Chinical Analysis Of Acute Lymphoblastic Leukemia In 36 Children With A Relapse:A Retrospective Observational Study

Objective:Analysis early clinical features of acute lymphoblastic leukaemia (ALL) in children with a relapse in Children’s Hospital of Chongqing Medical University, aiming to monitor relapse of childhood leukemia better by analyzing clinical characteristics of relapsed childhood ALL, provides the treatment basis for the clinical treatment.Methods:A retrospective analysis of 381 children with ALL, treated on the CCLG-ALL 2008 protocol between March 2008 and December 2013 was performed.36 children relapsed, among 29 patients relapsed after adhering to their treatment. In this study, early clinical characteristics, early indexes of laboratory examination, early treatment response, and the recurrence time after treatment were analyzed. Kaplan-Meier analyses were conducted to identify the overall survival rates and median survival time, a log-rank test was used to compare groups.Result:1.381 children with newly diagnosed ALL were treated with the CCLG-ALL2008 protocol. Median follow-up time was 24.6 (range 7.3-76.4) months, Of 36 children with relapsed ALL,29 who has good treatment compliance, relapse rate 7.7%(29/374).Among them 19 were males and 10 were females, the rate of sex was 1.9 to 1.median age at diagnosis was 5.2 (range 1.7-14.2) years, medial relapsed time was 13.0±3.9 (range1.5-40.0) months.18cases (62.1%) for early relapse group and 11 cases (37.9%) for late relapse group.2.Among 24 children who had the initial WBC count more than 100×109/L,6 cases relapsed(25.0%).Of 331 children with B-ALL 26 children(7.8%) relapsed, and of 33 children with T-ALL 6(9.0%)children relapsed. Among 18 cases with BCR/ABL fusion gene positive,5 cases (17.2%) suffered from relapse, and one (20%;6.2%;3.3%) in each of 5 cases with MLL/AF4、16 cases with E2A/PBX1、30 cases with TEL/AML.3.The rate of prednisone good response in prednisone test was 86.2% (25/29).The rate of children who bone marrow status on day 15 was M2 in 47 and M3 in 14 was 14.3%(n=7;n=2).4 case who bone marrow status on day 33 was M2, one suffered from relapse. The relapse rate of children with minimal residual disease(MRD) positive on day 33 was13.9%(5/36)4. The high risk period of relapse of childhood ALL was within 2 years after complete remission (CR). Isolated bone marrow relapsed in 21 patients (72.4%),2 patients (6.9%)bone marrow had combined testicular central nervous system relapse and 1 patient (3.4%) bone marrow had combined relapse in central nervous system,Isolated central nervous system relapse in 4 patients (13.8%),1 patient relapsed in the eye.8 patients (27.6%) relapsed in maintenance therapy stage,7 patients (24.1%) relapsed in consolidation therapy stage,5 patients (17.2%) relapsed in late intensive chemotherapy stage,3 patients(10.3%)relapsed in early intensive chemotherapy stage and 6 patients (20.7%) relapsed after finish treatment, SR relapsed in maintenance therapy and finish treatment stage was 73.3%,HR relapsed before maintenance therapy stage was 90%. Children with BCR-ABL in the HR relapsed in 5 of 10 patients (50%).5.Single analysis confirmed that the age>6 years old, WBC>50×109/L, prednisone poor responders, T-ALL, the fusion gene positive, and the risk stratification was IR or HR were related with early relapse (P<0.05)6.The treatment rate for 36 relapsed children was38.9%(14/36),of 14 relapsed children 3 were received a stem cell transplantation in other institution and 2 survived. Among 11 patients were treated by intensive therapy,8 patients (72.7%) achieved second complete remission,3 of those relapsed which after the second complete remission and gave up their treatment. of 11 relapsed children 4 survived, and 1 child had finish treatment.Conclusion:To provide personalized follow up to assess for relapse and novel approaches are needed to minimize relapse risk for children with BCR/ABL fusion gene positive, which may reduce relapse rate and improve the prognosis.