Prognostic factors of childhood acute lymphoblastic leukemia with TCF3::PBX1 in CCCG-ALL-2015: A multicenter study

Background

Contemporary risk-directed treatment has improved the outcome of patients with acute lymphoblastic leukemia (ALL) and TCF3::PBX1 fusion. In this study, the authors seek to identify prognostic factors that can be used to further improve outcome.

Methods

The authors studied 384 patients with this genotype treated on Chinese Children's Cancer Group ALL-2015 protocol between January 1, 2015 and December 31, 2019. All patients provisionally received intensified chemotherapy in the intermediate-risk arm without prophylactic cranial irradiation; those with high minimal residual disease (MRD) ≥1% at day 46 (end) of remission induction were candidates for hematopoietic cell transplantation.

Results

The overall 5-year event-free survival was 84.4% (95% confidence interval [CI], 80.6–88.3) and 5-year overall survival 88.9% (95% CI, 85.5–92.4). Independent factors associated with lower 5-year event-free survival were male sex (80.4%, [95% CI, 74.8–86.4] vs. 88.9%, [95% CI, 84.1–93.9] in female, p = .03) and positive day 46 MRD (≥0.01%) (62.1%, [95% CI, 44.2–87.4] vs. 87.1%, [95% CI, 83.4–90.9] in patients with negative MRD, p < .001). The presence of testicular leukemia at diagnosis (n = 10) was associated with particularly dismal 5-year event-free survival (33.3% [95% CI, 11.6–96.1] vs. 83.0% [95% CI, 77.5–88.9] in the other 192 male patients, p < .001) and was an independent risk factor (hazard ratio [HR], 5.7; [95% CI, 2.2–14.5], p < .001).

Conclusions

These data suggest that the presence of positive MRD after intensive remission induction and testicular leukemia at diagnosis are indicators for new molecular therapeutics or immunotherapy in patients with TCF3::PBX1 ALL.     

中国儿童基本药品可及性多中心研究

目的调查我国儿童基本药品的可及性现状,为提高我国儿童基本药品可及性,促进儿童合理用药提供依据。方法采用现况调查方法,于2017年5月26日至6月2日选取我国东部、中南部、西部和北部地区17个省或直辖市的55家公立医院,以调查表的形式对42种儿童基本药品进行可及性调查。每个药品调查原研药和仿制药两个品种。研究内容包括可获得性、价格、可承受性。42种儿童基本药品在所有调查机构中可以得到的百分比,即为该药品的可获得性。价格研究采用中位价格比值(MPR),即某一种药品单位价格的中位数与国际参考价格的比值,并针对所有药物得出中位MPR。药品费用的可承受性研究,是将治疗某一标准疗程疾病所需的费用,折算成赚取全国日最低工资所花费的天数,计算治疗该常见疾病的可承受性。对可获得性、价格、可承受性指标进行描述性分析。结果在42种调查药品中,原研药和仿制药的平均可获得性分别为33%和32%。原研药和仿制药的中位MPR分别为5.43和1.55;既有原研药又有仿制药的19种药品价格比较,原研药和仿制药的中位MPR分别为7.73和2.04。针对4种常见儿童疾病(肺炎、消化性溃疡、先天性甲状腺功能减低症、难治性肾病)的5种基本药品进行可承受性研究,使用仿制药需要花费0.63(0.16~6.17)d全国日最低工资,使用原研药需要花费1.03(0.16~11.53)d全国日最低工资。结论在42种儿童基本药品中,原研药和仿制药的可获得性均较低。仿制药价格基本合理,可承受性较好;原研药价格明显高于国际参考价,可承受性较差。需进一步提高我国儿童基本药品可及性。     

全国31家医院儿科患者中心血管通路应用现况调查

目的调查我国儿童中心血管通路装置使用现状,为儿科患者中心血管通路装置的规范化使用、专业护理提供借鉴,为儿科静脉治疗管理提供支持与依据。方法采取便利抽样方法,于2018年7月23—31日,选取福棠儿童医学发展研究中心成员医院及医联体的31家儿童专科医院、设置儿科的妇幼保健院及综合医院,对所有使用中心血管通路的患儿,采用研究小组自制儿童中心血管通路使用状况调查表进行调查,并观察并发症发生情况。共采集1333份调查表,有效1288份,有效率96.62%。结果31家医院中三级医院22家、二级医院9家,1288例使用中心血管通路输液的患儿中,PICC 860例,占66.77%,中心静脉置管(CVC)342例,占26.55%,输液港(PORT)77例,占5.98%,脐静脉置管9例,占0.70%;科室分布主要集中于血液肿瘤科、ICU、儿外科、心血管科、新生儿科;PICC、CVC、PORT置管部位分别以上肢(90.00%,774例)、颈内静脉(73.39%,251例)、胸部(96.10%,74例)为主;中心血管通路装置维护中,存在多种敷料并存现象。结论中心血管通路在儿科患者群体已经得到广泛使用,中心血管通路装置的选择较为规范,但在管路的维护、敷料的使用、输液接头的选择及相关并发症的控制方面尚有待进一步加强。建议儿科护理专业人员及护理管理者,进一步强化中心血管通路置管及维护的相关知识,依照国际及国家静脉输液治疗指南及标准加大管理及督促力度,进一步降低儿科患者中心血管通路并发症的发生率。     

盐酸拓普替康治疗卵巢癌16例分析

目的 观察国产盐酸拓普替康(TPT)治疗卵巢癌的近期疗效和不良反应。方法 对16例卵巢癌给予单药拓普替康1．25mg／m^2 d1～5或联合DDP40mg／m^2d1.6化疗，每21天为一疗程，观察疗效和不良反应。结果 国产盐酸拓普替康治疗恶性卵巢癌的近期有效反应率为37．5％，主要的不良反应为骨髓抑制。结论拓普替康可作为治疗经铂类等药物失败的晚期卵巢恶性肿瘤的有效药物，其主要毒副反应为骨髓抑制。每例均需G—CSF支持，较高经费支持是其使用受到限制的主要原因。     

Prevalence of human papillomavirus and cervical intraepithelial neoplasia in China: A pooled analysis of 17 population-based studies

High-risk (HR) human papillomavirus (HPV) prevalence has been shown to correlate well with cervical cancer incidence rates. Our study aimed to estimate the prevalence of HR-HPV and cervical intraepithelial neoplasia (CIN) in China and indirectly informs on the cervical cancer burden in the country. A total of 30,207 women from 17 population-based studies throughout China were included. All women received HPV DNA testing (HC2, Qiagen, Gaithersburg, MD), visual inspection with acetic acid and liquid-based cytology. Women positive for any test received colposcopy-directed or four-quadrant biopsies. A total of 29,579 women had HR-HPV testing results, of whom 28,761 had biopsy confirmed (9,019, 31.4%) or assumed (19,742, 68.6%) final diagnosis. Overall crude HR-HPV prevalence was 17.7%. HR-HPV prevalence was similar in rural and urban areas but showed dips in different age groups: at age 25–29 (11.3%) in rural and at age 35–39 (11.3%) in urban women. In rural and urban women, age-standardized CIN2 prevalence was 1.5% [95% confidence interval (CI): 1.4–1.6%] and 0.7% (95% CI: 0.7–0.8%) and CIN3+ prevalence was 1.2% (95% CI: 1.2–1.3%) and 0.6% (95% CI: 0.5–0.7%), respectively. Prevalence of CIN3+ as a percentage of either all women or HR-HPV-positive women steadily increased with age, peaking in 45- to 49-year-old women. High prevalence of HR-HPV and CIN3+ was detected in both rural and urban China. The steady rise of CIN3+ up to the age group of 45–49 is attributable to lack of lesion removal through screening. Our findings document the inadequacy of current screening in China while indirectly raising the possibility that the cervical cancer burden in China is underreported.