亚叶酸钙解救培美曲塞所致重度骨髓抑制

Calcium folinate rescue therapy for severe myelosuppression induced by pemetrexed

1例70岁女性患者因转移性非小细胞肺癌接受培美曲塞联合顺铂方案化疗,化疗2个周期后,肺癌部分缓解,但出现Ⅱ级白细胞计数(WBC)减少和血清肌酐升高。考虑肾损伤与顺铂有关,故在第3周期停用顺铂,采用培美曲塞单药化疗。单药化疗后第10天患者出现发热,实验室检查示全血细胞减少,WBC 1.1×10^9/L,中性粒细胞计数0.54×10^9/L,血小板计数(PLT)63×10^9/L,血红蛋白(Hb)72 g/L,红细胞计数(RBC)2.23×10^12/L。患者接受血小板、红细胞悬液输注和粒细胞集落刺激因子等对症支持治疗5 d,但全血细胞继续下降:WBC 0.2×10^9/L,中性粒细胞0.13×10^9/L,PLT 0×10^9/L,Hb 59 g/L,RBC 1.88×10^12/L。诊断:培美曲塞所致Ⅳ级骨骼抑制。给予亚叶酸钙解救治疗(首剂100 mg/m^2,以后50 mg/m^2,1次/6 h,共4 d)。亚叶酸钙解救治疗23 d后,WBC 6.8×10^9/L,中性粒细胞3.84×10^9/L,PLT 169×10^9/L,Hb 95 g/L,RBC 2.99×10^12/L。

A 70-year-old female patient received chemotherapy regimen of pemetrexed combined with cisplatin for metastatic non-small-cell lung cancer. After 2 cycles of chemotherapy, the tumor partly relieved, but the patient developed grade II leukopenia and serum creatinine elevation. Renal injury was considered to be caused by cisplatin. Therefore, cisplatin was discontinued in the third cycle and pemetrexed monotherapy was given. On day 10 of the chemotherapy, the patient developed fever and laboratory tests revealed pancytopenia, white blood cell count (WBC) 1.1×10^9/L, neutrophil count 0.54×10^9/L, platelet count (PLT) 63×10^9/L, hemoglobin (Hb) 72 g/L, and red blood cell count (RBC) 2.23×10^12/L. The patient received symptomatic and supportive treatments such as platelet and erythrocyte suspension infusion, and granulocyte colony stimulating factor subcutaneous injection, but her complete blood count continued to decline, with WBC 0.2×10^9/L, neutrophil 0.13×10^9/L, PLT 0×10^9/L, Hb 59 g/L, and RBC 1.88×10^12/L.Ⅳ myelosuppression induced by pemetrexed was diagnosed. Calcium folinate was given for rescue therapy (the first dose was 100 mg/m^2, then 50 mg/m^2 every 6 hours for 4 days). After 23 days of calcium folinate treatment, the laboratory tests showed WBC 6.8×10^9/L, neutrophil 3.84×10^9/L, PLT 169×10^9/L, Hb 95 g/L, and RBC 2.99×10^12/L.