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Chen X, Lei XY, Guan XM, Dou Y, Wen XH, Guo YX, Gao HQ, Yu J. [Risk factors for recurrence of childhood acute lymphoblastic leukemia after treatment with the Chinese Children's Cancer Group ALL-2015 protocol]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:701-707. [PMID: 39014946 DOI: 10.7499/j.issn.1008-8830.2401010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
OBJECTIVES To investigate the cumulative incidence of recurrence (CIR) in children with acute lymphoblastic leukemia (ALL) after treatment with the Chinese Children's Cancer Group ALL-2015 (CCCG-ALL-2015) protocol and the risk factors for recurrence. METHODS A retrospective analysis was conducted on the clinical data of 852 children who were treated with the CCCG-ALL-2015 protocol from January 2015 to December 2019. CIR was calculated, and the risk factors for the recurrence of B-lineage acute lymphoblastic leukemia (B-ALL) were analyzed. RESULTS Among the 852 children with ALL, 146 (17.1%) experienced recurrence, with an 8-year CIR of 19.8%±1.6%. There was no significant difference in 8-year CIR between the B-ALL group and the acute T lymphocyte leukemia group (P>0.05). For the 146 children with recurrence, recurrence was mainly observed in the very early stage (n=62, 42.5%) and the early stage (n=46, 31.5%), and there were 42 children with bone marrow recurrence alone (28.8%) in the very early stage and 27 children with bone marrow recurrence alone (18.5%) in the early stage. The Cox proportional-hazards regression model analysis showed that positive MLLr fusion gene (HR=4.177, 95%CI: 2.086-8.364, P<0.001) and minimal residual disease≥0.01% on day 46 (HR=2.013, 95%CI: 1.163-3.483, P=0.012) were independent risk factors for recurrence in children with B-ALL after treatment with the CCCG-ALL-2015 protocol. CONCLUSIONS There is still a relatively high recurrence rate in children with ALL after treatment with the CCCG-ALL-2015 protocol, mainly bone marrow recurrence alone in the very early stage and the early stage, and minimal residual disease≥0.01% on day 46 and positive MLLr fusion gene are closely associated with the recurrence of B-ALL.
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Affiliation(s)
- Xia Chen
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Xiao-Ying Lei
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Xian-Min Guan
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Ying Dou
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Xian-Hao Wen
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yu-Xia Guo
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Hui-Qin Gao
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Jie Yu
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
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Combinational treatment of TPEN and TPGS induces apoptosis in acute lymphoblastic and chronic myeloid leukemia cells in vitro and ex vivo. Med Oncol 2022; 39:109. [PMID: 35578067 DOI: 10.1007/s12032-022-01697-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
TPEN and TPGS have recently shown selective cytotoxic effects in vitro and ex vivo leukemia cells. In this study, we aimed to test the synergistic effect of combined TPEN and TPGS agents (thereafter, T2 combo) on Jurkat (clone-E61), K562, Ba/F3, and non-leukemia peripheral blood lymphocytes (PBL). The ED50 doses (i.e., TPEN ED50: 3.2 μM and TPGS ED50: 34 μM, potency ratio R = 10.62 = TPGS (ED50)/TPEN (ED50)) were identified as dose-effect curve (%DNA fragmentation (sub-G1 phase) versus agent concentration). The most effective synergistic doses were determined according to isobole analysis. The apoptotic and oxidative stress effects of combined doses (TPEN 0.1, 0.5, 1 μM) and TPGS (5, 10, 20 μM)) were evaluated by DNA fragmentation (sub-G1 phase), mitochondrial membrane potential, oxidation of stress sensor protein DJ-1, and activation of executer protein CASPASE-3. They testified to the synergistic effect of the T2 combo (e.g., TPEN 1: TPGS 20, combination index (CI) 0.90 < 1; 1/3.2+ 20/34, > 90% induced apoptosis) in all 3 cell lines. As proof of principle, we challenged complete bone marrow (n = 5) or isolated cells from bone marrow (n = 3) samples from acute pediatric acute B-cell patients and found that T2 combo (1:20; 10:200) dramatically reduced (- 50%) the CD34+/CD19+cell population and increased significantly CD19+/CASP-3+ positive B-ALL cells up to 960%. The T2 combo neither induced DNA fragmentation, altered ΔΨm, nor induced oxidation of stress sensor protein DJ-1, nor activated CASP-3 in PBL cells. We conclude that by using different combinations of TPEN and TPGS, a more efficient treatment strategy can be developed for leukemia patients.
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He YY, Wu XJ, Zhou DH, Yang LH, Mai HR, Wan WQ, Luo XQ, Zheng MC, Zhang JL, Ye ZL, Chen HQ, Chen QW, Long XJ, Sun XF, Liu RY, Li QR, Wu BY, Wang LN, Kong XL, Chen GH, Tang XY, Fang JP, Liao N. A Nomogram for Predicting Event-Free Survival in Childhood Acute Lymphoblastic Leukemia: A Multicenter Retrospective Study. Front Oncol 2022; 12:854798. [PMID: 35425700 PMCID: PMC9002097 DOI: 10.3389/fonc.2022.854798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Even though childhood acute lymphoblastic leukemia (ALL) has an encouraging survival rate in recent years, some patients are still at risk of relapse or even death. Therefore, we aimed to construct a nomogram to predict event-free survival (EFS) in patients with ALL. METHOD Children with newly diagnosed ALL between October 2016 and July 2021 from 18 hospitals participating in the South China children's leukemia Group (SCCLG) were recruited and randomly classified into two subsets in a 7:3 ratio (training set, n=1187; validation set, n=506). Least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression analysis were adopted to screen independent prognostic factors. Then, a nomogram can be build based on these prognostic factors to predict 1-, 2-, and 3-year EFS. Concordance index (C-index), area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the performance and clinical utility of nomogram. RESULT The parameters that predicted EFS were age at diagnosis, white blood cell at diagnosis, immunophenotype, ETV6-RUNX1/TEL-AML1 gene fusion, bone marrow remission at day 15, and minimal residual disease at day 15. The nomogram incorporated the six factors and provided C-index values of 0.811 [95% confidence interval (CI) = 0.792-0.830] and 0.797 (95% CI = 0.769-0.825) in the training and validation set, respectively. The calibration curve and AUC revealed that the nomogram had good ability to predict 1-, 2-, and 3-year EFS. DCA also indicated that our nomogram had good clinical utility. Kaplan-Meier analysis showed that EFS in the different risk groups stratified by the nomogram scores was significant differentiated. CONCLUSION The nomogram for predicting EFS of children with ALL has good performance and clinical utility. The model could help clinical decision-making.
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Affiliation(s)
- Yun-yan He
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-jing Wu
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Graduate School, Guangxi Medical University, Nanning, China
| | - Dun-hua Zhou
- Children’s Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Li-hua Yang
- Department of Pediatrics, Southern Medical University Zhujiang Hospital, Guangzhou, China
| | - Hui-rong Mai
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Wu-qing Wan
- Department of Pediatrics, Second Xiangya Hospital of Central South University, Changsha, China
| | - Xue-qun Luo
- Department of Pediatrics, Sun Yat-Sen University First Affiliated Hospital, Guangzhou, China
| | - Min-cui Zheng
- Department of Hematology, Hunan Children’s Hospital, Changsha, China
| | - Jun-lin Zhang
- Graduate School, Guangxi Medical University, Nanning, China
| | - Zhong-lv Ye
- Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Hui-qin Chen
- Department of Pediatrics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qi-wen Chen
- Department of Pediatrics, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xing-jiang Long
- Department of Pediatrics, Liuzhou People’s Hospital, Liuzhou, China
| | - Xiao-fei Sun
- Department of Pediatrics, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ri-yang Liu
- Department of Pediatrics, Huizhou Central People’s Hospital, Huizhou, China
| | - Qiao-ru Li
- Department of Pediatrics, Zhongshan People’s Hospital, Zhongshan, China
| | - Bei-yan Wu
- Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Li-na Wang
- Department of Pediatrics, Guangzhou First People’s Hospital, Guangzhou, China
| | - Xian-ling Kong
- Department of Pediatrics, Boai Hospital of Zhongshan, Zhongshan, China
| | - Guo-hua Chen
- Department of Pediatrics, Huizhou First People’s Hospital, Huizhou, China
| | - Xian-yan Tang
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Jian-pei Fang
- Children’s Medical Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Ning Liao, ; Jian-pei Fang,
| | - Ning Liao
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- *Correspondence: Ning Liao, ; Jian-pei Fang,
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