儿童急性淋巴细胞白血病骨髓CASZ1、TAL1表达对维持化疗期间口服6巯基嘌呤耐受性的影响OA

Objective To investigate the effects of Castor zinc finger 1(CASZ1)and basic helix-loop-helix tran-scription factor TAL1 expression in bone marrow tissue of children with acute lymphoblastic leukemia(ALL)on maintaining oral 6-mercaptopurine(6-MP)tolerance during chemotherapy.Methods Clinical data of 94 children with ALL who under-went 6-MP+cyclophosphamide+cytarabine(CAT)chemotherapy in the Department of Pediatric Hematology and Oncology of Xingtai People's Hospital from January 2022 to February 2024 were selected,and 40 children with non-malignant hemato-logical diseases and normal bone marrow were selected as the control group.Quantitative real-time PCR was used to detect the expression of CASZ1 and TAL1 in bone marrow tissue of children with ALL.Factors influencing 6-MP tolerance during ma-intenance chemotherapy and the value of CASZ1 and TAL1 expression in evaluating 6-MP chemotherapy tolerance were sta-tistically analyzed.Results The relative expression levels of CASZ1 and TAL1 in bone marrow tissue of the ALL group were(3.24±0.54)and(2.98±0.42),respectively,which were significantly higher than those in the control group(0.89±0.20)and(0.91±0.18)(t=26.706,29.722,both P＜0.001).The expression of CASZ1 and TAL1 in ALL bone marrow tissue was pos-itively correlated(r=0.667,P＜0.001).The expression levels of CASZ1 and TAL1 in bone marrow tissue of children with ALL were significantly higher in the high-risk group than in the low-risk group(t=12.055,13.497,both P＜0.001).There were no statistically significant differences in the expression of these two markers with respect to gender,age,treatment regimen,im-munophenotype,infection status,red blood cell transfusion status,platelet count,or human granulocyte colony-stimulating fac-tor(all P＞0.05).High levels of CASZ1 and TAL1 were risk factors for 6-MP chemotherapy intolerance in children with mod-erate-to-high clinical risk ALL[OR(95％CI)=1.508(1.188-1.916),1.377(1.123-1.688),1.359(1.085-1.703)].The AUCs for bone marrow CASZ1 expression,TAL1 expression,and their combination in predicting 6-MP chemotherapy tolerance were 0.878,0.811,and 0.934,respectively.The combination of the two was superior to their individual predictive values(Z=4.611,5.222,both P＜0.001).The durations of white blood cell count＜1×109/L,absolute neutrophil count＜0.5× 109/L,and platelet count＜25×109/L in ALL children with high expression of bone marrow CASZ1 and TAL1 were all significantly longer than those in the low expression groups(t=12.426,7.562,16.606,all P＜0.05).Conclusion Upregulation of CASZ1 and TAL1 expression in bone marrow tissue of children with ALL is associated with 6-MP tolerance and may serve as novel indicators for evaluating bone marrow suppression.