Yang-Chun Ma

and 7 more

Aoli Zhang

and 14 more

Background: Acute myeloid leukemia (AML) and hyperleukocytosis are related to an unfavorable prognosis. The impact of hyperleukocytosis on the prognosis of pediatric AML has not been fully explained so far. We aimed to assess the clinical characteristics and prognosis of pediatric AML with hyperleukocytosis, referred to as white blood cell (WBC) count ≥50×109/L. Methods: A total of 307 newly diagnosed non-acute promyelocytic leukemia patients were continuously enrolled at our center from October 2005 to September 2015. 81 patients with initial leukocyte counts ≥50×109/L. The baseline demographic and clinical characteristics of AML patients were compared. Progression-free survival (PFS) and overall survival (OS) were documented. Results: Hyperleukocytosis occurred in 26.38% of AML patients, and FAB M5 subtype (n=41, 50.62%) and FLT3-ITD mutations (n=16, 19.75%) had a high proportion in AML and hyperleukocytosis. Overall mortality was significantly higher in patients with hyperleukocytosis than patients without hyperleukocytosis (50.62% vs. 35.84%, P=.020). Patients with hyperleukocytosis had a lower 10-year PFS and OS rates than those without hyperleukocytosis (44.4%±9.4% vs. 59.7%±5.5%, P=.041; 49.4%±9.4% vs. 64.2%±5.4%, P=.051, respectively). There were similar PFS and OS rates between the subgroups of patients with WBC count 50-100×109/L and WBC count ≥100×109/L (43.8%±13.3% vs. 44.9%±12.3%, P=.507; 46.9%±13.3% vs. 51.0%±12.3%, P=.907, respectively). In all patients with hyperleukocytosis, male and FAB M5 subtype patients had a significantly inferior survival, while CBF-AML had a better survival. Conclusions: A WBC count greater than 50×109/L at onset was a critical predictive adverse factor in pediatric AML.

jing feng

and 5 more

Background: Deletion of cyclin-dependent kinase inhibitor 2A (CDKN2A) is prevalent in pediatric acute lymphoblastic leukemia (ALL) and the prognostic importance of CDKN2A deletion is still controversial. Procedure: A total of newly diagnosed 655 pediatric ALL cases were treated with Chinese Children’s Leukemia Group-acute lymphoblastic leukemia 2015 (CCLG-ALL 2015) protocol[1]. We investigated the difference among B-ALL and T-ALL patients with CDKN2A deletion for clinical characteristics at diagnosis, immunophenotype, risk stratification, cytogenetic risk group, and early treatment responses.We also analyzed the prognostic markers for event-free survival(EFS) in CDKN2A-deleted patients. Result: The incidence of CDKN2A gene deletion was presented in 14.6% (87/595) of B-ALL subgroup and 40.0% (24/60) of T-ALL subgroup. T-ALL subgroup was characterized by a higher male/female ratio, a higher proportion of older children (>10 years old) and WBC counts of greater than 50x109/L compared to B-ALL(P<0.05). In the univariate analysis, CNS 2, cytogenetic risk groups, prednisone poor responders (PPR), poor early response (PER), and MRD≥0.01% at day 46 (P<0.05) were associated with a poor event-free survival. Multivariable analysis revealed that PPR and MRD≥0.01% at day 46 were independent inferior prognostic factors for event-free survival(P<0.05). Conclusions: The incidence of CDKN2A deletion was more prevalent in T-ALL. CDKN2A deletion was significantly more prevalent in older (>10 years old) boys with leukocyte counts of greater than 50x109/L among T-ALL. PPR and MRD≥0.01% at day 46 were an independent prognostic factor for EFS in pediatric CDKN2A-deleted ALL.