Evaluation of the efficacy of two successive protocols on pediatric acute lymphoblastic leukemia with E2A-PBX1 fusion gene / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of BCH-03 and CCLG-08 protocols in treating E2A-PBX1 pediatric acute lymphoblastic leukemia (ALL).</p><p><b>METHOD</b>From January 2003 to January 2011, 59 ALL patients identified as E2A-PBX1 were analyzed in a retrospective study. There were 37 and 22 patients treated with Protocol BCH-03 and CCLG-08, respectively. The clinical characteristics at diagnosis, response to early treatment, the time of relapse, relapse-free survival (RFS) and event-free survival (EFS) in the two groups were analyzed.</p><p><b>RESULT</b>There were no significant differences in gender, age, initial white blood cell count, the central nervous system involvement, immunophenotype, prednisone response, the rate of complete remission, and the time of relapse between the two groups (P > 0.05). The only difference in induction therapy of the two protocols existed in the glucocorticoids used, that is, BCH-03 used 60 mg/m(2) prednisolone and CCLG-08 used 6 mg/m(2) dexamethasone. The doses of vincristine, daunorubicin and L-asparaginase were the same in the two groups. At the end of induction therapy, the MRD negativity rate in BCH-03 group was significantly higher than that in CCLG-08 group (84.2% vs. 47.1%, P = 0.018). The incidences of severe infection of the two groups during induction of remission were similar (P = 0.135). The EFS of BCH-03 group was significantly superior to that of CCLG-08 group (94.5% vs. 71.5%, P = 0.010), and the RFS of BCH-03 group tended to be better than that of CCLG-08 group (94.5% vs. 78.6%, P = 0.059).</p><p><b>CONCLUSION</b>Compared to Protocol CCLG-08, Protocol BCH-03 was more effective for pediatric E2A-PBX1 ALL, and 60 mg/m(2) prednisolone was more suitable for the induction therapy of this subtype of pediatric ALL.</p>

Treatment with combined all-trans retinoic acid and anthracycline of 37 children with acute promyelocytic leukemia / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the clinical features of childhood acute promyelocytic leukemia (APL) and to analyze the survival and prognostic factors and efficacy and safety of combined treatment with all-trans retinoic acid (ATRA) and anthracycline.</p><p><b>METHOD</b>The clinical features of 37 children with newly diagnosed APL hospitalized in our center during January 2005 to February 2009 were retrospectively analyzed.</p><p><b>RESULT</b>Thirty percent of patients were at low risk, 43% patients were at intermediate risk, 27% patients were at high risk. Sixty percent of patients had DIC. Retinoic acid syndrome (RAS) was present in 2 patients (6%). Death during induction occurred in 3 patients (8%). Complete remission (CR) was achieved in 83.7% of patients. The patients in high risk group had higher risk than those in intermediate and low risk group (P = 0.029). The time to achieve CR was not significantly different (P = 0.612). Idarubicin had no advantage compared with daunorubicin in time to achieve CR (P = 0.628). Survival rates were calculated using Kaplan-Meier statistical method, and 2 years event-free survival (EFS) rate was 81%, the 2-year EFS rate was 100% for low-risk group, 81% for intermediate-risk group, and 60% for high-risk group.</p><p><b>CONCLUSION</b>Using combined chemotherapy with ATRA and anthracyclines had the following advantages: high CR rate, high long-time survival rate and low side effect. DIC remained the main complication among patients receiving induction treatment. Initial WBC count and platelet count are important prognostic factors which might be useful in prognostication and treatment planning.</p>

Relation between TEL-AML1 expression level and clinical characteristics as well as early response to treatment in children with acute lymphoblastic leukemia / 中国实验血液学杂志

The study was aimed to investigate the relation between the expression level of TEL-AML1 (translocation ETS leukemia-acute myeloid leukemia 1) fusion gene and clinical characteristics as well as early response to treatment in children with ALL (acute lymphoblastic leukemia). With real-time quantitative polymerase chain reaction (RQ-PCR), the expression level of TEL-AML1 at diagnosis and MRD (minimal residual disease) at the end of induction of remission were detected in 35 children with ALL, including 20 SR (standard risk) and 15 IR (intermediate risk) patients. The expression level of TEL-AML1 and clinical characteristics at diagnosis were compared between MRD negative and MRD positive patients. The relation between TEL-AML1 expression levels at diagnosis, MRD level and clinical characteristics as well as early response to treatment were also explored. The results indicated that the expression levels of TEL-AML1 at diagnosis were 1.63 x 10(4) copies/10(4) copies ABL (median). At the end of induction of remission, 16 patients (10 SR and 6 IR patients) did not achieve molecular remission, whose MRD levels were 0.84 - 282.93 copies/10(4) copies ABL. No relation was found between expression levels of TEL-AML1 at diagnosis and clinical characteristics as well as MRD level. There was a significant relation between MRD level and blast count in peripheral blood (PB) at day 8 after prednisone trial induction. Significant relations between MRD level and presenting leukocyte count, blast percentage in PB were also found in the patients with presenting leukocyte count < 25 x 10(9)/L. TEL-AML1 expression level at diagnosis of MRD negative patients was lower than that of MRD positive ones. It is concluded that therapy after induction of remission is of importance by the fact that 45.71% children with TEL-AML1(+) ALL did not achieve molecular remission at the end of induction of remission. The effectiveness of prednisone trial predicts the MRD level. In addition, presenting leukocyte count, blast percentage in PB and TEL-AML1 expression level at diagnosis may have an effect on MRD level to some extent.

Clinical Features and Treatment of Eosinophilic Lymphoid Granuloma in Children / 实用儿科临床杂志

Objective To explore the clinical features and treatment of eosinophilic lymphoid granuloma(ELG) in children,in order to increase understanding of the disease.Methods Clinical features,laboratory examination,pathological examination,treatment and the-(rapeutic) effect of 5 patients with ELG were retrospectively studied,and the related literature were reviewed.Results Five cases were all boys.They all presented many subcutaneous swellings and lymphadenopathy.A case among them was associated with nephrotic syndrome,and 2 cases had the complication of eczema repeatedly,and 1 case ever had 2 times episodes of asthmatiform bronchitis.All of them had no hepatomegaly and splenomegaly,physically was well developed.Only chemotherapy was supplied to all the patients.During the course of therapy,4 cases among them recurred.After that,they were successfully treated with irradiation of lesion or cyclosporine(CsA).Conclusions ELG in children is as same as adult in clinicopathological features.It tends recur only with chemotherapy.We can get better curative effect with the synthetic treatment of chemotherapy,radiotherapy,operation or oral CsA and so on.

Analysis of 21 children with acute non-lymphoid leukemia carrying AML1/ETO fusion gene / 中华儿科杂志

<p><b>OBJECTIVE</b>It was revealed that t(8; 21) (q22; q22) was one of the most common chromosomal aberrations in acute non-lymphoid leukemia. The translocation was found to be involved in the AML1 gene on the chromosome 21 and the ETO gene on the chromosome 8, and resulted in the formation of AML1/ETO fusion gene on the derivative chromosome 8. The fusion gene was a transcription factor and played a direct role in the leukemogenesis. The translocation was mainly observed in M(2), accidentally in M(4) and M(1) and rarely in MDS. Here we studied the main clinical data in children with acute non-lymphoid leukemia (ANLL) carrying the AML1/ETO fusion gene. In addition, we discussed the significance of the detection of AML1/ETO fusion gene in the diagnosis and prognosis of children with ANLL.</p><p><b>METHODS</b>The authors investigated 29 patients in our hospital from December 2000 to March 2002. The patients were divided into two groups. Group A included 21 patients, 14 males and 7 females. They were 3.6 to 14 years old and the median was 9. Group B included 8 patients, 6 males and 2 females. They were 0.8 to 14 years old and the median was 6. Diagnosis was made according to FAB and MIC criteria and the expression of AML1/ETO fusion gene was detected with nested RT-PCR. The patients were treated according to DA, DAE or BFM regimen, respectively. The main clinical indexes including age, Hb, white blood count, platelet, blasts in PBC and BM, and time of arrival at complete remission (CR), were compared statistically between the two groups with t test of independent samples.</p><p><b>RESULTS</b>All the 21 patients in group A were found carrying AML1/ETO, and 17 patients (81%) were classified as M(2), the other 4 cases were of M(2) developed from MDS-RAEB-T, M(4Eo), M(5) and eosinophil leukemia, respectively. Eighteen out of 20 patients whose effects could be assessed reached CR, and the CR ratio was 90%. Two patients in group B were of AML-M(1), 3 M(2), 1 M(3), 1 M(4), and 1 M(5), respectively. None of them was found carrying AML1/ETO. Seven cases reached CR and the ratio was 87.5%. There was no significant difference between the two groups in the above clinical indices.</p><p><b>CONCLUSIONS</b>Between the two groups of patients there was no significant difference in the above clinical indices. RT-PCR for the detection of AML1/ETO in children with ANLL was quick, convenient and sensitive, and could be regarded as a useful method for the diagnosis and prognosis of ANLL.</p>