[Effect of the Risk Factors for Treatment-Related Death in Children with Acute Lymphoblastic Leukemia]

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% (13/10⁹) and 22.5%(14/62), respectively，which showed a significantly difference（P=0.03）. The mortality rates of ALL children with WBC<50×10⁹/L, 50-100×10⁹/L, and >100×10⁹/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>50×10⁹/L, BCR/ABL and KMT2A rearrangement are the possible risk factors causes of death in children after treatment.