大剂量甲氨蝶呤治疗小儿急性淋巴细胞白血病临床耐受性研究

目的观察大剂量甲氨蝶呤（MTX）连续24 h持续静脉输注治疗小儿急性淋巴细胞白血病的临床耐受性。方法247例次进行大剂量甲氨蝶呤连续24 h持续静脉输注,第36 h四氢叶酸钙解救,检测44 h、68 h血药浓度,观察不良反应发生率。结果不良反应表现为消化道症状、Ⅰ°-Ⅱ°白细胞减少,无严重不良反应发生。标危组和高危组不良反应发生率差异无统计学意义。结论大剂量甲氨蝶呤加四氢叶酸钙治疗儿童白血病时,毒副作用较为常见,大多可耐受,通过监测血药浓度,并根据血药浓度进行适当的四氢叶酸钙解救,可防止出现严重的毒副作用,并避免过渡解救而影响疗效。

The tolerance of high-dose methotrexate (HD-MTX) in the treatment of the children with acute lymphoblastic leukemia

Aim To observe the tolerance of high-dose methotrexate （HD-MTX） infused intravenously for 24h in the treatment of the children with acute lymphoblastic leukemia （ALL）. Methods HD-MTX was infused for 24h in 247 cases of children acute lymphoblastic leukemia followed by calcium folinate （CF） for rescue at the 36th hour, and then at the 44th,68th,92nd hour, the blood medicine concentration was examined and the incidence rate of the side effects observed. Results The advers reaction appeared as digestive tract symptoms,the white blood cell reduced for Ⅰ°-Ⅱ°,without other serious adverse reactions. Conclusions HD-MTX results in toxicity in ALL patients receiving this treatment, which include bone marrow suppression, abnormal liver function, gastrointesinal symptoms. Few vital cases of toxicity are found. However,leucovorin rescue plays a key role in preventing the toxicity and getting an optimal treatment effect. MTX level should be monitored closely to help decide the point to initiate leucovorin rescue.