| Objective By Al children retrospective analysis of clinical data,explore the predisposing factors of TLS. To provide the basis for the prevent,early diagnose and treat TLS.Methods1. Retrospective analysis 833 patients with newly diagnosed AL clinical data during the period from 2009 January to 2014 August, in our hospital. summarize the incidence rate of TLS, Analysis the relationship of gender, age, MICM type[1], blood routine, electrolyte type, liver and kidney function and TLS, to understand the remission induction in children with TLS.2. Uesd SPSS21.0 statistical software and sorting data.Use `(34)±S or median to describe the measurement data, groups comparsion adopted t test;Use describtive count and chi-square test to data. P < 0.05 with a statitcal signifiace.Results1. In the 833 AL children, 491 boys, 342 girls, boy to girl ratio was1.44:1, the median age was 4 years 8 months(31-95 months), infantile leukemia 49 cases(5.88%), aged 1-5years old 398 cases(47.78%), aged5-10 years old 256 cases(30.73%), above 10 years old 130 cases(15.61%).Chongqing 422 cases(50.66%), Sichuan 304 cases(36.49%), Guizhou 91cases(10.92%), Yunnan 6 cases(0.72%), other native place 9 cases(1.08%).2. MICM2.1 Morphology classification In the 833 AL children, ALL 581 cases(69.75%), AML 252 cases(30.25%), ALL:AML=2.31:1. In the 581 ALL cases, L1 223 cases(38.38%), L2 323 cases(55.59%), L3 34 cases(5.85%).In the 252 AML cases,M0 1 cases(0.40%), M1 12 cases(4.76%), M2 80 cases(31.75%),M3 43 cases(17.06%), M4 9 cases(3.57%), M5 65 cases(25.79%), M6 14cases(5.56%), M7 12 cases(4.76%), unknown type 16 cases(6.35%).2.2 Immunology classification In the 581 ALL children, 572 cases were examined by immunology,examination T-ALL 68 cases(11.89%), B-ALL 504 cases(88.11%),B-ALL:T-ALL=7.41:1. In 504 B-ALL cases, Pro-B-ALL 38 cases(7.54%),Pre-B-ALL 120 cases(23.81%), common B-ALL 333 cases(66.07%),mature B-ALL 13 cases(2.58%). 252 AML cases were all divided into AML Immune phenotype.2.3 Cytogenetics classification In the 833 AL children, 743 cases were examined by chromosome examination,chromosome abnormality 354 cases(47.64%), hypodiploid 43cases(12.15%),high diploid 148 cases(41.81%). Checked out t(8; 21) 33cases(9.32%), t(15; 17) 30 cases(8.47%), t(9; 22) 15 cases(4.24%), t(1;19) 13 cases(3.67%), t(4; 11) 12 cases(3.39%), t(8; 14) 9 cases(2.54%).2.4 Molecular genetics classification In the 833 AL children, 682 cases were examined by molecular biology examination, checked out fusion gene abnormality 205 cases(30.06%),PML/RARa+ 37 cases(5.43%), TEL/AML1+ 36 cases(5.28%),E2A/PBX1+ 25 cases(3.67%), BCR/ABL+ 23 cases(3.37%),ETO/AML1+ 13 cases(1.91%), MLL/AF4+ 11 cases(1.61%).3. In the 833 AL children,occured TLS 26 cases(3.12%). 147 HAL children, occurred TLS 14 cases(9.52%), 687 NHAL children, occurred TLS 12 cases(1.75%). HAL was significantly correlated with the occurrence of TLS(P<0.05).4.In 26 TLS patients, 10 cases(38.46%) occurred Spontaneous, 16cases(61.54%) occurred after chemotherapy, the average time 52.88 +30.18h(12-120h). 26 TLS children, 13 patients continued treatment, 9cases(69.23%) underwent dialysis treatment, 7 cases(77.78%) and uric acid > double normal limit, the mean value is 1369.29 + 551.64 umol/L(886-2523.6umol/L),3 cases(33.33%) with blood urea nitrogen level increased remarkable, and the mean value is 27.26 + 4.30 mmol / L(23.54-31.97mmol/L).5. 147 cases of HAL patients bone marrow blast percentage mean83.97 + 14.00%, white blood cell percentage of naive cells mean 7.216 +19.93%, ALT>50U/L 25cases(17.01%), LDH>330U/L 134 cases(91.16%),UA≥467umol/L 61 cases(41.50%), Cr>90umol/L 6 cases(4.08%), BUN>7.14mmol/L 9 cases(6.12%), K ≥ 6.0 mmol/L 4 cases(2.72%), P ≥2.1mmol/L 5 cases(3.40%), Ca≤1.75 mmol/L 10 cases(6.80%).6. infantile leukemia、T-ALL and mature B-ALL、LDH>330U/L、Cr>90umol/L、BUN>7.14mmol/L、K≥6.0mmol/L、Ca≤1.75mmol/L have the remarkable difference with TLS(P<0.05). Gender, chromosome and fusion gene abnormal, bone marrow or blood immature cells proportion、ALT > 50U/L, UA ≥ 467umol/L 、 P ≥ 2.1mmol/L have no remarkable difference with TLS(P > 0.05).7. CCLG-ALL-2008 chemotherapy with ALL children, In the 147 HAL patients, the TLS group 8 patients completed the VDLD induction remission, 4 cases(50%)up to CR. The Non-TLS group 47 patients completed the VDLD induced remission, 12 cases(25.53%)up to CR, TLS CR rate and without TLS children had no significiant difference(P>0.05).Conclusions1. The incidence of TLS in HAL group was remarkable exceed than NHAL children.Therefore, HAL children need to be highly vigilant in the occurrence of TLS. Although NHAL with a low rate of TLS, but also can happen, NHAL were also need monitor for liver, kidney function and electrolyte condition, to prevent the occurrence of TLS, treatment as soon as possible, help the children cross the dangerous period of TLS.2. In the 26 TLS cases,38.46% occurred Spontaneous, 61.54%occurred after chemotherapy,the time after chemotherapy all within 5 days.So in the first anti tumor treatment of 1-5 days, should be closely monitored liver, kidney function and electrolyte condition(especially uric acid level), early diagnosis, dialysis treatment in time. For patients with no beginning treatment of tumors should also be timely monitored liver,kidney function and electrolyte condition, alert to STLS.3. TLS predisposing factors: Infantile leukemia、T-ALL and mature B-ALL 、LDH> 330U/L、Cr>90umol/L、BUN>7.14mmol/L、K≥6.0mmol/L、Ca≤1.75mmol/L(P<0.05). Therefore, for AL children with the above risk factors, it is necessary to adjust the internal environment,balance electrolyte disturbance, protect the vital organs, monitor the liver and renal function(especially uric acid level)before chemotherapy, and timely diagnosis TLS, and dialysis treatment If necessary.4. This study are shown only if diagnose and treat TLS timely, prevent the change of TLS, through a dangerous period of TLS, TLS children CR rate and without TLS children had no significiant difference(P > 0.05).Thus,the occurance of TLS will not affect the children treatment of tumor prognosis. |
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