Geiser C F, Bishop Y, Jaffe N, Furman L, Traggis D, Frei E
Blood. 1975 Feb;45(2):189-95.
A toxic syndrome characterized by fever, headache, and vomiting, lasting 2-5 days, occurred in 61% of 39 children with acute leukemia in complete remission, receiving central nervous system prophylaxis with intrathecal methotrexate, and in 14% of 34 children receiving the same plus cranial radiation. The syndrome was accompanied by pleocytosis with lymphocytes, monocytoid cells, and neutrophils. There was evidence of cumulative Mtx toxicity, since the toxic syndrome occurred mostly after the third and fourth dose and did not recur with longer intervals between doses. The incidence of the syndrome was significantly reduced by the use of Elliott's B solution as Mtx diluent, rather than water or normal saline. The occurrence of pleocytosis and toxic clinical syndrome was also significantly reduced in patients receiving concomitant cranial radiation, probably due to the lympholytic action of radiotherapy and the depressed cellular response of irradiated tissues. The use of Elliott's B solution as diluent for IT Mtx and an appropriate interval between Mtx doses are suggested for prevention of this toxic syndrome.
一种以发热、头痛和呕吐为特征，持续2至5天的中毒综合征，在39例急性白血病完全缓解且接受鞘内注射甲氨蝶呤进行中枢神经系统预防的儿童中有61%出现，在34例接受相同治疗加头部放疗的儿童中有14%出现。该综合征伴有淋巴细胞、单核样细胞和中性粒细胞增多。有累积甲氨蝶呤毒性的证据，因为中毒综合征大多在第三和第四剂后出现，且在剂量间隔较长时不再复发。使用埃利奥特B溶液作为甲氨蝶呤稀释剂而非水或生理盐水，可显著降低该综合征的发生率。接受同步头部放疗的患者中，细胞增多症和中毒临床综合征的发生率也显著降低，这可能是由于放疗的淋巴细胞溶解作用以及受照射组织的细胞反应抑制。建议使用埃利奥特B溶液作为鞘内注射甲氨蝶呤的稀释剂，并在甲氨蝶呤剂量之间保持适当间隔，以预防这种中毒综合征。
