Clinical Manifestations Of Acute Lymphoblastic Leukemia With Pneumonia In Pediatric Patients After Chemotherapy

ObjectiveTo analyze and study the clinical manifestations of acute lymphoblastic leukemia(ALL)with pneumonia in children after chemotherapy,and to provide evidences into the early diagnosis of ALL with pneumonia,so as to provide better guidance to clinicians to observe the patients,choose the therapeutic timing and strategy.Methods(1)A total of 108 pediatric ALL patients(115 case-times)with pneumonia after chemotherapy were retrospectively analyzed.The clinical data and chest multi-slice spiral(MSCT)findings of the patients,who were treated with Chinese children cancer group(CCCG)-ALL-2015 protocol,were collected to study the risk factors for pneumonia and the relationship between pathogens and MSCT performance.(2)These pediatric patients sustained chest CT scan with multislice spiral CT(LightSpeed 16-slice spiral CT;GE healthcare).The CT scan conditions were as follows:5.0mm slice thickness,0.1mm slice spacing.All image data were interfaced and measured with a picture archiving and communication systems(PACS).(3)All statistical analysis was analyzed by SPSS version 22.0.A P value of<0.05 was considered to be statistically significant.Results(1)Of the newly diagnosed cases,77.4%of pulmonary infection were manifested during induction remission,reaching a peak at 31-60 days after initiation of chemotherapy,and the median time was at 44th day.And the incidence of infection increased significantly when patients had neutropenia(66.96%).(2)As to the cases which were etiological suspected or diagnosed:bacterial(36.59%)and fungi(41.46%)were the two most common kinds of pathogens.Among the patients with bacterial infections,the infection incidence of Gram-positive bacteria(21.95%)was higher than the Gram-negative bacteria(14.63%).(3)Among the pediatric ALL patients with pulmonary infection,the main chest CT features were ground glass opacity(57.4%),the co-existence of ground glass opacity and consolidation(33.9%),stripe or reticular shadows(33.0%).There was no significant difference between the chest CT performance of bacterial and fungal infection(P>0.05).ConclusionThe incidence of pulmonary infection is significantly increased during remission induction,especially when they are neutropenic.Bacteria and fungi are the primary pathogens of pneumonia in these pediatric patients.However,changes in the chest MSCT images are poor indicators of the nature of pneumonia.