The Effect Of Hematologic Toxicity At First Complete Remission And Its Recovery On The Prognosis Of Pediatric Acute Lymphoblastic Leukemia

Objective:To provide objective basis for better risk classification and supporting treatment by means of discussing the effect of hematologic toxicity at first myeloid complete remission and its recovery during the whole induction chemotherapy on the prognosis of children with acute lymphoblastic leukemiaMethods:The clinical data of these 181 children with ALL who were diagnosed and received continuous chemotherapy in the Department of Pediatrics,General Hospital of Ningxia Medical University from January 2008 to December 2016 were collected retrospectively..They were divided into three groups according to the different degrees of hematological toxicity at the first complete remission:CR group(hematological toxicity grade 0-Ⅱ),CRi 1 group(hematological tox-icity grade Ⅲ)and CRi2 group(hematological toxicity grade IV).The durations of hematological partial and complete recovery(Hb>65 or 80g/L,PLT>25 or 50×109/L,ANC>0.5 or 1.0×109/L)during the whole period of induction chemotherapy were calculated.The recurrence and death of patients was measured through the case history or telephone follow-up,and the clinical characteristics,early treatment response,blood cell count and other data were collected for in-ter-group comparison and survival analysisResults:1.Characteristics at first visit and early treatment response:There were significant differences in age and high leukocyte ratio at the first visit,MRD positive ratio at the end of induction chemotherapy(33 days)between CR group and CRi group(P<0.05)2.Durations of hematological recovery:Platelet has the earliest recovery:the median time to achieving 25×109/L is 12 days and 50×109/L,13 days.The he-moglobin is in the middle:the median time to 65g/L is 15 days and 80 g/L,26 days.Neutrophil has the latest recovery:the median time to 0.5 ×109/L is 21 days and 1.0×109/L,28 days.The durations of hematological recovery was shorter in intermediate-risk and high-risk than low-risk groups.The children who achieve complete platelet(50×109/L)recovery within 15 days have less severe ane-mia,severe neutropenia,blood transfusions,infections and lower MRD positive ra-tio than non-recovered group3.Prognostic factors:Univariate analysis showed that grade Ⅲ-Ⅳ hematologi-cal toxicity at the first complete remission,hematological toxicity non-recovered in the early stage,positive of d-33MRD,WBC>50×109/L and age≥10 years old at the first visit,high risk classification were the common adverse factors af-fecting OS and DFS(P<0.05).The results of multivariate analysis showed that age,risk classification and the condition of hematological toxicity recovery were independent influential factors of OS and DFS.(P<0.05)Conclusion:1.Severely hematological toxicity at complete remission is an adverse factor which affecting the prognosis of ALL,and children with high WBC at the first visit indicate severe hematological toxicity than those with low white blood cells2.During the whole induction chemotherapy,the recovery of platelets is the earliest,followed by hemoglobin and neutrophils are the latest.The duration in the high-risk group is significantly shorter than low-risk group3.The early recovery of platelets within 15 days during induction chemotherapy can be used as a marker for early hematological recovery and is highly related to MRD.It is also an independent factor which affecting the prognosis of children with ALL.