| Research background and objective:Acute Lymphoblastic Leukemia(ALL)is a disease originated from abnormal precursor lymphocyte.Premature lymphocytes in bone marrow,peripheral blood and lymphatic tissue in the abnormal proliferation and accumulation.Its behavior has obvious heterogeneity on the biological and clinical behavior.ALL is the most common malignant tumor for children accounting for 25% of the children’s malignant tumor.It is one of the main diseases of death in children under the age of 15.With the improvement of current risk-classified treatment and supportment,the long-term disease-free survival rate more than 80% in developed countries,but it is still nearly 20% of children by reason of recurrence or long-term unable to relieve to die.Including gender,age,number of white blood cells to begin with,early treatment reaction can be used for ALL children’s evaluate prognostic indicators.The chromosome karyotype is now recognized as independent prognostic indicators for ALL children.Through four hospitals’ 1579 cases of primary diagnose and chromosome checked patient’s age,gender,immune classification,clinical classification,relapse,abnormal genes and chromosome karyotype analysis,to understand the ALL children in our country chromosomes change characteristics and to guide clinical.Methods:This study selected from 2001 to 2014 primary diagnosed and chromosome checked ALL children from the hematological department of pediatrics,Tongji Hospital Affiliated Tongji Medical College,Shanghai children’s medical center,Tianjin institute of haematology children hospital blood disease diagnosis and treatment center,and the hematological department of children’s hospital affiliated to Suzhou university.Collecting ALL children’s gender,age,time,deadline,immune classification and clinical risk information to begin with,to analyse ALL children with chromosome abnormality and correlation with clinical indicators.SPSS 19.0 statistical software was used for statistical processing and analysis,percentage or forming rate for enumeration date,median for measurement data,rate between groups by chi-square test.P<0.05 for the difference is statistically significant.By the methods of Kaplan Meier(K-M)to assess survival status and draw survival curve.The Log-rank test was used to the survival comparison within the groups.Results:1.1579 cases of primary diagnosed and chromosome checked ALL children from the four hospitals in 2001~2014,follow-up to deadline,survivor 1163 cases(73.7%),died 191cases(12.1%)and unknown 227 cases(14.2%),recurrence of 268 cases(17%).2.1579 cases had normal karyotype 855 cases(54.1%),abnormal karyotype 724cases(45.9%),merely had numerical chromosomal aberrations 204 cases(29.74%),merely had structural chromosomal aberrations 212 cases(30.9%),both had numerical and structural chromosomal aberrations 270 cases(30.9%).Normal karyotype group’s final follow-up survival and recurrence and abnormal karyotype group was statistically significant.(P<0.001 and P=0.045)3.The age range of children is from 3 months to 17 years,the median age is 5 years old.age≤1 year old,a total of 24 cases,accounted for 1.5% of the total number of abnormal karyotype 9 cases(37.5%).1 ~ 6 years old,a total of 991 cases,accounted for 62.8% of the total number of 433 cases of abnormal karyotype(43.7%).Age > 6 years old,a total of 564 cases,accounted for 35.7% of the total number of 244 cases of abnormal karyotype(43.3%).Children with the last condition of different age groups has statistical significance(P <0.001),while age and karyotype,recurrence is not statistically significant(P = 0.828,P =0.828).Main abnormal karyotype in ≤1 year old age group is the hypodiploid,t(4;11).For1 ~ 6 years old group is normal karyotype,hyperdiploid,t(1;19).For age > 6 years old groups is normal karyotype,hyper diploid,t(9;22),t(1;19).4.Boys in group have 981 cases,598 cases of girls,boy to girl ratio is 1.64:1.Boys with abnormal karyotype have 490 cases(50%),abnormal karyotype in girls have 261 cases(43.6%).Gender and abnormal karyotype with statistical significance(P = 0.015).5.This group of immunity in ALL children with T-ALL,mature B – ALL and pro B-ALL.T-ALL in 154 patients(9.8%),mature B-ALL in 1274 patients(80.7%),pro B-ALL 50cases(3.2%),the unknown 101 cases(6.4%).T-ALL abnormal karyotype of 55 cases(35.7%),mainly for the del(1 p32).Abnormal karyotype in mature B-ALL group 268cases(45.2%),mainly for hyperdiploid,t(9;22),t(1;19).Pro B-ALL abnormal karyotype has 268 cases(45.2%),mainly for the hyperdiploid,t(1;19).Children with immune classification and karyotype of no statistical significance(P = 0.081).6.Clinical risk classification: low risk group of 577 cases(36.5%),moderate group 475cases(30.1%),high risk group of 519 cases(32.9%).Abnormal karyotype low-risk group232 cases(40.2%),mainly for the diploid.Dangero us group of abnormal karyotype in 186cases(16.8%),mainly for the diploid,t(9;22),t(1;19).High risk group of 265 cases of abnormal karyotype(20.2%),mainly for the diploid,t(4;11),t(9;22),t(1;19).Recurrence of clinical risk classification and the survival state and statistically significant(both P < 0.001).7.Our research group has 268 cases of recurrence,chromosome was abnormal in 122(45.5%),mainly for the t(4;11),t(9;22),t(1;19).Survivor has 81 cases(30.2%),death,108 cases(40.3%),64 cases(29.5%)of the unknown.8.Our group found genetic abnormalities in ALL children with a total of 457 people,accounting for 28.94%.Main abnormal gene has TEL/AML,MLL,SIL/TAL1,E2A/PBX1,BCR/ABL.TEL/AML with 264 cases,genetic testing in children with TEL/AML positive,chromosome karyotype is mainly for the normal karyotype,hyperdiploid,while found t(12;21)only in 2 cases.In 62 patients,BCR/ABL gene detection in children with BCR/ABL positive,detect the t(9;22)in 35 cases(56.5%),SIL/TAL1 in 12 cases,of which the del q32(1)in 2 cases(16.7%).E2A/PBX1 there are 72 cases,including t(1;19)36 cases(50%).MLL have 38 cases,measure the t(4;11)17 cases(44.7%).In conclusion:1.ALL children with normal chromosome karyotype was 54.1%,the abnormal karyotype was 45.9%.And pure abnormal number was 29.74%,simple abnormal structure was 30.9%,number and structure of all abnormal accounted for 39.36%.2.ALL number abnormal karyotype in children,hyperdiploid accounted for 42.5%,pseudodiploid is 6.1%,the hypodiploid accounted for 1.7%.This group of abnormal chromosome karyotype structure,mainly including the t(12;21),t(9;22),del(1 q32),t(1;19),t(4;11)and complex karyotype.3.ALL children chromosome karyotype has certain relevance with prognostic factors including age,gender,number of white blood cells to begin with,the immune classification,clinical classification,early treatment response and so on. |
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