Outcome Of Treatment And Prognostic Factors In Childhood Acute Lymphoblastic Leukemia

Objective:To analyse the treatment outcome of pediatric acute lymphoblastic leukemia (ALL) with CCLG-ALL-08protocol, investigate the prognostic factors of ALL, and provide theoretical evidences for further improving the event-free survival (EFS).Methods:A prospective study was carried out on the children aged between10months and14years with newly diagnosed acute lymphoblastic leukemia in our department during April2008and March2012. Kaplan-Meier method was used to estimate EFS, the differences between groups were compared with the log-rank test. Data were analyzed by SPSS17.0.Results:A total of134patients were recruited and treated with the protocol CCLG-ALL-08. The rate of induction complete remission (CR) was93.3%with a median time of15days. The overall3-year EFS was (81.9.±4.1)%, and the3-year EFS in standard-risk (SR), intermediate-risk (IR) and high-risk (HR) groups were (92.7±3.5)%,(79.5±11.1)%and (51.8±11.2)%, respectively (P<0.05). Relapses occurred in10patients (7.5%) in a median time of12.5months, consisting of6patients with isolated hematologic and4with isolated central nervous system (CNS), with no testicular leukemia relapse and second tumor occurred. Seven patients died and the mortality rate was5.2%with3of deaths due to chemotherapy complications.Conclusion:The tolerance of the protocol CCLG-ALL-08was favorable, and the EFS rate close to that of the best level in the world. The standardized clinical risk classification and periodical assessment of treatment effect contribute to lower relapse rate, reduce complication, and improve the quality of life. Objective:To investigate the effect and safety of two different induction treatment regimens on childhood acute lymphoblastic leukemia, as well as to provide the theoretical evidence for further improving the complete remission rate, and reducing the chemotherapy-related deaths.Methods:A retrospective analysis was carried out on newly diagnosed childhood acute lymphoblastic leukemia.111patients treated with XH-99induction regimen from July2000to March2008were assigned to the group A;148patients in group B were treated with CCLG-ALL-08induction regimen from April2008to March2012. To compare the treatment outcomes of two groups, including median time of remission, bone marrow suppression time, infection rates, non-leukemia mortality during remission and whether or not to delay chemotherapy.Results:The complete remission rate of group A and B were92.8%and93.9%, respectively (P=0.717). And non-leukemia mortality during remission were3.6%and2.7%, respectively (P=0.688). The median time of remission and bone marrow suppression time of group B were significantly shorter than those of group A (29.5±3.8vs32.8±6.7days and8.5±2.1vs10.7±2.3days; P<0.001). The infection rates of group A and group B were25.2%and16.2%, respectively (P=0.028). The chemotherapy delay rates were29.7%and18.9%in group A and group B, respectively (P=0.042).Conclusion:Compared with XH-99, the CCLG-ALL-08induction treatment improved the safety by shortening bone marrow suppression time, reduced infection rate during remission, and ensured the completion of chemotherapy for children with acute lymphoblastic leukemia. Objective:To study the prognostic factor on event-free survival in childhood with acute lymphoblastic leukemia, and provide theoretical basis to further prolong the survival time and improve quality of life.Methods:A retrospective analysis was carried out on214children with newly diagnosed acute lymphoblastic leukemia in the past10years. Kaplan-Meier method was used to estimate EFS rates, Cox regression proportional hazards model was used to analyze the20possible prognostic factors. Statistics was done by SPSS17.0Results:The overall EFS rate were (89±2.2)%,(78.3±3.2)%and (74.8±3.6)%in1year,3years and5years respectively. The5-years EFS in SR, IR and HR were (88.7±3.7)%,(78.4±9.0)%and (51.7±6.9)%, respectively (P<0.01). The univariate analysis indicated that age, initial white blood cell count (WBC), hemoglobin level, lactate dehydrogenase level, fusion genes (BCR-ABL or MLL-AF4), karyotype, the risk grade of disease, prednisone response, early response to treatment, poor treatment compliance, and MRD positive were significantly related to the EFS. Multivariate analysis showed that WBC>100×109/L, BCR-ABL or MLL-AF4positive and poor response to induction therapy were risk prognostic factors for event-free survival in childhood with acute lymphoblastic leukemia.Conclusion:WBC≥100×109/L, BCR-ABL or MLL-AF4positive, and poor response to induction therapy have important prognostic values in children acute lymphoblastic leukemia. MRD levels is an important index for modifying the chemotherapy protocol.