大剂量甲氨蝶呤治疗急性淋巴细胞白血病

目的研究3g/m2和5g/m2甲氨蝶呤(MTX)治疗急性淋巴细胞白血病(ALL)的血、脑脊液MTX浓度和不良反应。方法ALL患儿43例共接受98例次MTX3g/(m2·次)或5g/(m2·次)治疗,对两剂量组进行MTX血药质量浓度、脑脊液浓度及不良反应比较。结果1.MTX44、66h血药质量浓度与23hMTX血药质量浓度明显相关(P<0.05);2.不同个体间及同一个体不同时间使用同一给药方案血药质量浓度、脑脊液浓度水平差异较大;3.两剂量组不良反应发生率无明显差异(P>0.05),骨髓抑制、肝功能损害的MTX血药质量浓度无明显差异(P>0.05)。结论对于标危、高危ALL分别采用3、5g/(m2·次)的剂量是合理的,无严重不良反应发生。

Clinical Study on High-Dose Methotrexate for Treating Acute Lymphocytic Leukemia in Children

Objective To study the serum and cerebrospinal fluid(CSF) concentrations of Methotrexate(MTX) and the toxicity effect between two different dosages of high-dose MTX (3 g/m 2,5 g/m 2) in the treatment of acute lymphocytic leukemia(ALL) in children.Methods Ninty-eight dosages of HD-MTX(including 3 g/m 2 and 5 g/m 2) were given to 43 cases of ALL children. The serum and CSF concentrations of MTX and the incidence of adverse reaction of the drug between 2 groups of high-dose MTX(3 g/m 2,5 g/m 2) were compared.Results 1.The serum concentrations of MTX at 44,66 h of MTX infusion were positively correlated with those at 23 h( P <0.05). 2.The difference of MTX concentrations in serum and CSF were exhibited in different individuals and in the same patient but in different drug administering time.3.There was no difference in the incidence of adverse drug reaction between 2 groups( P >0.05). The degrees of bone marrow depression and impaired liver function were not correlated with the blood concentration of MTX ( P >0.05).Conclusion For standard risk and high risk ALL children the administration of a dose of 3 g/m 2 and 5 g/m 2 respectively was reasonable,and no severe adverse effects are observed in both HD-MTX dosage groups.