| Background Acute lymphocytic leukemia(ALL),one of the most common malignant tumors in children under the age of 14,accounts for approximately 25.0% of all childhood cancers.Although the curative effect of acute lymphoblastic leukemia in children has been greatly improved in recent years,there are still about 15.0% to 20.0% of children with the eventual recurrence.The cure rate after the recurrence is only 25.0% to 40.0%.The recurrence has become one of the biggest factors that can threaten the survival of children,and it is the bottleneck in the treatment of acute lymphoblastic leukemia.Objective To analyze the risk factors related to the recurrence of acute lymphoblastic leukemia in children,and to explore the possibility of the recurrence of using multi-parameter combined monitoring in the early treatment period,so as to improve the curative effect of acute lymphoblastic leukemia in children.Methods 1.The clinical data of children who were initially diagnosed with ALL in Henan Children’s Hospital from January 1,2013 to June 30,2020 were collected.The CCLG-2008 treatment plan was applied for stratified treatment.There were 71 people in the recurrence group and 75 people in the control group.A retrospective study method was adopted to analyze the levels of minimal residual disease(MRD)(flow cytometry and real-time fluorescent PCR),bone marrow cell morphology,the duration of bone marrow suppression,and the duration of the first bone marrow suppression during induction of remission chemotherapy between the two groups of children.2.SPSS 25.0 software was used for statistical analysis.For the two indicators of the duration of the first bone marrow suppression during induction of remission chemotherapy and duration of bone marrow suppression in the recurrence group and the control group,the Mann Whitney U test was used for the comparison between groups.For the early treatment response(proportion of bone marrow primordial lymphocytes on the 8th day and the 33 th day,MRD on the 33 th day),the chi-square test was used for the comparison between groups.P<0.05 meant that the difference was statistically significant.Results 1.Among the 430 cases initially diagnosed with ALL,71 recurred,with a recurrence rate of 16.5%.Among 71 children with the recurrence,simple bone marrow recurrence accounted for 80%;Simple extramedullary recurrence accounted for 15.5%,Among them,simple central nervous system recurrence accounted for 11.2%,simple testicular recurrence accounted for 4.2%;Recurrence of bone marrow combined with nervous system accounted for 1.4%,Recurrence of bone marrow combined with testis accounted for 2.8%.Very early recurrence accounted for 43.7%,early recurrence accounted for 35.2%,and late recurrence accounted for 21.1%.2.The duration of the first bone marrow suppression during induction of remission chemotherapy was 11.20+2.92 days in the recurrence group and 10.81+2.36 days in the control group.The difference between the two groups was not statistically significant(P>0.05).The duration of bone marrow suppression was 37.56+5.36 days in the recurrence group,and 36.91+5.09 days in the control group.The difference between the two groups was not statistically significant(P>0.05).3.(1)For the proportion of bone marrow primitive + immature lymphocytes on the 8th day,the data of 58 children in the recurrence group were complete.There were 8 cases in the M1 group(primitive + immature lymphocytes <5%),12 cases in the M2 group(primitive+immature lymphocytes ≥5% and <25%),and 38 cases in the M3 group (primitive+immature lymphocytes ≥25%).The data of 61 children in the control group were complete.There were 11 cases in the M1 group,11 cases in the M2 group,and 39 cases in the M3 group.The difference between the two groups was not statistically significant(P>0.05).(2)For the proportion of bone marrow primitive + immature lymphocytes on the 33 th day,there were 71 cases in the recurrence group.Among them,there were 59 cases in the M1 group,10 cases in the M2 group,and 2 cases in the M3 group.There were 75 cases in the control group.Among them,there were 71 cases in the M1 group,4 cases in the M2 group,and 0 cases in the M3 group.The difference between the two groups was statistically significant(P<0.05).For minimal residual disease(flow(3)cytometry)on the 33 th day,the data of 68 children in the recurrence group were complete.Among them,there were 24 cases in the <0.01% group and 44 cases in the 20.01% group.There were 75 cases in the control group.Among them,there were 44 cases in the <0.01% group and 31 cases in the ≥0.01% group.The difference between the two groups was statistically significant(P<0.05).For minimal residual disease on the 33 th day(real(4)-time fluorescent quantitative PCR),19 children in the recurrence group had positive fusion genes.Among them,there were 4 cases in the <0.01% group and 15 cases in the ≥0.01% group.23 children in the control group had positive fusion genes.There were 13 cases in the <0.01% group and 10 cases in the 20.01% group.The difference between the two groups was statistically significant(P<0.05).4.In the dynamic monitoring of bone marrow cell morphology in children with ALL,the applicability of morphology and flow cytometry was stronger.The sensitivity of real-time fluorescent quantitative PCR was higher.Conclusions 1.In the dynamic monitoring of bone marrow cell morphology in children with ALL,using flow cytometry and real-time fluorescent quantitative PCR is meaningful for monitoring MRD.The proportion of bone marrow primitive + immature lymphocytes in children in the recurrence group was high on the 33 th day,and the MRD of 20.01% on the 33th day was a detection indicator of high recurrence risk.2.Multi-parameter combined monitoring is superior to single parameter monitoring in predicting the recurrence of acute lymphoblastic leukemia in children. |
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