Zhou Ping, Xiong Hao, Li Jian-Xin, Li Hui, Tao Fang, Wang Zhuo, Chen Zhi, Li Kai-Li, Wu Sha
Department of Hematology and Oncology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital)， Tongji Medical College， Huazhong University of Science & Technology, Wuhan 430016, Hubei Province, China.
Department of Hematology and Oncology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital)， Tongji Medical College， Huazhong University of Science & Technology, Wuhan 430016, Hubei Province, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020 Dec;28(6):1837-1841. doi: 10.19746/j.cnki.issn.1009-2137.2020.06.008.
To explore the possible risk factors of death in children with acute lymphoblastic leukemia (ALL) after treatment.
The clinical data of 31 children with newly diagnosed acute lymphoblastic leukemia and dead after treatment in the Hematology Oncology Department of Wuhan children's Hospital from January 1, 2016 to December 31, 2019 were retrospectively analyzed. Univariate factor analysis and multivariate Cox regression analysis were used to analyze the each indexes of ALL children, and the possible risk factors causes of death in ALL children after treatment were analyzed.
Among 230 newly diagnosed ALL children, 31 (13.4%) cases were dead. Among them, there were 12 male and 19 female. The mortality rates were 9%(12/133) for male and 19.5%(19/97) for female, which showed a significantly difference（P=0.02）； among the dead ALL children, 6 were less than 1 year old, 23 were 1-10 years old, and 2 was more than 10 years old. The mortality rates in different age groups were 46.1 % (6/13), 11.7%(23/195) and 9%(2/22), respectively, which showed a significantly difference（P=0.00）； the mortality rates of the ALL children in standard risk group, medium risk group and high risk group were 6.7% (4/59), 11.9% (13/10) and 22.5%(14/62), respectively，which showed a significantly difference（P=0.03）. The mortality rates of ALL children with WBC<50×10/L, 50-100×10/L, and >100×10/L were 11%(22/199), 30%(3/10) and 28.5% (6/21), respectively, which showed a significantly difference（P=0.03）； the mortality rate of ALL.children with normal fusion gene was 11%(17/154), and for All children with TEL/AML, BCR/ABL and KMT2A rearrangement was 13.8%(5/36), 20%(2/10) and 50%(5/10), respectively（P=0.00）. The mortality rates of children with B-ALL and T-ALL were 13% (28/214) and 18.7% (3/16), respectively (P=0.54). The results of multivariate analysis showed that sex (P=0.03), age (P=0.00), and white blood cell count (P=0.05) were the risk factors of mortality.
The female, less than 1 year old at initial diagnosis, high risk ALL, WBC>50×10/L, BCR/ABL and KMT2A rearrangement are the possible risk factors causes of death in children after treatment.
探讨急性淋巴细胞白血病（ALL）患儿治疗后死亡的可能危险因素。
回顾性分析2016年1月1日至2019年12月31日在武汉市儿童医院血液肿瘤科新诊断的31例急性淋巴细胞白血病且治疗后死亡患儿的临床资料。采用单因素分析和多因素Cox回归分析ALL患儿的各项指标，分析ALL患儿治疗后死亡的可能危险因素。
在230例新诊断的ALL患儿中，31例（13.4%）死亡。其中，男性12例，女性19例。男性死亡率为9%（12/133），女性死亡率为19.5%（19/97），差异有统计学意义（P=0.02）；在死亡的ALL患儿中，6例年龄小于1岁，23例年龄为1 - 10岁，2例年龄大于10岁。不同年龄组的死亡率分别为46.1%（6/13）、11.7%（23/195）和9%（2/22），差异有统计学意义（P=0.00）；标准危险组、中危组和高危组ALL患儿的死亡率分别为6.7%（4/59）、11.9%（13/10）和22.5%（14/62），差异有统计学意义（P=0.03）。白细胞计数<50×10⁹/L、50 - 100×10⁹/L和>100×10⁹/L的ALL患儿死亡率分别为11%（22/199）、30%（3/10）和28.5%（6/21），差异有统计学意义（P=0.03）；融合基因正常的ALL患儿死亡率为11%（17/154），而存在TEL/AML、BCR/ABL和KMT2A重排的ALL患儿死亡率分别为13.8%（5/36）、20%（2/10）和50%（5/10）（P=0.00）。B - ALL和T - ALL患儿的死亡率分别为13%（28/214）和18.7%（3/16）（P=0.54）。多因素分析结果显示，性别（P=0.03）、年龄（P=0.00）和白细胞计数（P=0.05）是死亡的危险因素。
女性、初诊年龄小于1岁、高危ALL、白细胞计数>50×10⁹/L、BCR/ABL和KMT2A重排是ALL患儿治疗后死亡的可能危险因素。
