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Wu CP, Zheng YZ, Li J, Wen H, Weng KZ, Zhuang SQ, Wu XG, Hua XL, Zheng H, Chen ZS, LE SH. [Clinical Features and Prognosis of Acute T-cell Lymphoblastic Leukemia in Children--Multi-Center Data Analysis in Fujian]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2024; 32:6-13. [PMID: 38387892 DOI: 10.19746/j.cnki.issn.1009-2137.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To evaluate the efficacy of acute T-cell lymphoblastic leukemia (T-ALL) in children and explore the prognostic risk factors. METHODS The clinical data of 127 newly diagnosed children with T-ALL admitted to five hospitals in Fujian province from April 2011 to December 2020 were retrospectively analyzed, and compared with children with newly diagnosed acute precursor B-cell lymphoblastic leukemia (B-ALL) in the same period. Kaplan-Meier analysis was used to evaluate the overall survival (OS) and event-free survival (EFS), and COX proportional hazard regression model was used to evaluate the prognostic factors. Among 116 children with T-ALL who received standard treatment, 78 cases received the Chinese Childhood Leukemia Collaborative Group (CCLG)-ALL 2008 protocol (CCLG-ALL 2008 group), and 38 cases received the China Childhood Cancer Collaborative Group (CCCG)-ALL 2015 protocol (CCCG-ALL 2015 group). The efficacy and serious adverse event (SAE) incidence of the two groups were compared. RESULTS Proportion of male, age≥10 years old, white blood cell count (WBC)≥50×109/L, central nervous system leukemia, minimal residual disease (MRD)≥1% during induction therapy, and MRD≥0.01% at the end of induction in T-ALL children were significantly higher than those in B-ALL children (P <0.05). The expected 10-year EFS and OS of T-ALL were 59.7% and 66.0%, respectively, which were significantly lower than those of B-ALL (P <0.001). COX analysis showed that WBC≥100×109/L at initial diagnosis and failure to achieve complete remission (CR) after induction were independent risk factors for poor prognosis. Compared with CCLG-ALL 2008 group, CCCG-ALL 2015 group had lower incidence of infection-related SAE (15.8% vs 34.6%, P =0.042), but higher EFS and OS (73.9% vs 57.2%, P EFS=0.090; 86.5% vs 62.3%, P OS=0.023). CONCLUSIONS The prognosis of children with T-ALL is worse than children with B-ALL. WBC≥100×109 /L at initial diagnosis and non-CR after induction (especially mediastinal mass has not disappeared) are the risk factors for poor prognosis. CCCG-ALL 2015 regimen may reduce infection-related SAE and improve efficacy.
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Affiliation(s)
- Chun-Ping Wu
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Yong-Zhi Zheng
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Jian Li
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Hong Wen
- Department of Pediatrics, The First Affiliated Hospital of Xiamen University, Xiamen 361000, Fujian Province, China
| | - Kai-Zhi Weng
- Department of Pediatric Renal Rheumatology and Immunology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Shu-Quan Zhuang
- Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Xing-Guo Wu
- Department of Pediatrics, Nanping First Hospital, Nanping 353000, Fujian Province, China
| | - Xue-Ling Hua
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Hao Zheng
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Zai-Sheng Chen
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Shao-Hua LE
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China.E-mail:
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Li M, Zheng YZ, Li J, LE SH, Zheng H, Chen ZS, Weng KZ, Zhuang SQ, Wu XG, Wen H. [Clinical Characteristics and Prognosis of MLL Rearranged Childhood Acute Lymphocyte Leukemia]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2023; 31:973-979. [PMID: 37551464 DOI: 10.19746/j.cnki.issn.1009-2137.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
AbstractObjective: To investigate the clinical characteristics and prognostic factors in childhood acute lymphoblastic leukemia with MLL gene-rearrangement-positive (MLL-r+ ALL). METHODS The clinical data of 1 414 newly diagnosed children with ALL admitted to five hospital in Fujian province from April 2011 to December 2020 were retrospectively analyzed. The clinical characteristics and efficacy of MLL-r+ and MLL-r- subgroup were compared. The prognostic factors of MLL-r ALL were analyzed by COX regression model. RESULTS Among all children with ALL, the proportion of patients aged less than 1 year old was 1.8%, and the detection rate of MLL-r+ was 3.4% (48/1 414). The positive detection rate of MLL-r in the age groups <1 year old, and ≥1 year old and ≤14 years old was 38.5% (10/26) and 2.7 (38/1 388), respectively, the difference was statistically significant (P<0.000). Compared with MLL-r- group, the MLL-r+ group had a higher proportion of patients with age <1 year, white blood cell (WBC) count ≥50×109/L, combined central nervous system leukemia (CNSL) and testicular leukemia(TL), while MRD <0.01% on d 33 or d 46 of induction chemotherapy was lower (all P<0.05). The expected 10-year event free survival(EFS) rate and overall survival(OS) rate of the MLL-r+ group were significantly lower than those of the MLL-r- group (EFS: 49.9% vs 77.0%; OS: 55.3% vs 82.9%, P<0.05). COX regression model analysis showed that age <1 year, minimal residual disease (MRD) ≥0.01% on d 33 or d 46 of induction chemotherapy were independent risk factors for worse OS and EFS in MLL-r+ ALL patients (all P<0.05). CONCLUSION Age <1 year old, high WBC, concomitant CNSL and TL are more common in children with MLL-r+ ALL at initial diagnosis, with poor early treatment response and long-term prognosis. Age <1 year old at initial diagnosis and MRD positive after induction chemotherapy may be risk factors for poor prognosis.
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Affiliation(s)
- Mei Li
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Yong-Zhi Zheng
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Jian Li
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Shao-Hua LE
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Hao Zheng
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Zai-Sheng Chen
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory, Fuzhou 350001, Fujian Province, China
| | - Kai-Zhi Weng
- Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian Province, China
| | - Shu-Quan Zhuang
- Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Xing-Guo Wu
- Nanping First Hospital, Fujian, Nanping 353000, Fujian Province, China
| | - Hong Wen
- The First Affiliated Hospital of Xiamen University, Xiamen 361000, Fujian Province, China,E-mail:
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Pan LL, Zheng YZ, LE SH, Hua XL, Zheng H, Chen ZS, Li J. [Comparison of the Early Efficacy and Serious Adverse Events between CCCG-ALL 2015 and CCLG-ALL 2008 in the Treatment of Pediatric Patients with Acute Lymphoblastic Leukemia]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2022; 30:1009-2137(2022)03-0-07. [PMID: 35680796 DOI: 10.19746/j.cnki.issn.1009-2137.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the early efficacy and serious adverse events (SAE) related to chemotherapy of different protocols in the treatment of pediatric patients with acute lymphoblastic leukemia (ALL), so as to improve the overall survival rate. METHODS A comparison of the early efficacy and SAE was performed between pediatric patients treated with Chinese Children Cancer Group-ALL 2015 (CCCG-ALL 2015) protocol from January 2019 to June 2020 and those treated with Chinese Children Leukemia Group-ALL 2008 (CCLG-ALL 2008) protocol from January 2017 to December 2018. RESULTS The remission rate before consolidation chemotherapy between the two groups was not significantly different (P=0.198), but the negative conversion rate of minimal residual disease (MRD) in CCLG-ALL 2008 group was significantly higher than that in CCCG-ALL 2015 group (P=0.000). The incidence of SAE in CCCG-ALL 2015 group was significantly lower than that in CCLG-ALL 2008 group (P=0.021), and the incidence of infection-related SAE was significantly higher in the latter (P=0.001), while the difference of non-infection-related SAE was not statistically significant (P=0.623). In addition, the treatment-related mortality in CCCG-ALL 2015 group was significantly lower than that in CCLG-ALL 2008 group (P=0.003). CONCLUSION CCCG-ALL 2015 regimen reduces the intensity of chemotherapy, which can significantly decrease the chemotherapy-related SAE (especially infection-related SAE), as well as treatment-related mortality. However, the MRD negative conversion rate is low before consolidation treatment, and the overall long-term efficacy remains to be further observed.
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Affiliation(s)
- Li-Li Pan
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fuzhou 350001, Fujian Province, China
| | - Yong-Zhi Zheng
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fuzhou 350001, Fujian Province, China
| | - Shao-Hua LE
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fuzhou 350001, Fujian Province, China
| | - Xue-Ling Hua
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fuzhou 350001, Fujian Province, China
| | - Hao Zheng
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fuzhou 350001, Fujian Province, China
| | - Zai-Sheng Chen
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fuzhou 350001, Fujian Province, China
| | - Jian Li
- Department of Pediatric Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fuzhou 350001, Fujian Province, China,E-mail:
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Zheng YZ, Zheng H, Li J, LE SH, Hua XL, Chen ZS, Zheng L, Li M, Chen YQ, Gao QL, Yang JH, Hu JD. [Children's NK/T Cell Lymphoma-Associated Hemophagocytic Syndrome: Clinical Analysis of 6 Cases]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2016; 24:1764-1770. [PMID: 28024491 DOI: 10.7534/j.issn.1009-2137.2016.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study the clinical features, treatment and prognosis of patients with NK/T cell lymphoma-associated hemophagocytic syndrome(NK/T-LAHPS). METHODS Retrospective analysis was used to explore the clinical data of 6 children with NK/T-LAHPS who were admitted in Department of Pediatric Hematology of Fujian Medical University Union Hospital from July 2012 to June 2016. The 6 patients included 4 boys and 2 girls, with a median age of 4 years(range 1.75 to 11). In 4 patients the hemophagocytic syndrome(HPS) occurred as the main primary manifestations of underlying lymphoma, in the other 2 patients HPS occurred during lymphoma progression. The clinical manifestations included persistent fever(6/6), hepatomegaly(6/6), splenomegaly(6/6) and pancytopenia(6/6). Laboratory data indicated that the level of ferritin(2179-15000 ng/ml) , LDH(608-3899 IU/L) and EBV-DNA(>105 copies/ml ) was elevated obviously. The other common clinical features of NK/T-LAHPS were hypoproteinemia(6/6), hepatic dysfunction(5/6), hypofibrinogenimia(5/6), hypertriglyceridemia(3) and hemophagocytosis in bone marrow(5/6). RESULTS After being treated according to the HLH-2004 protocol combined with supported therapy for 1 or 2 weeks, all the patients achieved a clinical response, and the laboratory indicators of HPS were improved. The combined chemotherapy of SMILE was given to 4 patients timely, among them 2 patients achieved complete remission(CR) and long term survival, 1 patient achieved partial remission(PR) and died of relapse after drug withdrawal and 1 patient died of aggravated lymphoma. The other 2 patients did not receive chemotherapy in time, HPS relapsed quickly, because of the progression of lymphoma, and all died of severe hepatic dysfunction and coagulopathy. CONCLUSION The NK/T-LAHPS is an invariably fatal disease with poor prognosis, and typically occurrs at the advanced stage or the terminal phase of the disease. HLH-2004- based protocol in combination with comprehensive therapy is hopeful for the patients with NK/T-LAHPS, which may delay the disease progression and provide opportunities for the treatment of primary disease. Once the laboratory indicators of HPS are improved, it is important to treat lymphoma timely with the combined chemotherapy of SMILE, which is significant for improving the prognosis.
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Affiliation(s)
- Yong-Zhi Zheng
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China
| | - Hao Zheng
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China
| | - Jian Li
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China
| | - Shao-Hua LE
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China
| | - Xue-Ling Hua
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China
| | - Zai-Sheng Chen
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China
| | - Ling Zheng
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China
| | - Mei Li
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China
| | - Yi-Qiao Chen
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China
| | - Qin-Li Gao
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China
| | - Jing-Hui Yang
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China
| | - Jian-Da Hu
- Department of Hematology, Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou 350001, Fujian Province, China. E-mail:
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