| Objective This study is aimed to explore the clinical and biological characteristics of childhood acute lymphoblastic leukemia(ALL)and assess their effect on the prognosis,so as to provide a theoretical evidence to the more scientific stratification treatment and further improve the overall efficacy of childhood ALL.Methods Retrospective study on clinical and laboratory data of patients with newly diagnosed ALL in Hospital between January 1,2006 to June 30,2016.A total of 290patients were enrolled,of which 37 cases who newly dignosed ALL from 2006 to2008 were using CCCG-ALL-2005 treatment protocol,197 cases who newly dignosed ALL from January 1,2009 to April 30,2015 were using CCCG-ALL-2009treatment protocol,56 cases who newly dignosed ALL from May 1,2015 to June 30,2016 were using CCCG-ALL-2015 treatment protocol.We analyzed retrospectively the clinical and biological characteristics of the 290 cases of childhood ALL,and assessed overall survival rate(OS)and event free survival(EFS).SPSS20.0 statistical software was used for analyze all the data.We used the Kaplan-Meier method to calculate 5-year OS and EFS,and Log-Rank test was applied to compare survival curves,and then we establish the multivariate COX regression model to do the analysis of multiple factors.Results 1.Clinical information:290 children with ALL were enrolled,and sex ratio was 1.42:1(170/120).The mean age was 4 years(ranged 0.33 to 15 years).11cases(3.79%)had central nervous system leukemia when newly dignosed ALL,and 1case(0.35%)had testicular leukemia.270 patients(93.1%)with B-cell phenotype,20patients(6.9%)with T-cell phenotype.Chromosome examination of normal chromosome karyotype in 155 cases(53.45%),no division in 67 cases(23.1%),hyper diploid in 23 cases(7.93%),hypodiploid in 13 cases(4.48%),structural abnormality in 32 cases(11.03%).Of all the fusion genes detected,TEL/AML1 fusion 38/246cases(15.45%),BCR/ABL fusion 8/246 cases(3.25%),MLL fusion 11/246cases(4.47%).According to the risk stratification,we divided 114 cases(39.31%)into low-risk(LR)group,95 cases(32.76%)into intermediate-risk(IR)group,and 81cases(27.93%)into high-risk(HR)group.2.The induction remission:The complete remission(CR)rates of patients with ALL were 96.9%after induction therapy,there were significant differences of EFS curves in complete remission patients and non remission patients.The marked minimal residual disease and unmarked MRD,at day 46 or day 55 MRD were significantly different between their 5-year EFS rate.At day 19 and day 35 MRD were not significantly different between their 5-year EFS rate.3.The 5-yesr OS rate of 290 ALL patients was 82.5±2.4%,and the 5-year EFS rate was 69.6±3.1%.5-years OS in LR group was 92.4±2.6%,and 72.1±5.1%of IR group,and 67.8±5.4%of HR group.5-years EFS in LR group was 82.8±4.5%,and 66.4±5.3%of IR group,and 56.0±6.0%of HR group.IR group and HR group were not significantly different between their 5-year EFS and OS rate(P=0.256),but LR group and IR group,or LR group and HR group were significantly different between their 5-year EFS and OS rate(P=0.005,P=0.003).As to patients used different treatment protocols,the 5-yesr OS rates were 75.7±7.1%?78.0±3.1%?83.3±6.4%,and the 5-year EFS rate were 64.9±7.8%?70.6±3.5%?81.7±5.6%.Childhood ALL belonged to different treatment protocols had no significant difference of survival rates(P=0.967,P=0.712).4.The result of univariate analysis showed that age(P=0.005),initial WBC(P=0.015),chromosome(P=0.04),BCR/ABL fusion(P=0.01),MLL fusion(P=0.009),bone marrow on the 19th day(P=0.015),MRD on the 46/55th day(P=0.006),risk group(P=0.005),and relapse(P=0.000)had significant influence on OS or EFS.The result of the COX regression multivariate analysis showed that age(P=0.018),risk group(P=0.033),and relapse(P=0.000)were effective prognostic factors for cases with childhood ALL.5.The relapse of childhood ALL were 55 cases(18.96%),in which 22 cases died of relapse.Early relapse had high death rate compared with late relapse(P=0.001),and isolated relapse of bone marrow had high death rate compared with other relapse(P=0.02).The result of the COX regression multivariate analysis showed that risk group(P=0.02),and MRD on the 46/55th day(P=0.006)were high-risk factors related to prognosis for children with relapse of ALL.The death rate of 290 childhood ALL patients was 14.83%,and LR group was 5.26%compared with IR/HR group22.18%(P<0.05).The death rate out of relapse was 6.5%,and different treatment protocols were 8.11%?7.11%?1.78%,CCCG-ALL-2015 protocol had a low death rate out of relapse compared with other protocols(P=0.027,P=0.031).Conclusions1.Age,initial WBC,chromosome,BCR/ABL fusion,MLL fusion,MRD on the46/55~thh day,risk group,and relapse were prognostic factors of childhood ALL patients,age,risk group,and relapse were independent prognostic factors.2.Childhood ALL using CCCG-ALL-2005,2009,and 2015 treatment protocol had no significant difference of survival rates.3.The 5-yesr OS rate of childhood ALL patients was 82.5±2.4%,and the 5-year EFS rate was 69.6±3.1%,the prognosis of IR/HR group of childhood ALL remains to be improved.4.The MRD on the 46/55~thh day played a critical role in assessing the prognosis of childhood ALL patients. |
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