To provide reference for early assessment of GC reactivity in children and optimization of chemotherapy, the differences in laboratory test results of children with acute lymphoblastic leukemia (ALL) with different glucocorticoid (GC) reactivity at initial diagnosis were analyzed to find indicators that could predict GC reactivity and construct corresponding prediction models.

We retrospectively analyzed the cases of children with ALL who were first diagnosed by the First Affiliated Hospital of Sun Yat-sen University. The clinical data and laboratory test results before induction chemotherapy were collected and counted, and the relevant risk factors of GC-resistant were screened. The binary logistic regression equation and nomogram were used to construct the prediction model, and the ROC curve was used to evaluate the diagnostic efficiency.

The laboratory test results at the initial diagnosis such as WBC count, APTT, coagulation factor 8, K⁺, Cl^-, CO₂, LDH, BCR-ABL1, ETV6-RUNX1 showed significant statistical differences between the ALL GC-resistant group and GC-sensitive group. APTT, K⁺ and WBC count were independent risk predictors of GC reactivity. The sensitivity and specificity of the predictive model were 0.80 and 0.84, respectively.

This study suggested that the prediction model combining APTT, K⁺ and white blood cell count before induction chemotherapy could provide a better reference for clinical judgment of GC reactivity in children with ALL, but more cases are still needed for further verification.