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目的 观察大剂量甲氨喋呤 (HD-MTX)治疗小儿急性淋巴细胞白血病 (AL L)过程中的毒副作用及预防措施。方法 1994— 2 0 0 2年间经诱导治疗完全缓解的 AL L患儿共 2 7例 ,累计进行 HD-MTX化疗共 10 1次。剂量为2 .5～ 3 .0 g/ m2 /次。化疗前后充分水化碱化。用药 3 6小时后开始用四氢叶酸钙解救。间隔 10天再重复化疗 ,连用 3次 ,以后每 3～ 6个月一次。结果 HD-MTX的毒副作用以骨髓抑制最常见 ,占 83 .2 %。胃肠道反应占 68.3 %。口腔及肛周溃疡占 9.89% ,其中 2 .96%为严重的口腔黏膜溃烂。肝功能损害的发生率为 8.89%。脱发程度轻微 ,1个月左右能生出新发。本组 2 7例均未发现肾功能损害和心脏毒性 ,仅 1例放弃治疗。结论 HD-MTX主要用于儿童 AL L“庇护所”治疗 ,化疗期出现的毒副作用 ,绝大多数程度并不严重 ,且可早期预防。患儿对 HD-MTX有较好的耐受性
Objective To observe the toxicities and side effects of high-dose methotrexate (HD-MTX) in children with acute lymphoblastic leukemia (AL L) and its preventive measures. Methods A total of 27 ALL children with complete remission after induction therapy during 1994-2002 were treated with HD-MTX chemotherapy for a total of 101 times. The dose is 2.5 ~ 3.0 g / m2 / time. Chemotherapy before and after full hydration alkalinization. Medication 3 6 hours after the rescue with calcium folinate. Intermittent 10 days and then repeat the chemotherapy, once every 3 to 3 months after every 6 months. Results The toxicity of HD-MTX was the most common in myelosuppression, accounting for 83.2%. Gastrointestinal reactions accounted for 68.3%. Oral and perianal ulcers accounted for 9.89%, of which 2.96% were severe oral mucosal ulceration. The incidence of liver damage was 8.89%. A slight degree of hair loss, about a month to give birth to a new hair. The group of 27 patients were found no renal damage and cardiotoxicity, only 1 case to give up treatment. Conclusion HD-MTX is mainly used in children with AL L “shelter” treatment, the side effects of chemotherapy, the vast majority of degrees are not serious, and early prevention. Children with HD-MTX have better tolerance