ABSTRACT
Objective:To explore the efficacy and safety of recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) and human granulocyte colony-stimulating factor (G-CSF) for the prevention of post-chemotherapy infections in pediatric hematologic neoplasms.Methods:A total of 134 children hospitalized for chemotherapy in 6 tertiary hospitals from July 2016 to June 2018 were collected, including 60 cases in Children's Hospital of Fudan University, 38 cases in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 29 cases in Children's Hospital Affiliated to Soochow University, 4 cases in the Affiliated Hospital of Qingdao University, 2 cases in Northwestern Women and Children's Hospital, and 1 case in Shandong Provincial Qianfoshan Hospital. The children were divided into GM-CSF group (38 cases), G-CSF group (45 cases) and GM-CSF+G-CSF group (51 cases) by using random number table method. The incidence of infections, the recovery time of absolute neutrophil counting (ANC), the decrease of blood platelet count (Plt) and the incidence of adverse reactions were compared among the three groups.Results:In all children, a total of 64 cases (47.8%) had infections during the myelosuppression phase after chemotherapy, of which 18 cases (47.4%) in GM-CSF group, 20 cases (44.4%) in G-CSF group, and 26 cases (51.0%) in GM-CSF+G-CSF group. The incidence of respiratory infection in G-CSF group was higher than that in GM-CSF group and GM-CSF+ G-CSF group [22.2% (10/45) vs. 2.6% (1/38), 4.0% (2/51), χ2 = 12.00, P = 0.002]. The median time to recovery of ANC > 1.5×10 9/L was 10.5 d (8 d, 15 d) in all children, 12 d (10 d, 16 d) in GM-CSF group, 9 d (8 d, 12 d) in G-CSF group, and 10 d (8 d, 16 d) in GM-CSF+G-CSF group. In all children, a total of 101 cases (75.4%) had Plt<50×10 9/L during the myelosuppression phase, and 79 cases (59.0%) had Plt <20×10 9/L. The differences in the incidence of Plt <50×10 9/L and <20×10 9/L among the three groups were not statistically significant (both P > 0.05). In all children, the adverse reactions occurred in 24 cases (17.9%), including 20 cases (14.9%) of fever, 2 cases (1.5%) of sore throat, 1 case (0.7%) of nausea, and 1 case (0.7%) of diarrhea; no adverse reactions of grade 2 or above occurred. The difference in the incidence of adverse reactions among the three groups was not statistically significant ( P>0.05). Conclusions:The efficacy of GM-CSF and G-CSF for the prevention of infections in pediatric hematologic neoplasms during the myelosuppression phase after chemotherapy is roughly equivalent, and combination of both has a good tolerance. The incidence of respiratory infection using GM-CSF alone or GM-CSF+G-CSF is low, which might benefit from the effect of GM-CSF on lung infections.
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Objective To investigate the effect of traumatic lumbar puncture (TLP) on central nervous system leukemia (CNSL) in children with acute lymphoblastic leukemia and the related factors of TLP. Methods A retrospective analysis was performed from the medical records of 106 children with ALL who were diagnosed and treated from January 2010 to December 2014. The factors affecting the occurrence of TLP and the effect of TLP on the prognosis of children with ALL were analyzed. Results A total of 106 patients were treated for ALL during the study period, of which 21 cases (19.8 %) experienced TLP, median platelet count in 85 patients (80.2%) without TLP and in 21 patients with TLP was (72.50 ± 69.53) × 109/L and (31.10 ± 19.82) × 109/L (t= 2.69, P= 0.008). A receiver operating characteristic curve was constructed for predicting the risk of TLP based on platelet count. Platelet count of 34 ×109/L at the time of TLP had a sensitivity of 76%and specificity of 66%in predicting TLP. According to cerebrospinal fluid type, 1 case (4.8%) of TLP type had CNSL, and 2 cases (2.9%) of CNS1 type had CNSL (P>0.05). The 3-year event-free survival (EFS) rate in TLP group and CNS1 group had no significant difference [(82.8 ± 4.8) % vs. (74.7 ± 9.9)%, P>0.05]. Conclusions In the diagnostic lumbar puncture, platelet count<34 × 109/L is significantly associated with risk of TLP. TLP type does not contribute to inferior EFS and increase the incidence of CNSL.
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Treatment options for children with acute promyelocytic leukemia include induced remission,consolidation therapy and maintenance therapy.The prognosis is related to the age of onset,initial white blood cell count in peripheral blood,negative situation of PML-RARa fusion gene and mutation rates of fms like tyrosine kinase 3 receptor gene.
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Objective To study the clinical significance of lung function and allergen detection in the diagnosis of cough variant asthma (CVA) in children. Method Forty-three cases of chronic cough in children with bronchial provocation (diastolic) test and skin prick allergy test results were analyzed, CVA group was 23 cases and control group was 20 cases. Results The positive of bronchial provocation (diastolic) test in CVA group was 19 cases, significantly higher than that in control group (3 cases, χ2=14.745, P ＜ 0.01 ).The positive of skin prick allergy test in CVA group was 17 cases , significantly higher than that in control group (5 cases, χ2 = 10.243,P ＜0.05). The correlation analysis showed that bronchial provocation (diastolic) test and skin prick allergy test was significantly correlated (r =0.404,P＜0.01 ).Conclusion Bronchial provocation (diastolic) test has an important role in the diagnosis of CVA; skin prick allergy test has a supporting role on the CVA diagnosis;allergens affect on lung function, bronchial provocation (diastolic) test with the help of skin prick allergy test in children with cough variant asthma diagnosis.