Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India.
Pediatr Blood Cancer. 2012 Sep;59(3):448-53. doi: 10.1002/pbc.24081. Epub 2012 Jan 23.
Intensification of systemic chemotherapy with inclusion of high dose methotrexate (HDMTX) has helped omit cranial irradiation from standard risk acute lymphoblastic leukemia (ALL) protocols, thereby eliminating the adverse side effects associated with its use. Administration of HDMTX needs meticulous monitoring. Limitations in the availability of trained staff and adequate infrastructure often pose problems in the developing world. The aim of this study was (1) to treat childhood ALL with a protocol that would have reduced use of cranial irradiation and containing infusions of high-dose methotrexate HDMTX (5 g/m(2)) without compromising on survival, and (2) evaluate the experience with HDMTX in a tertiary care cancer centre in a developing country.
A retrospective chart review was done of 41 consecutive children with a confirmed diagnosis of ALL who had received at least one cycle of HDMTX as part of their consolidation treatment with regard to the patient demographic profile, details of HDMTX infusion and leucovorin rescue, toxicity, additional hospitalization, delay in next cycle of chemotherapy and survival.
The clinically most significant toxicities observed were mucositis 39% (58/149) and fever 28% (42/149) together leading to additional hospital stay in 7% (11/149) cycles and neutropenia grade 3 or more in 24.8% (34/137) contributing to delay in next cycle of chemotherapy in 15% (23/149) cycles.
With this strategy, it was possible to omit or reduce the dose of cranial irradiation while maintaining survival outcomes. The administration of HDMTX therapy was found to be feasible and safe with the precautions described.
通过强化全身化疗并包含高剂量甲氨蝶呤（HDMTX），可以避免标准风险急性淋巴细胞白血病（ALL）方案中的颅脑照射，从而消除与该方法相关的不良副作用。HDMTX 的给药需要进行细致的监测。在发展中国家，由于训练有素的工作人员和充足基础设施的缺乏，往往会导致问题。本研究的目的是：（1）用一种方案治疗儿童 ALL，该方案将减少颅脑照射的使用，并包含大剂量甲氨蝶呤（HDMTX）（5g/m2）的输注，而不影响生存；（2）评估在发展中国家的一家三级癌症中心使用 HDMTX 的经验。
回顾性分析了 41 例连续确诊为 ALL 的儿童患者的病历，这些患者至少接受了一个周期的 HDMTX 巩固治疗，包括患者的人口统计学特征、HDMTX 输注和甲酰四氢叶酸解救的细节、毒性、额外住院、下一个化疗周期的延迟以及生存情况。
观察到的最严重的临床毒性是粘膜炎 39%（58/149）和发热 28%（42/149），这两种毒性导致 7%（11/149）的周期需要额外住院，中性粒细胞 3 级或更高级别占 24.8%（34/137），导致 15%（23/149）的周期需要延迟下一个化疗周期。
采用这种策略，可以避免或减少颅脑照射剂量，同时保持生存结果。在描述的预防措施下，HDMTX 治疗的给药是可行和安全的。
