广西医学Issue(12)：1782-1784,3.DOI:10.11675/j.issn.0253-4304.2015.12.27
大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的安全性观察
Safety of high-dose methotrexate for treatment of children with acute lymphoblastic leukemia
代艳 1黄欣秋 1何爽 2杜华 1梁珍花 1陆元奉 1王耀菊 1何鹏 1陆建良1
作者信息
- 1. 广西壮族自治区人民医院儿科，南宁市 530021
- 2. 广西壮族自治区人民医院儿童康复科，南宁市 530021
- 折叠
摘要
Abstract
Objective To explore the safety of high-dose methotrexate(HD-MTX) for the treatment of children with acute lymphoblastic leukemia(ALL).Methods A total of 62 children with ALL were treated with HD-MTX according to the corresponding protocol,and the side effects of treatment were observed .Results Among 257 case-times HD-MTX therapy in 62 children with ALL , the occurrence rates of neutropenia of gradeⅡ-Ⅳ,hypohemoglobinemia and thrombocytopenia were 54.1%(139/257),48.2%(124/257) and 14.8%(38/257), respectively,and the occurrence rates of liver function damage of grade Ⅱ -Ⅳ, stomatitis and gastrointestinal reaction were 38.1%(98/257),42.0%(108/257) and 26.8%(69/257),respectively.No intraoperative renal function damage of grade Ⅱ -Ⅳ,severe infection or death occurred.Of 202 tests of plasma methotrexate(MTX) concentration,the incidence of excretion delay was 30.2%(61/202). The proportion of patients with plasma MTX concentration >1.0 μmol/L 44 hours after treatment was 42.4%(56/132),and plasma MTX concentration >0.3 μmol/L 68 hours after treatment was 7.1%(5/70).The incidences of stomatitis,myelosuppression,gastrointestinal reaction and 1iver function damage in the delayed excretion group were significantly higher than those in the normal excretion group 44 hours after treatment(P<0.05).There was no significant difference in the incidences of side effects between children receiving the first -time rescue with calcium folinate in the 36th and 42nd hour after treatment (P>0.05).Conclusion Individual difference exists in ethotrexate excretion.Rescue with calcium folinate according to the plasma MTX concentration is safe and effective,which can reduce the side effects of HD-MTX for ALL.关键词
急性淋巴细胞白血病/甲氨蝶呤/大剂量/血药浓度/儿童/安全性Key words
Acute lymphoblastic leukemia/Methotrexate/High dose/Plasma concentration/Children/Safety分类
医药卫生引用本文复制引用
代艳,黄欣秋,何爽,杜华,梁珍花,陆元奉,王耀菊,何鹏,陆建良..大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的安全性观察[J].广西医学,2015,(12):1782-1784,3.
