大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病的临床效果及不良反应发生情况分析

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)的临床效果及不良反应发生情况.方法 回顾性分析2018年1月至2019年1月收治的60例ALL患儿的临床资料,所有患儿均采用HD-MTX治疗.观察患儿治疗后血药浓度变化及不良反应发生情况,并比较不同C48 h分级患儿的CF解救次数、解救剂量及不...

Analysis of clinical effect and adverse reactions of high dose methotrexate in the treatment of children with acute lymphoblastic leukemia

Objective To investigate the clinical effect and adverse reactions of high dose methotrexate(HD-MTX)in the treatment of children with acute lymphoblastic leukemia(ALL).Methods The clinical data of 60 children with ALL admitted from January 2018 to January 2019 were retrospectively analyzed.All children received HD-MTX treatment.The changes of plasma concentration and the occurrence of adverse reactions were observed after treatment,and the times and dose of CF rescue and occurrence of adverse reactions in children with different C₄₈h grades were compared.Results During the detection,the MTX plasma concentration of the children was the highest at 0.5 h after medication,and gradually decreased with time.At 72 h after medication,the MTX plasma concentration decreased to(0.03±0.01)μmol/L.The incidences of gastrointestinal reaction,liver function injury,mucosal injury,bone marrow suppression and renal function injury of children decreased successively,the incidences were 25.00%(15/60),20.00%(12/60),16.67%(10/60),11.67%(7/60)and 6.67%(4/60),respectively.The rescue times and total dose of children with C₄₈h grade 1~3 were less than those of children with C₄₈h grade 4~6(P<0.05).The incidences of adverse reactions in children with C₄₈h grade 1~3 were lower than those in children with C₄₈h grade 4~6(P<0.05).Conclusion Elimination delay of MTX will increase the risk of adverse reactions such as gastrointestinal reactions,and children with C₄₈h grade≥4 have a higher risk of occurrence of adverse reactions.Persistent high MTX plasma concentration is positively correlated with the risk of adverse reactions.