Multiple Epstein-Barr Virus-associated Smooth Muscle Sarcomas of the Gut in a Child Treated for Acute Lymphoblastic Leukemia

Clinical features and prognosis of acute lymphoblastic leukemia in children with Epstein-Barr virus infection

BACKGROUND

Acute lymphoblastic leukemia (ALL) is one of the most common malignant diseases of the hematopoietic system in children. Although the etiology of ALL is unknown, it has been reported that it may be associated with Epstein-Barr virus (EBV) infection. The aim of this study was to analyze the impact of EBV infection on the clinical features and prognosis of childhood ALL.

METHODS

A total of 162 children with ALL admitted to Heilongjiang Provincial Hospital from January 2018 to December 2020 were selected for this stud, and were divided into 2 groups, infected group and non-infected group, according to whether they had EBV infection. Differences in clinical characteristics between the 2 groups were analyzed by χ² or t-test. The impact of EBV infection on the prognosis of children was analyzed by Kaplan-Meier survival and Cox regression analysis.

RESULTS

The 2 groups were statistically significantly different (P<0.05) according to comparison of characteristics such as first symptoms, karyotype, immunophenotyping, clinical risk, whether secondary infection occurred during chemotherapy, and lymphocyte subsets. Logistic regression results suggested that first symptoms, karyotype, immunophenotyping, clinical risk, the presence of secondary infection during chemotherapy, and lymphocyte subsets were independently associated with EBV infection in children with ALL (P<0.05). The complete remission rate at 46 days after chemotherapy, event-free survival (EFS), overall survival (OS), and survival rate were lower in the infected group than non-infected group, and the complete remission recurrence rate was higher than non-infected group (P<0.05). The EBV DNA levels were statistically lower in the good prognosis group (1.07±0.25×10³ copies/L) than poor prognosis group (8.86±1.14 ×10³ copies/L) (P<0.01). The area under the curve (AUC) for EBV to predict prognosis in children with ALL was 0.921, sensitivity and sensitivity were 86.57%, 80.16%.

CONCLUSIONS

Infection with EBV is associated with first symptoms, karyotype, immunophenotyping, clinical risk, secondary infection during chemotherapy, and lymphocyte subpopulation index levels in children with ALL, and children with EBV infection have a reduced clinical remission rate and poor prognosis. Therefore, the detection of EBV DNA is clinically important for assessing the prognosis of their disease.

Effects of Epstein-Barr virus infection on liver function in children

OBJECTIVE

In order to analyze the effect of Epstein-Barr (EB) virus infection on the liver function of children, the age and season of children susceptible to EB virus were analyzed in this study.

METHODS

In this study, 118 children with EB infection from Cangzhou Central Hospital were selected as the subjects, and 10 children with normal liver function were selected as the control group. Compared with normal children, the changes of blood cells, immune cells and indicators related to liver function in patients with EB virus infection were compared, and the expression of EB virus -DNA in patients' peripheral blood was analyzed. Immunohistochemistry was used to analyze the location and changes of CD4+T lymphocytes, CD8+T lymphocytes, and granzyme B cells in the liver of the patients. And changes in liver tissue were studied by in situ hybridization.

RESULTS

It was found that children in early childhood (1-3 years old) were the most susceptible group, and summer and autumn were the most susceptible seasons. Compared with normal children, the number of red blood cells and white blood cells in patients infected with EB virus increased, while the number of platelets decreased, but the difference was not significant. The liver function indexes of Alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total bilirubin (TBIL), and lactate dehydrogenase (LDH) increased after infection. The content of CD4+T lymphocytes decreased, while that of CD8+T lymphocytes increased. The level of immune factor IgG increased significantly (P<0.01), granzyme B cells were positive compared to that of normal humans, and positive lymphocytes containing EBER appeared.

CONCLUSION

Therefore, EB virus may affect liver function by acting CD8+T lymphocytes in children.