| Objective: To investigate the biological characteristics,chemotherapeutic effects,toxic side effects and survival prognosis of children aged 10-16 years with acute lymphoblastic leukemia,and to provide a clinical research basis for the selection of treatment options and assessm ent of prognosis for adolescent children with ALL.Method: The clinical data of children aged 10-16 years with initial ALL admitted to the Departme nt of Hematology and Oncology of Kunming Children’s Hospital from August 2018 to F ebruary 2021 were retrospectively analyzed,and a total of 60 cases were eligible for enr ollment.The clinical characteristics,risk group stratification,efficacy and chemotherape utic side effects of the two groups of children with ALL were counted separately,and rel apse and death were followed up in the two groups.The Wilcoxon rank sum test was use d to compare the differences between the two groups in terms of peripheral blood picture and percentage of infantile cells in peripheral blood,and the chi-square test was used to compare gender,ethnicity,initial WBC,immunophenotyping,risk level,karyotype,initi al extramedullary infiltration,tumour lysis,hormonal response on day 8,microresidual d isease（MRD）during induction of remission therapy and toxic side effects between the t wo groups.reactions,and ineligible using Fisher’s exact probability method.The Kaplan-Meier method was used to analyse the EFS rate and OS rate in adolescent children.The Log-rank test was used to compare the effect of each clinical factor on the EFS rate and OS rate in adolescent children with ALL,and those with a P value <0.1 were entered int o a multi-factor regression model to analyse the independent risk factors affecting the pr ognosis of the children.Result: 1.General clinical data: The median age of the 60 cases of adolescents with ALL aged 10-16 years was 11.6 years（10-15.1 years）.There were 36 male cases（60.0%）and 24 fe male cases（40.0%）,with a male-to-female ratio of 1.5:1;50 cases（83.3%）were Han Ch inese and a total of 10 cases（16.7%）were from ethnic minorities,mainly including Yi,Dai,Hani,Lisu,Miao,Brown,and Nu.The Wilcoxon rank sum test compared the adole scent and non-adolescent groups in terms of gender,ethnicity,initial Hb,PLT,and There was no statistical difference in peripheral blood na（?）ve cells,while there was a difference in initial peripheral blood leukocyte count（P < 0.05）,which showed that adolescent chil dren with ALL had a heavier tumour load at initial diagnosis than non-adolescents.2.Risk group stratification and MICM typing and other clinical characteristics: the chi-s quare test results showed that in the grouping of initial diagnosis leukocyte count ≥100×109/L,the proportion of children with adolescent ALL（33.3%）was greater than that o f non-adolescents（15.0%）,and the difference was statistically significant;39 children w ith B-ALL（65.0%）and 21 children with T-ALL（35.0%）in the adolescent group In the n on-adolescent group,there were 54 cases of B-ALL（90.0%）and 6 cases of T-ALL（10.0%）,the proportion of children with T-ALL in the adolescent group was higher than that in the non-adolescent group,and the difference was statistically significant（P < 0.05）;t he proportion of children in the adolescent high-risk group（38.3%）was higher than that in the non-adolescent group（25.0%）,and the difference was statistically significant;ad olescents were more The proportion of diploidy（4.7%）was lower than that of pseudodip loidy（38.3%）,and the difference in karyotype was statistically significant;the proportio n of BCR-ABL positive（15.0%）,E2A-PBX1 positive（10.0%）,MLL rearrangement（8.3%）,and SIL-TAL positive（8.3%）was higher in adolescents than in non-adolescents,w hile the prognosis of good genes TEL-AML positivity（0.0%）was lower than in non-ad olescents,and the difference in gene expression between the two groups was statistically significant.3.Treatment effect and toxic side effects during induction remission: During induction r emission chemotherapy,the adolescent group had a 60.0% poor hormonal response at da y 8,which was higher than the non-adolescent group（35.0%）,and the difference was sta tistically significant.The difference in liver function impairment between adolescents an d non-adolescents during induction remission was statistically significant,suggesting tha t liver function impairment occurred more frequently in adolescents than in non-adolescents.The most common toxic side effects in adolescents during induction remission wer e infections（58.4%）,including lung infections（33.3%）,abdominal infections（11.7%）,o ral infections（6.7%）,skin and soft tissue infections（5.0%）,and central nervous system i nfections（1.7%）.4.Survival: The 3-year EFS rate was 70.0% and the 3-year OS rate was 73.3% in the 60 children with adolescent ALL.There were 6 cases of relapsed children,with an overall r elapse rate of 10.0%.5.Analysis of prognostic factors: univariate prognostic analysis showed statistically sign ificant effects of hormonal response,immunophenotyping,risk level grouping,day 15 a nd day 33 MRD on prognosis.Conclusion: 1.Adolescent children with ALL have the following characteristics: heavy tumour load a t initial diagnosis,higher proportion of males,T-lineage ALL,BCR-ABL positive,MLL rearrangement,children in the high-risk group and poor hormonal response at day 8 than in younger children with ALL,and a lower proportion of high diploidy than in younger children with ALL.2.The 3-year EFS and OS rates were 70.0% and 73.3% respectively,which were lower i n the adolescent group than in the younger group（81.7% and 91.7%）.3.The 3-year recurrence rate of 10.0% in the adolescent group in this study was lower th an that of 11.7% in the non-adolescent group.The median time to recurrence was longer in adolescents than in non-adolescents,but the survival rate after recurrence was lower t han that of non-adolescents,which might be related to the fact that the high-intensity che motherapy in adolescent ALL children reduced their recurrence rate.4.Infection-related deaths predominated among the causes of death in adolescent childre n with ALL.5.The 3-year EFS rate for SIL-TAL positive children in this study was 60.0%,which is l ower than the 3-year EFS rate for other fusion genes with known poor prognosis,predict ing that this gene may be a poor prognosis gene.6.Whether the lower EFS rate and OS rate in children with initial white blood cell count s ≤4.0 x 109/L in this study compared to other groups has any significance on the surviv al prognosis of adolescent ALL children needs to be further investigated. |
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