Application of nephrogram in the HD-MTX chemotherapy of children with intermediate/high risk acute lymphoblastic leukemia
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摘要: 目的 本研究旨在通过对比分析，探讨肾图在中/高危急性淋巴细胞白血病儿童大剂量甲氨蝶呤（high-dose methotrexate，HD-MTX）化疗中的应用。方法 304例病人回顾性研究，按照第一次HD-MTX化疗前是否肾图检查分为A，B两组，A组根据肾图检查结果调整甲氨蝶呤（methotrexate，MTX）化疗剂量。比较两组胃肠道反应、黏膜炎、肝功能损害、骨髓抑制、合并感染等副反应，以及MTX浓度范围，亚叶酸钙（calcium folinate，CF）解救剂量（CF/MTX），研究AB两组间差异是否有统计学意义。结果 两组胃肠道反应（χ2=92.809，P<0.001），粘膜炎（Z=4.257，P<0.001），感染（χ2=7.352，P=0.007），以及MTX浓度范围上的差异（χ2=35.553，P<0.001），以及CF解救剂量（CF/MTX）（χ2=35.526，P<0.001）差异有统计学意义。结论 中/高危急淋患儿HD-MTX化疗前进行肾图检查，个体化给予MTX剂量，可以在保证有效MTX药物浓度同时，明显减少MTX化疗的副反应，减少亚叶酸钙的解救剂量。Abstract: Objective To investigate the application of nephrogram in HD-MTX chemotherapy among children with intermediate/high risk acute lymphoblastic leukemia. Methods A retrospective comparative study was conducted. A total of 304 patients was included. According to whether the nephrogram checks before the first HD-MTX chemotherapy was given, the patients were divided into group A and B. Patients in group A were adjusted MTX chemotherapy dose based on nephrogram findings. The two groups' gastrointestinal reactions, mucositis, side effects of liver damage, bone marrow suppression, infection, MTX concentration range, as well as CF rescue dose (CF/MTX) were compared.Results Thedifferences of the two groups' gastrointestinal reactions(χ2=92.809,P<0.001), mucositis(Z=4.257,P<0.001), infection(χ2=7.352,P=0.007), as well as MTX concentration range(χ2=35.553,P<0.001), as well as CF rescue dose (CF/MTX)(χ2=35.526,P<0.001)were statistically significant. Conclusions Intermediate/high risk ALL children should be given nephrogram examination beforeHD-MTX chemotherapy and dose of MTX should be individualized. In these ways, the effective concentration of the MTX can be ensure, at the same time, the side effects of MTX chemotherapy and the rescue dose of leucovorin can be reduced.
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Key words:
- Methotrexate /
- Leukemia /
- Epidemiologic methods
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汤静燕,薛惠良,陈静,等. 儿童B系急性淋巴细胞性白血病SCMC-ALL-2005方案评估 [J].中华医学杂志, 2012,92(8):546-550. 鲍亮,吴南海,吴敏媛,等. CCLG-ALL 2008方案治疗儿童急性淋巴性白血病单中心疗效分析 [J].中国小儿血液与肿瘤杂志, 2016,21(2):66-72. 徐卫群,汤永民,方澄清,等. 大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病排泄延迟分析 [J].中华血液学杂志, 2005,26(1):15-18. 中华医学会儿科学分会血液学组,中华儿科杂志编辑委员会. 儿童急性淋巴细胞白血病诊疗建议(第三次修订草案) [J].中华儿科杂志, 2006,44(5):392-395. Basch E,Iasonos A,McDonough T,et al. Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events:results of a questionnairebased study [J].Lancet Oncol, 2006,7(11):903-909. Evans WE, Relling MV,Boyett JM,et al. Dose pharmacokinetlc bariability influence the efficacy of high-dose methotrexate for the treatment of children with acute lymphoblastic leukemia:what can we learn from small studies [J]. Leuk Res, 1997,21(5):435-437. Odoul F, Guellec CL, Lamagnere JP,et al. Prediction of methotrexate elimination after hign dose influsion in children with acute lymphoblastic leukemia using a population pharmacokinetic approach [J]. Fundam Clin Pharmacol, 1999,13(5):595-604. Seidel H, Nygaard R, Moe PJ,et al. On the prognostic value of systemic methotrexate clearance in childhood acute lymphoblastic leukemia [J]. Leuk Res, 1997,21(5):429-432. 陈洋,夏江宝,何晓东,等. MTHFR基因多态性在MTX治疗急性淋巴细胞白血病过程中毒性反应的Meta分析 [J]. 中华疾病控制杂志, 2015,19(8):811-815. Pearson AD, Amineddine HA, Yule M,et al.The influence of serum methotrexte concentrations and drug dosage on outcome in childhood acute lymphoblastic leukemia [J]. Br J Cancer, 1991,64(1):169-173. 段彦龙,张永红,石慧文,等. 儿童急性白血病应用大剂量甲氨蝶呤严重并发症3例临床分析及文献复习 [J]. 中国小儿血液与肿瘤杂志, 2013,18(6):277-281. 蔡静怡,杨志刚,谭健烽,等. 急性白血病患者生命质量及其影响因素分析 [J].中华疾病控制杂志, 2014,18(10):935-939. 李现军,孙建梅,李广宙,等. 99Tcm-DTPA肾动态显像对早期慢性肾功能衰竭的诊断价值 [J]. 中华核医学杂志, 2005,25(1):32. 庞露,杜晓明,朱旭,等. 甲氨蝶呤治疗成人血液系统恶性肿瘤的血药浓度与肾功能的相关性研究 [J]. 中国临床药理学杂志,2016,32(2):135-137,177. 范芳,余炜,谢瑞祥,等. 血药浓度监测下大剂量甲氨蝶呤24h滴注疗法延迟排泄分析 [J].中国医院药学杂志,2016,36(2):115-119. 叶启东,顾龙君. 儿童急性淋巴细胞白血病的个体化治疗——TPMT和MTHFR基因多态性 [J].中国实用儿科杂志,2016,31(4):286-291. -
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