Effect Of Risk Stratification Therapy On Prognosis In Children With Acute Myeloid Leukemia

Objective: To explore the impact of risk stratification therapy on prognosis in children with acute myeloid leukemia,to confirm the important value of risk stratification therapy in transforming the prognosis of children with acute myeloid leukemia,and to provide guidance for clinical treatment.Methods: Children with acute myeloid leukemia admitted from January 2017 to December 2020 were selected for analysis.Children admitted before 2019 were included in the control group and treated with the 2015 acute myeloid leukemia treatment plan.Hematopoietic stem cell transplantation was performed according to the guidelines for treatment timing of hematopoietic stem cell transplantation.Children admitted in 2019 and later were included in the study group and treated with the 2019 acute myeloid leukemia treatment plan.Low risk children were treated with chemotherapy,and mid and high-risk children were treated with hematopoietic stem cell transplantation as soon as possible Collect general and clinical data of all child patients,including age,gender,white blood cells,hemoglobin,platelet count,blood primordial immature cells,FAB typing,chromosome karyotype,fusion gene,mutant gene,bone marrow remission rate,early treatment response,occurrence of chemotherapy related complications,event free survival,overall survival,risk stratification,and recurrence Compare the bone marrow remission rate,early treatment response,and chemotherapy-related complications of children in the control group and the study group,and analyze the 2-year follow-up survival and recurrence All child patients were divided according to different risk levels(low risk,medium risk,and high risk),and the treatment effects,survival,and relapse rates of the control group and the study group were compared All child patients were divided into recurrent and non recurrent groups based on whether they recurred during a 2-year follow-up,and the risk factors for recurrence were analyzed.All child patients were divided into survival group and death group based on the overall survival status during the 2-year follow-up,and the relevant influencing factors for overall survival were analyzed.Children in the survival group were divided into event group and non event group based on whether there were events during the 2-year follow-up,and the relevant influencing factors for event free survival were analyzed.result:(1)The general data of children in the control group and the study group were not statistically significant(P>0.05)and were comparable.(2)The bone marrow remission rate in the study group was higher than that in the control group(P<0.05),the negative rate of bone marrow MRD was higher than that in the control group(P<0.05),and the incidence of chemotherapy related complications was lower than that in the control group(P<0.05).During a 2-year follow-up,the event-free survival rate and overall survival rate in the study group were higher than those in the control group(P<0.05),while the recurrence rate was lower than that in the control group(P<0.05).In patients with low risk children,there was no statistically significant difference between the control group and the study group in terms of bone marrow remission rate,early treatment MRD negative rate,and event free survival rate,overall survival rate,and recurrence rate within 2 years of follow-up(P>0.05);In patients with moderate to high-risk children,there is a phenomenon that the bone marrow remission rate,bone marrow MRD negative rate,event free survival rate,and overall survival rate in the study group are higher than those in the control group(P<0.05),and the recurrence rate is lower than those in the control group(P<0.05).In the control group,the bone marrow remission rate,bone marrow MRD negative rate,event free survival rate,and overall survival rate of high-risk children were lower than those of low-risk children,while the recurrence rate was higher than that of low-risk children(P<0.05).The bone marrow remission rate,bone marrow MRD negative rate,event free survival rate,overall survival rate,and recurrence rate of patients with high-risk children in the study group were not statistically significant compared with those of patients with low-risk children(P>0.05).(3)Analysis of relevant influencing factors for relapse in children with acute myeloid leukemia:In univariate analysis,there were significant differences between the recurrent group and the non recurrent group in terms of white blood cells,fusion gene MLL,CEBPA mutations,MRD negative rate,risk stratification at initial diagnosis as medium to high risk,and not using the 2019 treatment regimen for acute myeloid leukemia(P<0.05).In multivariate analysis,leukocytes,CEBPA mutations,early treatment response,risk stratification at initial diagnosis,and treatment regimen for acute myeloid leukemia were independent factors associated with relapse(P<0.05).(4)Analysis of related factors affecting the overall survival of children with acute myeloid leukemia: In univariate analysis,there were significant differences between the survival group and the death group in terms of white blood cells,fusion gene MLL,CEBPA mutations,bone marrow remission rate,MRD negative rate,chemotherapy related complications,risk stratification at initial diagnosis as medium to high risk,and not using the 2019 treatment regimen for acute myeloid leukemia(P<0.05).In multivariate analysis,fusion gene MLL,CEBPA mutation,bone marrow remission,early treatment response,risk stratification at initial diagnosis,and treatment regimen for acute myeloid leukemia were associated independent factors affecting overall survival(P<0.05).(5)Analysis of relevant influencing factors on event-free survival in children with acute myeloid leukemia: In univariate analysis,there were significant differences between the event group and the non event group in terms of fusion gene AML1-ETO,bone marrow remission,early treatment response,chemotherapy related complications,risk stratification at initial diagnosis,and treatment regimen for acute myeloid leukemia(P<0.05).In multivariate analysis,chemotherapy related complications,risk stratification at initial diagnosis,and treatment regimen for acute myeloid leukemia were independent factors related to event free survival(P<0.05).Conclusion:(1)Adopting the 2019 acute myeloid leukemia treatment plan for hierarchical risk management of childhood acute myeloid leukemia can effectively improve the remission rate,promote the negative conversion of bone marrow MRD,and improve the event free survival rate and overall survival rate The prognosis of children with acute myeloid leukemia(AML)(relapse,overall survival,and event free survival)is influenced by multiple factors.The risk stratification at initial diagnosis is medium to high risk,and failure to adopt the 2019 acute myeloid leukemia treatment plan is an independent influencing factor for relapse,overall survival,and event free survival Risk stratification should be actively evaluated before treatment of acute myeloid leukemia,and bone marrow transplantation should be actively taken for patients with moderate to high-risk children.