1例大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病排泄延迟的个体化治疗

Individualized Analysis of a Case of Delayed Excretion caused by High Dose of Methotrexate in Children with Acute Lymphoblastic Leukemia

目的通过1例大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病出现排泄延迟的治疗实践,探讨个体化治疗措施,促进临床安全用药。方法1例急性淋巴细胞白血病患儿进行甲氨蝶呤相关药物基因检测,利用药物基因预警存在的风险,根据甲氨蝶呤血药浓度分析排泄延迟的相关危险因素,制定个体化解救方案。结果药物基因检测结果提示患儿有排泄延迟和毒性增加的可能,甲氨蝶呤的剂量降低至标准剂量的70%并提前做好水化、碱化等应对策略,发生排泄延迟后,分析相关危险因素与药物基因、泮托拉唑、肾损伤等有关,积极进行水化、碱化的同时根据血药浓度监测动态调整亚叶酸钙剂量,患儿未发生严重不良反应。结论大剂量甲氨蝶呤在治疗儿童急性淋巴细胞白血病发生排泄延迟时充分水化、碱化,根据血药浓度监测动态调整个体化解救方案,在保持疗效的同时避免药物毒性的蓄积,探讨个体化治疗措施,促进临床安全、合理用药。

Objective Through a case of delayed excretion caused by high-dose methotrexate in the treatment of the child with acute lymphoblastic leukemia,this paper discusses individualized treatment measures to promote clinical safety.Methods Methotrexate related drug genes were detected in a child with acute lymphoblastic leukemia.The drug genes were used to warn risks,analyze the related risk factors of delayed excretion according to the methotrexate plasma concentration,and formulate an individualized rescue plan.Results The results of drug gene test suggest that the child had the risk of delayed excretory and toxicity.The dose of methotrexate was reduced to 70%of the standard dose,and coping strategies such as hydration and alkalization were prepared in advance.After the occurrence of delayed excretory,the risk factors were found to be related to druggene,pantoprazole sodium,and kidney injury.No serious adverse reactions occurred in the child with active hydration and alkalization and dynamic adjustment of calcium folinate dose according to blood drug concentration monitoring.Conclusion High dose methotrexate was fully hydrated and alkalized in the treatment of delayed excretion in the child with acute lymphoblastic leukemia.The individualized rescue scheme was dynamically adjusted according to the blood drug concentration monitoring,so as to maintain the curative effect and avoid the accumulation of toxicity,explore individualized treatment measures,and promote clinical safety and rational drug use.