CCLG-ALL2008方案治疗不同分子生物学特征儿童急性淋巴细胞白血病的长期疗效分析

OBJECTIVE

To study the long-term clinical effect of the CCLG-ALL2008 regimen in the treatment of children newly diagnosed with acute lymphoblastic leukemia (ALL) with different molecular biological features.

METHODS

A total of 940 children who were newly diagnosed with ALL were enrolled in this study. The children were treated with the CCLG-ALL2008 regimen. A retrospective analysis was performed for the long-term outcome of ALL children with different molecular biological features.

RESULTS

Among the 940 children with ALL, there were 570 boys and 370 girls, with a median age of onset of 5 years (range 1-15 years) and a median follow-up time of 65 months (range 3-123 months). The complete response (CR) rate was 96.7%, the predicted 10-year overall survival (OS) rate was 76.5%±1.5%, and the event-free survival (EFS) rate was 62.6%±3.0%. After CR was achieved after treatment, the overall recurrence rate was 21.9%. The children with positive ETV6-RUNX1 had the lowest recurrence rate and were prone to late recurrence, and those with positive MLL rearrangement had the highest recurrence rate and were prone to early recurrence. The children with positive ETV6-RUNX1 had a significantly higher predicted 10-year OS rate than those with positive TCF3-PBX1, BCR-ABL, or MLL rearrangement and those without molecular biological features (P<0.05). The children with positive ETV6-RUNX1 had a significantly higher predicted 10-year EFS rate than those with positive BCR-ABL or MLL rearrangement (P<0.05).

CONCLUSIONS

Molecular biological features may affect the long-term prognosis of children with ALL, and positive MLL rearrangement and BCR-ABL fusion gene are indicators of poor prognosis. Children with positive ETV6-RUNX1 fusion gene have the highest long-term survival rate.

Effects of life history and reproduction on recruitment time lags in reintroductions of rare plants

Reintroductions are important components of conservation and recovery programs for rare plant species, but their long-term success rates are poorly understood. Previous reviews of plant reintroductions focused on short-term (e.g., ≤3 years) survival and flowering of founder individuals rather than on benchmarks of intergenerational persistence, such as seedling recruitment. However, short-term metrics may obscure outcomes because the unique demographic properties of reintroductions, including small size and unstable stage structure, could create lags in population growth. We used time-to-event analysis on a database of unusually well-monitored and long-term (4-28 years) reintroductions of 27 rare plant species to test whether life-history traits and population characteristics of reintroductions create time-lagged responses in seedling recruitment (i.e., recruitment time lags [RTLs]), an important benchmark of success and indicator of persistence in reintroduced populations. Recruitment time lags were highly variable among reintroductions, ranging from <1 to 17 years after installation. Recruitment patterns matched predictions from life-history theory with short-lived species (fast species) exhibiting consistently shorter and less variable RTLs than long-lived species (slow species). Long RTLs occurred in long-lived herbs, especially in grasslands, whereas short RTLs occurred in short-lived subtropical woody plants and annual herbs. Across plant life histories, as reproductive adult abundance increased, RTLs decreased. Highly variable RTLs were observed in species with multiple reintroduction events, suggesting local processes are just as important as life-history strategy in determining reintroduction outcomes. Time lags in restoration outcomes highlight the need to scale success benchmarks in reintroduction monitoring programs with plant life-history strategies and the unique demographic properties of restored populations. Drawing conclusions on the long-term success of plant reintroduction programs is premature given that demographic processes in species with slow life-histories take decades to unfold.

[Value of S100A8 in evaluating the prognosis of children with acute lymphoblastic leukemia]

OBJECTIVE

To study the association between S100A8 expression and prognosis in children with acute lymphoblastic leukemia (ALL).

METHODS

The clinical data of 377 children with ALL who were treated with the CCLG-2008-ALL regimen were retrospectively reviewed. ELISA and PCR were used to measure serum protein levels and mRNA expression of S100A8. The Kaplan-Meier method was used for survival analysis and a Cox regression analysis was also performed.

RESULTS

The children were followed up for 56 months, and the overall survival rate of the 377 children was 89.1%. The prednisone good response group had significantly lower S100A8 protein and mRNA levels than the prednisone poor response group (P<0.01). In the children with standard or median risk, both S100A8 protein and mRNA levels were associated with event-free survival rate (P<0.05). There were significant differences in S100A8 protein and mRNA levels between the children with different risk stratifications (P<0.01). The children who experienced events had significantly higher S100A8 protein and mRNA levels than those who did not (P<0.01). The Kaplan-Meier survival analysis and the Cox regression model suggested that S100A8 overexpression was an independent risk factor for the prognosis of children with ALL.

CONCLUSIONS

High S100A8 expression may be associated with the poor prognosis of children with ALL and is promising as a new marker for individualized precise treatment of children with ALL.

[Twoyear outcomes and the influence factors of indirect pulp treatment in primary teeth: a retrospective study]

OBJECTIVE

To evaluate the outcomes and to find out the influence factors of indirect pulp treatment in primary teeth.

METHODS

Children who received indirect pulp treatment in primary teeth in the Department of Pediatric Dentistry in Peking University School and Hospital of Stomatology from August, 2014 to September, 2016 were collected in the Electronic Medical Record Database of Peking University School and Hospital of Stomatology, via the database for scientific research provided by the corporation of Kaientai. The children selected as the subjects of this study were followed up over 1.5 years, and they were under 9 years old if in the group of primary molars while the children in the group of primary anterior teeth were under 4 and a half years old. Those children who were not reviewed regularly or didn't have complete medical records were removed. Basic information, the relevant medical records and radiographic records of those children were collected. All teeth were examined clinically and classified into 2 outcomes, teeth in group H were regarded as succeeded, and teeth in group P were regarded as failed. Survival analysis was applied. The survival rate and survival time of the deciduous teeth calculated. Multivariate analysis was performed by using Cox proportional hazard model.

RESULTS

One hundred and six children were finally included, aged from 1.6 to 8.8 years, with the mean age of (5.0±1.7) years. 168 primary teeth (122 primary molars, 46 primary anterior teeth) were included, and the average follow up time was (729±244) days. Thirty-five primary teeth (23 primary molars, 12 primary anterior teeth) failed upon clinical or radiographic examinations by September, 2018. The cumulative survival probability of half a year, one year, one year and a half, two years, two and a half years for the indirect pulp treatment was 93.5%, 92.9%, 87.5%, 82.7%, and 75.5% through the KaplanMeier method, respectively. Through the analysis of Cox proportional hazard model, in primary molars, the survival probability tended to be lower when the number of tooth surface affected by caries was greater (OR=1.709, P<0.05). Compared with primary molars, the survival probability of primary anterior teeth was lower, but the difference was not significant.

CONCLUSION

Complying the current instructions in our department, the cumulative survival probability of two and a half years after the indirect pulp treatment in primary teeth was 75.5%. In primary molars, the survival probability tended to be lower when the number of tooth surfaces affected by caries increased.

[Expression of β-integrin family members in children with T-cell acute lymphoblastic leukemia]

OBJECTIVE

To study the expression of β-integrin family members in children with T-cell acute lymphoblastic leukemia (T-ALL) and their significance.

METHODS

Quantitative real-time PCR analyses were performed to assess the expression levels of β-integrin family members in bone marrow samples from 22 children with newly-diagnosed T-ALL and 21 controls (16 children with non-malignant hematologic disease and 5 healthy donors with bone marrow transplantation). Jurkat cells were treated with integrin inhibitor arginine-glycine-aspartate (Arg-Gly-Asp, RGD) peptide. The cell viability and apoptosis rate were determined by CCK8 assay and flow cytometry respectively.

RESULTS

The mRNA levels of integrins β₂, β₃, and β₅ were significantly lower in children with T-ALL than in controls (P<0.05). In T-ALL patients, high integrin β₃ expression was associated with lower white blood cell counts (<100×10⁹/L), minimal residual disease (MRD) positivity, and day 33 bone marrow negative remission (P<0.05). In T-ALL patients, higher integrin β₅ expression was associated with relapse of T-ALL (P<0.05). Based on survival curve analysis, higher integrin β₃ expression was related to lower event-free survival and overall survival rates. RGD peptide treatment inhibited the proliferation of Jurkat cells and increased their apoptosis rate (P<0.05).

CONCLUSIONS

β-Integrin may play a role in the occurrence and development of T-ALL by affecting cell proliferation and apoptosis. The expression of integrin β5 is closely related to the risk of relapse of T-ALL. The expression of integrin β3 is closely related the treatment response and prognosis of T-ALL.

[Clinical characteristics and prognostic analysis of children and adolescents over 10 years of age with acute lymphoblastic leukemia]

OBJECTIVE

To explore the clinical characteristics and prognosis of children and adolescents over 10 years of age with acute lymphoblastic leukemia (ALL).

METHODS

A total of 86 newly diagnosed ALL children and adolescents over 10 years of age (62 cases of B-ALL and 24 cases of T-ALL) were enrolled. Clinical characteristics, therapeutic effect and prognostic factors were retrospectively analyzed. Event-free survival (EFS) and overall survival (OS) rates were estimated by the Kaplan-Meier method. Prognostic factors were evaluated by COX regression analysis.

RESULTS

Of 86 patients, 62 were in medium risk, and 24 in high risk. At diagnosis, 53 patients (62%) had hepatomegaly, 50 patients (58%) had splenomegaly, and 46 patients (54%) had lymphoadenopathy. Twenty-nine patients (34%) showed high leukocyte counts (≥50×10⁹/L) at diagnosis. The karyotype analysis was performed on 78 patients. The percentage of hyperdiploidy was 19% (15 cases), and that of hypodiploidy was 5% (4 cases). Eleven patients (14%) had abnormalities of chromosome structure. Of them, one patient was Philadelphia chromosome-positive, and another patient had the t (1; 19) chromosomal translocation. Three patients (4%) were positive for TEL/AML1, 3 (4%) were positive for E2A/PBX1, 6 were positive for BCR/ABL (7%), and 4 (5%) were positive for SIL/TAL1. During 4 weeks of induction therapy, 85 patients (99%) achieved complete remission (CR). In 86 patients, the 5-year anticipated EFS and OS were (64±6)% and (75±5)% respectively. The 5-year EFS and OS in the medium risk group were significantly higher than those in the high risk group (P<0.05). The 5-year EFS in B-ALL patients was significantly higher than that in T-ALL patients (P<0.05). COX multivariate analysis showed that white blood counts at diagnosis and minimal residual disease (MRD) after induction therapy were independent prognostic factors.

CONCLUSIONS

Children and adolescents with ALL over 10 years of age often have clinical characteristics of unfavorable prognosis. White blood counts at diagnosis and MRD after induction therapy may be important factors for the long-term prognosis.

[Clinical characteristics and prognostic analysis of children and adolescents over 10 years of age with acute lymphoblastic leukemia]

OBJECTIVE

To explore the clinical characteristics and prognosis of children and adolescents over 10 years of age with acute lymphoblastic leukemia (ALL).

METHODS

A total of 86 newly diagnosed ALL children and adolescents over 10 years of age (62 cases of B-ALL and 24 cases of T-ALL) were enrolled. Clinical characteristics, therapeutic effect and prognostic factors were retrospectively analyzed. Event-free survival (EFS) and overall survival (OS) rates were estimated by the Kaplan-Meier method. Prognostic factors were evaluated by COX regression analysis.

RESULTS

Of 86 patients, 62 were in medium risk, and 24 in high risk. At diagnosis, 53 patients (62%) had hepatomegaly, 50 patients (58%) had splenomegaly, and 46 patients (54%) had lymphoadenopathy. Twenty-nine patients (34%) showed high leukocyte counts (≥50×109/L) at diagnosis. The karyotype analysis was performed on 78 patients. The percentage of hyperdiploidy was 19% (15 cases), and that of hypodiploidy was 5% (4 cases). Eleven patients (14%) had abnormalities of chromosome structure. Of them, one patient was Philadelphia chromosome-positive, and another patient had the t (1; 19) chromosomal translocation. Three patients (4%) were positive for TEL/AML1, 3 (4%) were positive for E2A/PBX1, 6 were positive for BCR/ABL (7%), and 4 (5%) were positive for SIL/TAL1. During 4 weeks of induction therapy, 85 patients (99%) achieved complete remission (CR). In 86 patients, the 5-year anticipated EFS and OS were (64±6)% and (75±5)% respectively. The 5-year EFS and OS in the medium risk group were significantly higher than those in the high risk group (P<0.05). The 5-year EFS in B-ALL patients was significantly higher than that in T-ALL patients (P<0.05). COX multivariate analysis showed that white blood counts at diagnosis and minimal residual disease (MRD) after induction therapy were independent prognostic factors.

CONCLUSIONS

Children and adolescents with ALL over 10 years of age often have clinical characteristics of unfavorable prognosis. White blood counts at diagnosis and MRD after induction therapy may be important factors for the long-term prognosis.

[Recurrence and survival analysis of postoperative patients aged 25 to 59 years with differentiated thyroid carcinoma]

OBJECTIVE

To investigate the recurrence and survival of postoperative patients with differentiated thyroid carcinoma (DTC) aged from 25 to 59 years.

METHODS

We retrospectively analyzed the clinical data of 36 patients with DTC treated in our hospital from 1996 to 2011, and the recurrence and survival status of the patients were recorded. Kaplan-Meier analysis was carried out to analyze factors that affect the patient's survival.

RESULTS

Nine patients died of recurrence or metastasis, and the interval between the initial surgery and recurrence ranged from 22 to 46 months. The survival time of the 36 patients ranged from 34 to 135 months with a 10-year survival rate of 75.0%. Kaplan-Meier analysis showed that male patients had a significantly shorter mean survival time than female patients (Χ²=3.164, P=0.041); the median survival time of patients aged 45-59 years was obviously shorter than that of patients aged 25-44 years (Χ²=4.622, P=0.032); the postoperative survival in patients with 131I therapy was significantly longer than those who did not receive the therapy (Χ²=4.527, P=0.033), and was not affected by total excision of the thyroid gland (Χ²=0.988, P=0.320). No significant difference was found in the median survival of patients in different clinical stages (Χ²=2.2132, P=0.167).

CONCLUSION

In young and middle-aged patients with DTC, postoperative recurrence is the most likely in 2 to 4 years after the surgery. Male patients at 45-59 years of age who do not receive 131I treatment are at high risks of tumor recurrence.

[The prognostic value of early BCR-ABL transcripts level in 251 patients with chronic myeloid leukemia after treatment with imatinib]

OBJECTIVE

To understand the prognostic value of early monitoring BCR-ABL transcripts in patients with chronic myeloid leukemia (CML) after treatment with imatinib, and to provide the information for early assessment of prognosis and treatment options.

METHODS

The clinical data of 251 patients with CML in chronic phase (CML-CP) who received imatinib as first-line therapy were retrospectively analyzed, the progression-free survival (PFS)and overall survival (OS) between different BCR-ABL transcriptional level at 3 and 6 month after imatinib treatment were compared. Meanwhile, Chi-square test and logistic regression were used to analyze the risk factors for disease progression.

RESULTS

At 3 months after imatinib treatment BCR-ABL transcriptional levels>10%, >1%-≤ 10% and ≤ 1% were found in 92, 94 and 64 patients, their PFS were 53.3%, 71.3% and 86.2%, respectively. The results showed that the PFS of patients with low BCR-ABL transcriptional levels was significantly superior to that with high BCR-ABL transcriptional levels for CML at 3 months treatment (P<0.05). The OS of three group did not reach statistical significance (92.4% vs 96.8% vs 93.8%, P> 0.05). When 182 patients received imatinib treatment at 6 months, 22 patients with BCR-ABL transcriptional levels>10%, 50>1% -≤ 10% and 110 ≤ 1%, their PFS were 27.3% vs 66.0% vs 82.7% (P<0.05), the OS of three groups were 86.4% vs 94.0% vs 100%. There were significant differences among the three groups (P<0.05). Logistic regression confirmed that the level of BCR-ABL transcriptional level at 3 and 6 months after imatinib treatment was independent factor to influence the progress of disease.

CONCLUSION

It is important for the prognosis evaluation of CML patients to monitor BCR-ABL transcriptional level at 3 and 6 months after imatinib treatment.