大剂量甲氨喋呤治疗急性淋巴细胞白血病的血药浓度研究

The study on plasma concentration of high-dose methotrexate chemotherapy for children with acute lymphoblastic leukemia

目的 通过对甲氨喋呤 (MTX)治疗急性淋巴细胞白血病的血药浓度研究 ,探讨MTX剂量、血药浓度、效应、毒副作用等方面的关系 ,以及血药浓度检测的临床意义。方法 荧光偏振免疫分析法检测不同剂量MTX治疗的血药浓度 ,结合临床资料综合分析。结果 1.第 2 4hMTX的血清浓度随剂量增加而增加 ;白血病复发率随浓度增加而下降 ,分别为 4 0 %、33.3%、2 5 % ;2 .鞘注前脑脊液 (CSF)浓度均低于有效浓度 ,因此须加鞘注治疗 ;3.本研究中MTX血药浓度均低于发生严重毒副作用的高危浓度 ,毒副作用均较轻微。

Objective To investigate the relationship among methotrexate(MTX) plasma concentration,dosage,clinical effecicy and toxicity, and to evaluate it′s clinical significance.Methods MTX was measured by a flurorescence polarization immunoassay in plasma samples obtained from acute lymphoblastic leukemia(ALL) patients treated in different doses of MTX, and these results were analyzed combined with clinical manifestations.Results 1.The average of plasma concentration at 24 hours increased with the increasing doses of MTX. The relapse rate decreased with increased plasma concentration;2.The cerebrospinal fluid(CSF) concentrations prior to the intrathecal MTXinstillation were all below the effective concentration, so the intrathecal MTX instillation was needed;3.No severe toxicity was observed in the study, because the plasma concentration was below the high risk.Conclusion The study of MTX plasma concentration provides us an objective basis for the individualized chemotherapy.