Abnormal Clinical Features and Prognosis of ACTH in Pediatric Acute B Lymphocytic Leukemia

Qi NIE; Li LIU; Yue TIAN; Xiaoyan MAO; Qulian GUO; Xin TIAN

doi:10.12259/j.issn.2095-610X.S20241012

Volume 45 Issue 10

Oct. 2024

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Qi NIE, Li LIU, Yue TIAN, Xiaoyan MAO, Qulian GUO, Xin TIAN. Abnormal Clinical Features and Prognosis of ACTH in Pediatric Acute B Lymphocytic Leukemia[J]. Journal of Kunming Medical University, 2024, 45(10): 75-84. doi: 10.12259/j.issn.2095-610X.S20241012

Citation:

Qi NIE, Li LIU, Yue TIAN, Xiaoyan MAO, Qulian GUO, Xin TIAN. Abnormal Clinical Features and Prognosis of ACTH in Pediatric Acute B Lymphocytic Leukemia[J]. Journal of Kunming Medical University, 2024, 45(10): 75-84. doi: 10.12259/j.issn.2095-610X.S20241012

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Abnormal Clinical Features and Prognosis of ACTH in Pediatric Acute B Lymphocytic Leukemia

doi: 10.12259/j.issn.2095-610X.S20241012

Qi NIE^{1, 2},
Li LIU^{1, 3},
Yue TIAN^{1, 3},
Xiaoyan MAO⁴,
Qulian GUO⁴,
Xin TIAN^{1
,
,}

1.
Dept. of Hematology and Oncology，Kunming Children’ s Hospital / Affiliated Children’ s Hospital of Kunming Medical University, Kunming Yunnan 650228
2.
School of Clinical Medicine，Dali University，Dali Yunnan 671003
3.
School of Clinical Medicine，Kunming Medical University，Kunming Yunnan 650500
4.
Dept. of Pediatrics，Affiliated Hospital of Southwest Medical University，Luzhou Sichuan 646000, China

Received Date: 2024-07-10
Available Online: 2024-11-07
Publish Date: 2024-10-31

Abstract

Abstract

Objective To explore the clinical characteristics and prognosis of acute B lymphocytic leukemia in children with abnormal adrenal corticotropic hormone （ACTH）. Methods A total of 154 children with B-ALL admitted to the hematology Department of Kunming Children’ s Hospital from January 2019 to January 2023 were collected as the study objects. According to whether ACTH decreased, they were divided into the reduced group （75 cases） and the normal group （79 cases）. Clinical data of the patients were collected for comparison, and the risk factors affecting the prognosis were analyzed. Results The baseline data from two groups （gender, ethnicity, age）, number of chemotherapy sessions, severity of illness, hemoglobin levels, platelet counts, percentage of blast cells, relapse rates, mortality rates, event-free survival rates, overall survival rates, and both univariate and multivariate COX regression analyses of clinical factors affecting OS rates showed no statistical significance （P > 0.05）. However, peripheral blood leukocyte counts and groupings, glucocorticoid （GC） resistance rates, MRD positivity rates, and in the univariate Cox regression analysis, age ≥10 years, presence of central nervous system leukemia, leukocyte counts, and leukocyte groupings （50×10⁹/L vs ≥50×10⁹/L） had a statistically significant impact on the EFS rates of newly diagnosed B-ALL patients （P < 0.05）. Testicular infiltration, platelet counts, hemoglobin levels, bone marrow blast cell counts, cortisol levels, ACTH levels, gender, MRD, ethnicity, groupings （normal ACTH group vs reduced ACTH group）, and severity of illness on the EFS rates of newly diagnosed B-ALL patients was not statistically significant （P > 0.05）. Further multivariate Cox stepwise regression analysis （method: forward, conditional） revealed that leukocyte counts ≥50×10⁹/L and age ≥10 years are independent adverse prognostic factors for the EFS rates in these patients （P < 0.05）. Conclusion Children with B-ALL with reduced ACTH had higher rates of GC resistance, MRD positivity, and white blood cell count, ≥50×10⁹/L and age≥ 10 years were independent adverse prognostic factors for the EFS rate in children.
- Leukemia,
- Adrenal function,
- GC resistance,
- Prognosis

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