 1 case was positive in 4 cases with AML,which was positive for MLL/AF9,P=0.000.?3?22 cases of ALL were detected for the MICM typing,of which 2 cases of L1 type,10 cases of L2type,and 5 cases of L3 type.22 cases of ALL were detected for the immunophenotype of bone marrow,including 18 cases of pre-B acute lymphoblastic leukemia?pre B-ALL?,4 cases of mature B type acute lymphoblastic leukemia,and22 cases with ALL had co-expression of CD19 and cCD79a,5 cases with AML had co-expression of accounting for CD4,and 4 cases with AML had co-expression of accounting for CD38.?4?Of 14 cases with IAL,7 cases?50%?were abnormal in chromosome examination,of which 4 cases with ALL,3 cases with AML.6.Therapeutic reaction:of the 22 cases of ALL,20 received chemotherapy,of which 9 cases received induced remission on the 8th day,and the remission rate reached 45.0%.Among them,5 survived,4 died,and11 cases did not receive induced remission on the 8th day,1 survived,10 died;9 cases received with bone marrow remission on the 19th day,and the remission rate reached 35.0%;9 cases received with bone marrow remission on the 33th day,and the remission rate reached 45.0%.11 cases of induced remission were abandoned before the end of treatment,2 cases give up treatment after diagnosis for personal reasons,All patients died during telephone follow-up.6 cases were treated with 2006 high risk regimen for diagnosis and treatment of acute lymphoblastic leukemia?4 of them survived?.The follow-up time was 35 months,24 months,20 months and 11 months respectively.Two patients with acute lymphoblastic leukemia?ALL?in Beijing Children's Hospital in 2010 were followed up for 24 months.Recurrent death was performed with high risk regimen for diagnosis and treatment of childhood acute lymphoblastic leukemia in 2014.Follow-up for 22 months showed that 5 of the 9 cases of AML survived received chemotherapy in 2006 for diagnosis and treatment of acute lymphoblastic leukemia.Two of them received hematopoietic stem cell transplantation at the late stage of chemotherapy,one patient was followed up by telephone for 16 months,the other one was followed up by telephone for 19 months,and the other 2 cases developed pneumonia with respiratory failure during chemotherapy,and 1 case died of recurrent death.All of the 4 untreated children with AML died after 1 month telephone follow-up.Conclusions:1.The age characteristics of infantile leukemia were similar to other reports at home and abroad.The incidence of sex was mostly female,and the proportion of all and AML in ALL and AML was slightly higher than that in other reports in China.2.Infant ALL is mainly pro-B system,while infant AML is mainly M4 and M5,which is consistent with domestic and foreign reports.3.Infantile Acute Leukemia were first diagnosed with fever,hepatomegaly,lymph node enlargement and the increase of the total number of peripheral blood white blood cells as the main clinical manifestation.It was similar to the reports at home and abroad.The infiltration rate of the central system was significantly lower than that of the domestic and foreign reports.There was no difference in the clinical manifestations between the ALL group and the AML group.And the blood platelet count in the peripheral blood was shown on the initial treatment.There is no difference.4.The positive rate of MLL gene in 4.infant ALL was 19.23%,and the positive rate of MLL gene in AML was 18.18%.The positive rate was lower than that of the.ALL group.The positive rate of MLL was higher than that of AML.in the.ALL group.5.Prednisone reaction and high leukocyte count of more than 300 x 109/L at first treatment can be used as two risk factors for evaluating the prognosis of ALL children,.MLL gene rearrangement can be used as a risk factor for evaluating the prognosis of ALL.Sex inaction is a prognostic factor for children with ALL.6.The early remission rate of infant ALL is high,the abandonment rate is high,the mortality rate is high,the prognosis is very poor,the AML treatment effect is superior to ALL,which is consistent with the domestic and foreign reports.