Clinicalcharacteristics Analysis Of 55 Cases Replapsed Children Acute Lymphoblastic Leukemia

Objective: To investigate the relationship between the early clinical data and recurrence, and analyse the risk factor of ALL recurrence.Methods: A retrospective analysis of 545 newly diagnosed ALL children who have accepted treatment of CCLG-ALL 2008 protocol between March 2008 and December 2014. In this study, the clinical features of 55 cases of children with recurrent were analyzed.Result: Accepted treatment with the CCLG-ALL2008 protocol, 55 patients were relapsed, the recurrence rate was 10.1%. The recurrence rate in bone marrow alone, isolated central nervous system, and testicular were 6.7%, 1.8%, and 1.3% respectively. The recurrence rate in patients with initial WBC ≥ 50×109/L and WBC <50×109/L were 22.5% and 7.0% respectively(P=0.000). The recurrence rate in patients with T-cell ALL and B-cell ALL were 27.3% and 8.3%, respectively(P=0.000). The recurrence rate in patients with TEL/AML1-positive ALL, E2A/PBX1-positive ALL, and TEL/AML-positive ALL were 55.5%, 15.3%, and 3.7% respectively(P=0.014). The recurrence of prednisone good responder and prednisone poor responder rate were 9.8% and 11.1%, and the result has no significant difference(p=0.498). The recurrence rate of patients with M1, M2 and M3 of Day 15 marrows, were 7.8%, 20.8%, and 18.8% respectively(P=0.003). The recurrence rate of were 9.5%, 50.0% and 50.0% for patients with M1, M2 and M3 Day 33 marrows, respectively(P=0.014). The rate of recurrence of the MRD positive and negative groups, was 30.7% and 7.7% respectively(P=0.000). The recurrence rate in the standard-risk, intermediate-risk and the high-risk groups were 6.8%, 11.9% and 36.9% respectively(P=0.012). The median time to relapse after diagnosis in the standard-risk, intermediate-risk and the high-risk groups were 25.7 months, 7.9 months, and 10.3 months respectively(P=0.003).Conclusions: The research outcome indicates that the CCLG-ALL2008 protocol reduced relapse rate, but a relatively high recurrence rate is observed in children with high-risk ALL;the recurrence rate is not significantly correlated with prednisone response. WBC>50×109/L, T-cell ALL, BCR-ABL positive,bone marrow(on day 15,33)was in complete remission and MRD positive(on day 33)are the high risk factors of recurrence for childhood ALL.