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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