Long-term Follow-up And Prognosis Of 298 Cases Of Children With Acute Lymphoblastic Leukemia By GD-ALL-2008 Protocol

OBJECTIVE:To investigate the long-term clinical outcomes,intensity of chemotherapy,co mplications and prognostic factors of childhood acute lymphoblastic leukemia(ALL)treated by GD-ALL-2008 protocol.METHODS:Clinical data of 298 children who have diagnosed ALL and treated by GD-ALL-2008 protocol in Nanfang Hospital from 2008 January lto 2015 Dece mber 31 were retrospectively analyzed.Statistical analysis:The Chi-square test method was to assess differences between groups.The Kaplan-Meier method was to estimate the overall survival(OS)and event-free survival(EFS).Cox multi-factor analysis model to analyze the prognostic factors of those children.RESULTS:298 patients who have treated by GD-ALL-2008 protocol in Nanfang Hos pital were included in the study.Among them,196 patients were boys an d 106 patients were girls.They were divided intoSR,IR and HRgroups.The 3-year and 5-year OS rate were 87.5±2.0%and 84.9±2.2%respectively.The 3-yea r and 5-year EFS rate were 83.2±2.3%and 78.4±2.6%,respectively.The 3-year EFS rate of SR,IR and HR were 89.8±3.9%,86.6±2.9%,and 72.6±5.2%resp ectively.The 5-year EFS rate of SR,IR and HR were 89.8±3.9%,82.6±3.3%,and 66.2±5.7%respectively.The complete remission(CR)rate was 96.3%(n=287).Univariate analysis showed that gender,age,the risk of ALL,D33 bone marro w remission,mmmunophenotype,initial white blood cell count,granulocyte defici ency with fever,drug-induced liver damage,Central neurotoxicity,hyperglycemia,Myocardial damage,incomplete intestinal Obstnaction,pancreatitis,and BCR/A BL positive are associated with long-term EFS.Multivariate COX regression a nalysis showed that female was the good prognosis factor of long-term survival of ALL;More than 10 years old,initial white blood cell count≥50×109/L,n on-rerrussion in 33th day of induction(M3),and asparaginase-associated pan creatitis were long-term EFS independent risk prognostic factors.CONCLUSION:The 3-year EFS rate of 298 patients was 83.2±2.3%,and the 5-year EFS was 78.4±2.6%.HR group had poorer clinical outcomes;the CR rate was 96.3%,the relapse rate of those children was 14.1%,and the mortality rate was 13.4%;the highest chemotherapy-related mortality rate was occurred in inductio n stage.The BLOCK stage of HR group had high-intensity chemotherapy and many complications.Female was the good prognosis factor of long-term surviv al of ALL;More than 10 years old,initial white blood cell count≥50×109/L,non-remission in 33th day of induction(M3),and asparaginase-associated pancreatitis were long-term EFS independent risk prognostic factors.