大剂量甲氨喋呤治疗时不同四氢叶酸解救方法的研究  

RANDOMIZED COMPARISON OF DIFFERENT LEUCOVORIN RESCUE FOR HIGH DOSE METHOTREXATE USED IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA

作　　者：于亚平[1] 过国英[1] 周燕[1] 付元凤[1] 伏洁[1] 王兆全[1] 刘光陵[1] 

机构地区：[1]解放军南京军区总医院,江苏南京210002

出　　处：《白血病》2000年第4期228-230,共3页

摘　　要：目的 :探讨不同四氢叶酸解救方法对大剂量甲氨喋呤 (HDMTX)的毒性作用和疗效的影响。方法 :对 15例 80次 HDMTX治疗应用 2种不同四氢叶酸解救方法 ,每次 15 m g/ m2于 12 h开始和每次 12 mg/ m2于 2 4h开始 ,观察毒副作用和疗效 ,应用荧光偏振免疫分析法测定血清 MTX浓度。结果 :试验组 4例 HDMTX静滴结束后 2 4h和 48h的血清药物浓度均未达到毒性浓度。2种四氢叶酸解救方法的毒副作用发生率和恢复时间无明显差异。2组在随访期内的脑膜白血病复发率分别为 1/ 6和 0 / 9。结论 :应用 HDMTX(3.0 g/ m2 )持续 2 4h静滴时 ,推迟四氢叶酸解救的开始时间和减少四氢叶酸总量不增加毒性作用的发生率和严重程度 ,且有利于提高疗效。Objective: To explore the toxicity and efficacy of two different leucovorin rescue for high dose methotrexate (HDMTX) used in childhoud acute lymphoblastic leukemia (ALL).Methods:15 children were treated with 80 infusions of HDMTX (3 g/m 2 for 24 hour infusion).Leucovorin was administered intramuscularly either 15 mg/m 2 every 6 hour for 10～12 times or 12mg/m 2 every 6 hour for 6 8 times, beginning at hour 12 and 24 after the end of HDMTX respectively. MTX serum concentrations were determidned by fluorescence polarization immunoassay.Results: At hour 24 and 48 after the end of HDMTX, serum MTX concentrations were less than that of drug induced toxicity. The drug induced toxicity and their recovery time did not differ significantly between groups. There have been one isolated central nervous sysytem leukemia relapse in the children on early leucovorin rescue group, as compared with no one in the delayed leucovorin rescue group.Conclusion:In HDMTX regimen, a reduced and delayed leucovorin rescue can improve the efficacy of HDMTX without increasing drug induced toxicity.

关 键 词：急性淋巴细胞白血病 甲氨叶酸 治疗 

分 类 号：R725.5[医药卫生—儿科]