Objective:To explore the clinical characteristics and prognosis of pediatric acute lymphoblastic leukemia with hyperleukocytosis (HL-ALL).Methods:A retrospective case series study was conducted. Clinical data of 153 children with initial diagnosis of HL-ALL from January 2016 to April 2023 in Children's Hospital of Soochow University were retrospectively analyzed. The clinical characteristics, cytogenetic and molecular biological features, immunophenotyping, treatment response and prognosis of the children were recorded. The children were divided into B-lineage and T-lineage groups according to immunophenotyping; the clinical characteristics of the two groups were compared; the overall survival (OS) of children in the two groups was analyzed by the Kaplan-Meier method, and the log-rank test was performed; the factors affecting OS were analyzed by using the Cox proportional hazards model.Results:Among the 153 children, 105 cases were detected with disease-related fusion genes, including 31 cases of Philadelphia chromosome-positive (Ph +)/Philadelphia chromosome-like (Ph-like). Tumor lysis syndrome (TLS) was present during induction therapy in 28 cases, pulmonary infection in 53 cases, intracranial hemorrhage in 6 cases, and sepsis in 12 cases. Immunophenotyping showed 86 cases were lineage B and 67 cases were lineage T. There were statistically significant differences in gender and age of the children between the B-lineage and T-lineage groups (both P < 0.05); the incidence of coagulation abnormalities and the levels of hemoglobin, lactate dehydrogenase and uric acid in the B-lineage group were lower than those in the T-lineage group (all P < 0.001). The positive rates of Ph +/Ph-like, MLL rearrangement, E2A-PBX1 and TEL-AML in the B-lineage group were higher than those in the T-lineage group (all P < 0.05), while the positive rates of SIL-TAL was lower than that in the T-lineage group ( P < 0.05). In terms of early complications, the incidence of TLS in the B-lineage group was lower than that in the T-lineage group ( P < 0.05). The median follow-up time [ M ( Q1, Q3)] was 1 150 (460-2 000) d until 30 April 2024, and the 3-year OS rates of children in the B-lineage and T-lineage groups were 80.6% and 67.1%, respectively; the difference in OS of children between the two groups was not statistically significant ( P = 0.168). The results of univariate Cox analysis showed that white blood cell count, Ph +/Ph-like positivity, occurrence of TLS, pulmonary infection, and intracranial hemorrhage were the influencing factors of OS in B-lineage HL-ALL children (all P < 0.05); white blood cell count and coagulation abnormalities were the influencing factors of OS in T-lineage HL-ALL children (both P < 0.05). Conclusions:There are differences in children's gender, age, laboratory parameters and genetics between the B-lineage and T-lineage groups in HL-ALL. White blood cell count, Ph +/Ph-like positivity, occurrence of TLS, pulmonary infection, and intracranial hemorrhage are the factors affecting OS of B-lineage HL-ALL children; white blood cell count and coagulation abnormalities are the factors affecting OS of T-lineage HL-ALL children.

Objective: To investigate the relationship between the ubiquitin ligase E3 cirRNA(circHERC4/hsa＿circ＿0007113) and the senescence in Human embryonic lung fibroblasts(IMR-90)cells. Methods: The whole gene sequence of circHERC4 was obtained from circBase database and cloned into cirRNA expression vector pLC5-ciR. The recombinant pLC5-ciR(+) hsa＿circ＿0007113 was constructed in vitro. The recombinant plasmid was identified by PCR, enzyme digestion and sequencing. The recombinant plasmid was transfected into HEK293 T and IMR90 cells with liposome 2000 transfection reagent. The expression of circHERC4 in normal cells, empty vector group and recombinant vector group was detected by RT-PCR, and the senescence of cells was detected by SA-β-Gal staining. Cell proliferation was detected by CCK-8 method. Results: The overexpression vector of circHERC4 was successfully constructed by correct sequencing, and circHERC4 could be efficiently transfected in HEK293 T cells. Compared with the control group, the positive rate of SA-β-Gal staining in the recombinant vector group decreased(P<0.05), and the proliferation rate of cells increased(P<0.05). Overexpression of circHERC4 could improve the proliferation and inhibit the senescence in IMR90 cells. Conclusion It suggests that circHERC4 has potential function of anti-senescence, which lays a foundation for further study on the function of circHERC4.