Therapeutic Effect And Clinical Analysis Of PEG-Asp In Children With T-lymyphocytic Leukemia

Objective:To observe:1.The efficacy and adverse reactions of Pegaspargase(PEG-Asp)and L-Asp in the treatment of childhood T-lymphocytic leukemia(T-ALL),2.Whether increasing the amount of Pegaspargase in the maintenance treatment can improve the prognosis.Methods:A total of 125 children with T-ALL diagnosed by MICM method from July 2008 to November 2018 were collected from the Children's Hospital of Soochow University.Among them,120 cases were evaluated for their efficacy after induction of remission therapy.During the induction and remission phase,according to the use of PEG-Asp(85 cases)or L-Asp(35 cases),they were divided into two groups.Observed whether there were differences in gender,age,leukocyte count at first diagnosis,clinical risk group,and response to prednisone pretreatment in the two groups;The bone marrow morphology of D15 and D33 in induction remission stage of the two groups were observed,and the long-term prognosis was analyzed.Regular monitoring and recording laboratory indicators such as blood routine,biochemical complete set,water and an electrolyte,coagulation function,blood urease amylase or others of the two groups of children,to observe clinical adverse reactions.58 children who had entered the maintenance stage were divided into A and B groups according to whether PEG-Asp treatment was added or not.Group A(32 cases)added PEG-Asp and group B(26 cases)as control,the long-term effects of the two groups were observed.Results:The bone marrow morphology of 120 patients with T-ALL in this study was observed in the PEG-Asp group and L-Asp group at induction remission therapy D15,there was no significant difference of M1,M2 and M3 in the bone marrow between the two groups(P>0.05);The proportion of M1 and M2 status in bone marrow of PEG-Asp group was higher than that of L-Asp group in induction remission therapy D33,and there was significant difference between the two groups(P<0.05);There was no significant difference in the mortality rate between the two groups(P>0.05);The recurrence rate in the PEG-Asp group was significantly lower than that in the L-Asp group,and the difference was statistically significant(P<0.05);The 3-year OS of the PEG-Asp group and the L-Asp group were(78.3±5.1)%and(65.7±8)%,respectively,and EFS was(74.3±5.2)%and(62.9±8.2)%,respectively,there was no significant difference(P>0.05);The incidence of allergic reaction in PEG-Asp group was lower than that in L-Asp group,with statistical significance(P<0.05).There was no significant differences in the incidence of liver function damage,coagulation dysfunction,elevated blood sugar and acute pancreatitis between the two groups(P>0.05).Among the 58 children who entered maintenance therapy,the OS for group A and group B was(96.6±3.4)%and(65±9.4)%,respectively,and EFS was(87.1±6)%and(61.1±6),respectively,the OS and EFS of group A were significantly higher than those of group B,and the difference was statistically significant(P<0.05).120 children were graded according to risk and then compared again,only when the risk was high,the proportion of Ml and M2 in the bone marrow of the PEG-Asp group was higher than that in the L-Asp group,and the difference was statistically significant(P<0.05);The recurrence rate of PEG-Asp group was lower than that of L-Asp group,and the difference was statistically significant(P<0.05);58 children who entered maintenance therapy were graded according to risk and then compared again,only when the risk was high,the mortality of group A was significantly lower than that of group B(P<0.05).The OS of patients in group A and group B was(94.1±5.7)%and(59.6±11.1)%,and EFS was(84±8.5)%and(54.5±11.2)%,respectively.EFS was significantly higher than group B,and the difference between the two groups was statistically significant(P<0.05).Conclusions:PEG-Asp is as effective as L-Asp in the treatment of T-ALL in children,the rate of D33 induction in children with high-risk of PEG-Asp was higher than that in L-Asp group,and the long-term recurrence rate was lower.The incidence of allergic reaction of PEG-Asp was lower than that of L-Asp,and the other adverse reactions were similar.Adding PEG-Asp during maintenance therapy in children with high-risk can further improve the long-term efficacy of children.