HD-MTX方案和不同解救方法治疗成人难治复发性急性淋巴细胞白血病的研究

High dose methotrexate and different calcium folinate rescue for treatment in audlt refractory and relapsed acute lymphoblastic leukemia

目的探讨四氢叶酸钙(CF)不同解救时间对应用HD-MTX毒副作用和疗效的影响。方法对35例成人难治复发性ALL患者分别于HD-MTX静滴结束后12 h和20 h开始解救。观察毒副作用和疗效。应用荧光免疫偏振分析法(FPIA)测定血清MTX浓度。结果两组毒副作用和恢复时间及完全缓解率比较差异均无统计学意义(P>0.05),但在随访期内常规组4例出现复发,试验组仅2例复发。结论对HD-MTX方案推迟解救不会增加相关毒副作用的发生率和严重程度,且可提高治疗效果。

Objective To explore the toxicity and efficacy of two different calcium folinate rescue for high dose methotrexate used in refi＇actory and relapsed acute lympboblastic leukemia（ALL）. Methods Calcium folinate was administered intramuscularly, beginning at 12 h and 20 h after the end of HD - MTX respectively in 35 patients divided into two groups. MTX serum concentrations were determined by FPIA. Observe drug - induced toxicity and the efficacy of HDMTX regimen. Results The drug - induced toxicity and their recovery time did not different significantly between the two groups. So did complete remission rate of two groups. But there were 4 patients relapse in ordinary group, as compared with 2 patients in controlled group. Conclusion A delayed calcium folinate rescue in HD - MTX regimen can improve the efficacy of HD - MTX , without increasing drug - induced toxicity.