大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的不良反应临床观察

目的:探讨大剂量甲氨蝶呤(HD-MTX)治疗儿童急性淋巴细胞白血病(ALL)的不良反应。方法:对40例ALL患儿采用HD-MTX 2.0～5.0 g/m2治疗,观察治疗后患儿的临床症状和体征,并统计不良反应发生率。结果:经过3个疗程的临床治疗后,患儿出现了骨髓抑制、胃肠道反应、感染、肝损害、黏膜损害、心脏损害、神经系统症状、皮疹及脱发等不良反应。其中,骨髓抑制发生率为61.3%,胃肠道反应发生率为51.9%,感染发生率为38.1%,肝损害发生率为41.3%,黏膜损害发生率为15.6%,心脏损害发生率为10.0%,神经系统症状发生率为15.0%,皮疹发生率为6.9%,脱发发生率为5.0%;未见明显的肾功能损害。结论:HD-MTX治疗ALL患儿的不良反应较多,要积极对症治疗,加强对MTX血药浓度的监测以及个体化治疗,以提高患儿的长期无病生存率。

Clinical observation of adverse reactions of high-dose methotrexate in the treatment of children with acute lymphoblastic leukemia

Objective:To investigate the clinical adverse reactions of high-dose methotrexate(HD-MTX) in the treatment of children with acute lymphoblastic leukemia(ALL). Methods:Forty cases of children with ALL were treated with HD-MTX(2. 0-5. 0 g/m2). The clinical signs and symptoms were observed and the incidence rates of adverse reactions were counted. Results:After three courses of treatment,some adverse reactions,such as,bone marrow suppression,gastrointestinal reactions,infection,liver injury,mucosal damage, heart damage, neurological symptoms, rash and alopecia appeared. The incidence rate of bone marrow suppression, gastrointestinal reactions,infection, liver injury, mucosal damage, heart damage, neurological symptoms, rash and alopecia was 61. 3%, 51. 9%, 38. 1%,41. 3%,15. 6%,10. 0%,15. 0%,6. 9% and 5. 0%,respectively,but obvious renal injury did not appear. Conclusions:There were many adverse reactions of HD-MTX in the treatment of children with ALL, and it is important to carry out active symptomatic treatment,strengthen the monitoring of plasma concentrations of MTX and individualize treatment protocols,in order to increase the rate of long-term disease free survival.