The Biological Characteristics And Prognostic Analysis Of Children's Hyperleucocyte Acute Leukemia

Objectives:Discuss the biological characteristics and prognostic analysis of Children's hyperleucocyte acute leukemia.Methods:1.We select 164 patients from Feb.2014 to Oct.2015 in Kunming Children's Hospital.43 patients of HAL were selected as investigation objective,including 29 male and 14 female,from 3 months to 14 years old.The median age was 6 years old.6 patients of AML were selected,including 3 cases of M2,3 cases of Ms.37 patients of ALL were selected,including 21 cases of B-ALL,14 cases of T-ALL,2 cases of no immunophenotype.121 patients of NHAL were selected as contrast,including 74 male and 47 female,from 8 months to 14 years old.The median age was 4 years old.20 patients of AML were selected,including 7 cases of M2,6 cases of M3,2 cases of M4 and 4 cases of Ms,1 case of no immunophenotype.101 patients of ALL were selected,including 92 cases of B-ALL,9 cases of T-ALL.2.All the patients were received bone marrow aspiration cytology,and some patients were received immunophenonotype,fusion gene,cytogenetic and MRD examination.3.Some clinical data were reviewed,including peripheral WBC count,bone marrow blasts count(M3,promyelocyte count),hematocrit,results of immunophenotype,results of fusion gene and results of cytogenetics. All patients,chemotherapy method and CR rate after chemotherapy were recorded.33 days MRD remission rate after CCLG-2008 chemotherapy were recorded and 19 days MRD remission rate after CCCG-2015 chemotherapy were recorded.In HAL group,the cases of death patients,the mortality and recurrence rate after chemotherapy were recorded in AML and ALL.In NHAL group, the cases of death patients,the mortality and recurrence rate after chemotherapy were recorded in AML and ALL.The time from relapse to death of relapse patients in HAL and NHAL groups.The differences of parameters in HAL and NHAL groups were compared so as to know the characteristics and prognostic analysis of HAL.Results:1.In AML,CD 14 positive rate was 33.3% in HAL group and 0.0% in NHAL group.HAL group was significantly higher than NHAL group.This difference had statistical meaning.(P<0.05).2.1n ALL,CD2 positive rate was 31.4% in HAL group and 5.0% in NHAL group.CD3 positive rate was 31.4% in HAL group and 8.9% in NHAL group.CD4 positive rate was 14.3% in HAL group and 3.0% in NHAL group.CD5 positive rate was 34.3% in HAL group and 7.9% in NHAL group.CD7 positive rate was 51.4% in HAL group and 9.9% in NHAL group.CD8 positive rate was 22.9% in HAL group and 3.0% in NHAL group.HAL group was significantly higher than NHAL group.CD10 positive rate was 93.1% in NHAL group and 71.4% in HAL group.CD19 positive rate was 91.1% in NHAL group and 60.0% in HAL group.NHAL group was significantly higher than HAL group.These differences had statistical meaning.(P<0.05).3.1n ALL,BCR-ABL1 positive rate was 17.6% in HAL group and 5.0% in NHAL group.HAL group was significantly higher than NHAL group.This difference had statistical meaning.(P<0.05).The remission rate of BCR-ABL1 positive patients was 0.0% in HAL group and 80.0% in NHAL group.NHAL group was significantly higher than HAL group.This difference had statistical meaning.(P<0.05).4.The CCLG-2008 chemotherapy regimens of patients,33 days MRD remission rate was 45% in HAL group lower than 80.5% in NHAL group.This difference had statistical meaning.(P< 0.05).In ALL group,the patient mortality was 29.4% in HAL group and 6.3% in NHAL group.HAL group was obviously higher than NHAL group.This difference had statistical meaning.(P<0.05).In ALL group,The remission rate was 43.3% in HAL group lower than 69.1% in NHAL group.This difference had statistical meaning.(P< 0.05).In HAL group,the time from recurrence to death of 3 relapse patients was 14-46 days.The median days was 32 days.In NHAL group, the time from recurrence to death of 8 relapse patients was 45-136 days.The median days was 83 days. This difference had statistical meaning.(P<0.05).Conclusions:The following differences were existed between HAL and NHAL:1.In AML, Ms was easier to occur hyperleukocytosis.2.1n ALL,HAL had more likelihood to express T-lineage antigen than NHAL.The possibility of occuring hyperleukocytosis in T-ALL higher than in B-ALL.This may be one of the reasons for T-ALL with poor prognosis.3.1n ALL,HAL had more likelihood with BCR-ABL1 positive than NHAL.The prognosis of BCR-ABL1 positive patients in HAL group worse than in NHAL group.