Predictive Effect Of Percentage Of Monocytes On Neutrophil Recovery In Children With Acute Lymphoblastic Leukemia After Chemotherapy

Objective:To investigate the predictive effect of percentage of peripheral blood monocytes on peripheral blood neutrophil recovery in children with acute lymphoblastic leukemia after induction or reinduction of CAM regimens.Methods:From October 1,2016 to June 1,2022,we collected a total of 321 cases from 178 children with acute lymphoblastic leukemia who received CAM induction or CAM reinduction chemotherapy regimen in pediatric hematology department of Southern Medical University Pearl River Hospital.Their demographic data,peripheral blood absolute neutrophil count(ANC)and parameters related to peripheral blood monocyte percentage(Mon%)were analyzed retrospectively.Wilcoxon signed rank sum test were used to evaluate whether the duration of Mon%decline to nadir was significantly shorter than the duration of ANC decline to nadir after chemotherapy.To evaluate whether the days of Mon%recovered to 5%,10%or more than 15%after chemotherapy were significantly shorter than the days of ANC recovered from less than 0.5 × 109/L to more than 0.5×109/L.To evaluate whether the days after the first recovery of Mon%above 5%,10%or more than 15%after chemotherapy were significantly shorter than the days after the recovery of ANC above 0.5×109/L after chemotherapy.Pearson correlation、Spearman correlation、Point-biserial correlation or Kendall’s tau-b correlation analysis were used to compare the clinical characteristics,the recovery time or recovery speed of peripheral blood Mon%in different stages with the duration of neutrophil deficiency.And then important indicators were included in linear regression analysis.At the same time,ROC curve method was used to calculate the optimal threshold of peripheral blood Mon%related parameters to predict the recovery time of peripheral blood ANC.Results:In children with acute lymphoblastic leukemia,the time of Mon%to the nadir was 4 days earlier than the time of ANC to the nadir after CAM induction or CAM reinduction chemotherapy(P<0.05).The recovery time of Mon%(from the nadir level)in the three different stages was significantly shorter than that of the corresponding ANC from 0.5 × 109/L to above 0.5×109/L,and the recovery time of Mon%was 4 days,3 days and 2 days shorter,respectively(P<0.05).The recovery time of the three different stages of Mon%(from the first day after chemotherapy)was significantly shorter than that of the corresponding ANC recovery to more than 0.5×109/L,4 days,2 days and 1 day earlier,respectively(P<0.05).The recovery time of peripheral blood Mon%at three different stages was positively correlated with the recovery time of ANC(r=0.530,0.562 and 0.597,P<0.05).The recovery speed of peripheral blood Mon%at three different stages(from the lowest value to 5%-10%,10%-15%or above)was negatively correlated with the recovery time of ANC(r=-0.512,-0.443 and-0.555,P<0.05).According to ROC curve analysis,when peripheral blood Mon%recovered from the nadir to more than 15%within 7.5 days after chemotherapy,it could best predict whether ANC would rise from less than 0.5×109/L to more than 0.5×109/L within 10 days,that mean the duration of neutrophil deficiency is within 10 days(sensitivity:89.5%,specificity:70.0%).After the end of chemotherapy,the rate at which peripheral blood Mon%recovered from the lowest value to more than 15%was≥2.465(%/d),which could best predict whether ANC would rise from less than 0.5×109/L to more than 0.5×109/L within 10 days,that mean the duration of neutrophil deficiency is within 10 days(sensitivity 94.7%,specificity 62%).The Mon%first stage recovery time plus 4.5 days after chemotherapy is the best predictor for ANC recovery within 10 days(sensitivity 86.0%,specificity 43.0%).The Mon%first stage recovery time plus 5.5 days after chemotherapy is the best predictor for ANC recovery within 15 days(sensitivity 80.2%,specificity 45.0%).Conclusion:During hematopoietic cell decline and recovery after chemotherapy in children with acute lymphoblastic leukemia under CAM induction regimen or CAM reinduction regimen,the decline and rise time of Mon%in peripheral blood was earlier than the decline and rise time of ANC,so Mon%can be used to better predict the decline and recovery time of ANC in clinic work.