Cytogenetic Characteristics of Childhood Acute Lymphoblastic Leukemia:A Study of 1541 Chinese Patients Newly Diagnosed between 2001 and 2014

Objective:Cytogenetic abnormalities have been proven to be the most valuable parameter for risk stratification of childhood acute lymphoblastic leukemia(ALL).However,studies on the prevalence of cytogenetic abnormalities and their correlation to clinical features in Chinese pediatric patients are limited,especially large-scale studies.Methods:We collected the cytogenetics and clinical data of 1541 children newly diagnosed with ALL between 2001 and 2014 in four Chinese hospitals,and retrospectively analyzed their clinical features,prognosis and risk factors associated with pediatric ALL.

Asparaginase-associated pancreatitis in chemotherapytreated pediatric patients:a five-year retrospective study

Asparaginase(Asp)represents a key agent in induction remission for acute lymphoblastic leukemia(ALL)and certain subtypes of non-Hodgkin lymphoma(NHL).By catalyzing the hydrolysis of extracellular asparagine,thus depleting the level of plasma asparagine necessary for the growth of leukemic lymphoblasts,Asp can inhibit leukemic lymphoblast protein synthesis and lead to subsequent apoptosis with little myelosuppression.[1]This will achieve anti-leukemia efficacy,and promote the remission of leukemia.[2]A previous study showed that an Asp-containing regimen could significantly increase the event-free survival rate(71%vs.31%).[3]A previous study showed that those who completed the Asp regimen had a higher 5-year event-free survival rate(90%)than those who were unable to tolerate toxicity and quitted the treatment(73%).[4]

Using sound Clinical Paths and Diagnosis-related Groups(DRGs)-based payment reform to bring benefits to patientcare: A case study of leukemia therapy

China has been undertaking a profound reform on health care.Although more than 1.16 billion people have been covered by rural and urban medical insurance to date,the level of reimbursement from insurance is very limited,especially for critical diseases such as leukemia.This places heavy economic burdens on patients.Under these circumstances,systems innovation is imperative for the efficient utilization of limited funding.In this respect,certain valuable experience from other countries may prove helpful.The prospective payment system of Diagnosis-related Groups(DRGs),Clinical Paths,and the Comparative Effectiveness Analysis adopted by the National Institute of Health and Clinical Excellence(NICE,UK),can befine tools to reduce medical costs and improve quality of services.Treatments of acute promyelocytic leukemia at Rui-Jin Hospital,and childhood acute lymphoblastic leukemia at Shanghai Children’s Medical Center,can be taken as suitable models to illustrate the crucial role of Clinical Paths in guaranteeing clinical and cost effectiveness of medical services for critical diseases,and to satisfactorily justify the feasibility of DRGs in China.

Renal tumor in developing countries:142 cases from a single institution at Shanghai,China

Background:The clinical management of children with renal tumors including Wilms'tumor,clear cell sarcoma,rhabdoid tumor and other renal tumors in our center was designed according to the National Wilms'Tumor Study Group protocols.Methods:A total of 142 consecutive patients who had been diagnosed as having renal tumors at Shanghai Children's Medical Center were reviewed retrospectively in the period of December 1998 and September 2012.Diagnosis and treatment were decided by a multi-disciplinary team including oncologists,surgeons,pathologists and sub-specialized radiologists.Results:The median age of the patients at the time of diagnosis was 27 months.The tumor stages of the patients were as follows:stage I 24.6%,stage II 23.2%,stage III 32.3%,stage IV 14.1%,and stage V 5.6%.Favorable histology was diagnosed in 80.3%,anaplasia in 4.2%,clear cell sarcoma in 9.8%,rhabdoid tumor in 4.9%,and other renal tumors in 0.7%of the patients.The event-free and overall 5-year survival rates were 80%and 83%,respectively.Tumor relapse and progress was seen in 25 patients(17.6%).The median relapse time was 6 months(range:2-37 months).Seven relapsing patients were re-treated and four of them got second complete remission(three in stage II,one in stage I).Conclusion:A multi-disciplinary team work model is feasible in developing countries,and the renal tumors protocols basically from developed countries are safe in developing countries.