Venous thromboembolism in children with acute lymphoblastic leukemia in China:a report from the Chinese Children’s Cancer Group-ALL-2015

Venous thromboembolism(VTE)is a complication in children with acute lymphoblastic leukemia(ALL).The Chinese Children’s Cancer Group-ALL-2015 protocol was carried out in China,and epidemiology,clinical characteristics,and risk factors associated with VTE were analyzed.We collected data on VTE in a multiinstitutional clinical study of 7640 patients with ALL diagnosed in 20 hospitals from January 2015 to December 2019.First,VTE occurred in 159(2.08%)patients,including 90(56.6%)during induction therapy and 108(67.92%)in the upper extremities.T-ALL had a 1.74-fold increased risk of VTE(95%CI 1.08–2.8,P=0.022).Septicemia,as an adverse event of ALL treatment,can significantly promote the occurrence of VTE(P<0.001).Catheter-related thrombosis(CRT)accounted for 75.47%(n=120);and,symptomatic VTE,58.49%(n=93),which was more common in patients aged 12–18 years(P=0.023),non-CRT patients(P<0.001),or patients with cerebral thrombosis(P<0.001).Of the patients with VTE treated with anticoagulation therapy(n=147),4.08%(n=6)had bleeding.The VTE recurrence rate was 5.03%(n=8).Patients with VTE treated by non-ultrasoundguided venous cannulation(P=0.02),with residual thrombus(P=0.006),or with short anticoagulation period(P=0.026)had high recurrence rates.Thus,preventing repeated venous puncture and appropriately prolonged anticoagulation time can reduce the risk of VTE recurrence.

Retrospective Analysis of the Duration of Hospitalization of Imported Patients Infected with SARS-CoV-2 in Guangzhou, 2021

The pandemic of coronavirus disease 2019 is“not over,”in fact,the“dynamic clearing”policy for SARS-CoV-2 control and prevention in China has been firmly enforced.This study aimed to analyze the clinical symptoms and dynamic viral RNA changes in 2021 at Guangzhou Eighth People’s Hospital.This study showed that 31.4%of the patients(695/2212)tested negative for viral RNA from admission to the final release from quarantine.Of all negative cases,86.5%(601/695)remained in the hospital for no more than 5 days and were asymptomatic or mild.Among the remaining 402 patients who stayed for no more than 5 days,76.4%(307/402)were viral RNA retest positive during the isolation stage.However,96.4%of the peak viral RNA(296/307)was over Ct=33 cycles during the isolation stage.

Homoharringtonine is a safe and effective substitute for anthracyclines in children younger than 2 years old with acute myeloid leukemia

Homoharringtonine (HHT),a plant alkaloid from Cephalotaxus harringtonia,exhibits a unique anticancer mechanism and has been widely used in China to treat patients with acute myeloid leukemia (AML) since the 1970s.Trial SCMC-AML-2009 presented herein was a randomized clinical study designed based on our previous findings that pediatric AML patients younger than two years old may benefit from HHT-containing chemotherapy regimens.Patients randomized to arm A were treated with a standard chemotherapy regimen comprising mainly of anthracyclines and cytarabine (Ara-C),whereas patients in arm B were treated with HHTcontaining regimens in which anthracyclines in all but the initial induction therapy were replaced by HHT.From February 2009 to November 2015,59 patients less than 2 years old with de novo AML (other than acute promyelocytic leukemia) were recruited.A total of 42 patients achieved a morphologic complete remission (CR) after the first course,with similar rates in both arms (70.6% vs.72.0%).At the end of the follow-up period,40 patients remained in CR and 5 patients underwent hematopoietic stem cell transplantation in CR,which could not be considered as events but censors.The 5-year event-free survival (EFS) was 60.2%± 9.6% for arm A and 88.0%± 6.5% for arm B (P=0.024).Patients in arm B experienced shorter durations of leukopenia,neutropenia,and thrombocytopenia and had a lower risk of infection during consolidation chemotherapy with high-dosage Ara-C.Consequently,the homoharringtonine-based regimen achieved excellent EFS and alleviated hematologic toxicity for children aged younger than 2 years with de novo AML compared with the anthracycline-based regimen.

Early T-cell precursor leukemia:a subtype of high risk childhood acute lymphoblastic leukemia

Acute lymphoblastic leukemia includes T-cell acute lymphoblastic leukemia(T-ALL)and B-cell acute lymphoblastic leukemia(B-ALL).In children,T-ALL usually has a worse prognosis than B-ALL,although childhood T-ALL prognoses have improved remarkably.The varying outcomes among T-ALL cases suggest that an unrecognized biological heterogeneity may contribute to chemo-resistance.Deep exploration of T-lymphocyte development in recent years has found a subgroup of patients with a phenotype that resembles early T-cell precursor,which confers a much poorer prognosis than any other form of T-ALL.This novel subtype of T-ALL was called early T-cell precursor acute lymphoblastic leukemia(ETP-ALL).Flow cytometry data from T-ALL patients enrolled in Shanghai Children’s Medical Center between July 2002 and October 2010 were assessed according to Dr.Campana’s protocol.Among total 89 T-ALL cases,74 cases had enough immunophenotype data available to differentiate between ETP(CD1a^(-),CD8^(-),CD5^(dim),at least one marker of stem cell or myeloid lineage)and non-ETP.From these 74 subjects,12 ETP-ALL cases(16.2%)were identified.The event-free survival(EFS)rate at 66.8 months was 11.1%±10.1% for ETP-ALL and 57.6%±5.6% for non-ETP-ALL(P=0.003).The overall survival rates were 13.3%±11.0% for ETP-ALL and 64.7%±6.3% for non-ETP-ALL(P=0.002).Our findings demonstrate that early T-cell precursor leukemia is a very high-risk subtype of acute lymphoblastic leukemia with poor prognosis.

Treatment of childhood cancer in China:Current status and future direction

Introduction China has a population of 1.3 billion and 16.6%of the population(212 million)is below age of 15 years according to the sixth national census in 2010.1 Chinese National Central Cancer Registry(NCCR)collected data from 219 cancer registries distributed in different parts of China.In 2010 data from NCCR reported that childhood cancer comprised approximately 0.6%of all cancers.In a recent study analyzed data from 145 cancer registries in China,the age-standardized incidence rate of childhood cancer was 87.1 per million.The top five commonest childhood cancers were leukemia(35.6 per million),central nervous system(CNS)tumor(15.0 per million),lymphoma(6.4 per million),bone cancer(4.4 per million)and kidney cancer(3.7 per million).2 The incidence is lower than western countries but similar to those reported by other low-middle income countries.The reasons for lower incidence of childhood cancer may be related to incomplete data collection.In China,there is a large floating population,221 million,who were not permanent residents in locations they worked and might not be included in the city registration.The projected number of new cases of childhood cancer in 0-14 years is 22875,and new cases of leukemia projected to be 8943 in 2015.It is important to have accurate data on incidence and survival that will help the government in policy making on health care delivery.