叶酸状态和亚甲基四氢叶酸还原酶基因型对印度北部急性淋巴细胞白血病儿童大剂量甲氨蝶呤化疗并发症及结局的影响。
Effect of folate status and methylenetetrahydrofolate reductase genotypes on the complications and outcome of high dose methotrexate chemotherapy in north Indian children with acute lymphoblastic leukemia.
作者信息
Moulik Nirmalya Roy, Kumar Archana, Agrawal Suraksha, Mahdi Abbas Ali, Kumar Ashutosh
机构信息
Department of Pediatrics, Division of Pediatric Hematology/Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
出版信息
Indian J Med Paediatr Oncol. 2016 Apr-Jun;37(2):85-9. doi: 10.4103/0971-5851.180144.
PURPOSE
The genes of the folate metabolic pathway have been associated with toxicities during high dose methotrexate therapy for childhood ALL, however, the importance of intrinsic folate status in this regard is unclear.
METHODS
In the present study the effect of precourse folate levels and MTHFR genotypes on the complications during high dose methotrexate chemotherapy in children with ALL were examined.
RESULTS
Twenty-one children were studied. Folate deficiency was associated with higher incidence of neutropenia (P = 0.03) and longer duration of chemotherapy interruption (P = 0.009). Children with MTHFR1298 mutations needed more red cell transfusion (P = 0.03). All 3 deaths encountered were seen in folate deficient children.
CONCLUSIONS
Folate deficiency was associated with higher complications during high dose methotrexate therapy, the implications of which are important especially in resource poor settings with high prevalence of folate deficiency.
目的
叶酸代谢途径的基因已被证实与儿童急性淋巴细胞白血病（ALL）大剂量甲氨蝶呤治疗期间的毒性反应有关，然而，内源性叶酸状态在这方面的重要性尚不清楚。
方法
在本研究中，我们检测了治疗前叶酸水平和亚甲基四氢叶酸还原酶（MTHFR）基因型对ALL患儿大剂量甲氨蝶呤化疗期间并发症的影响。
结果
共研究了21名儿童。叶酸缺乏与中性粒细胞减少症的较高发生率（P = 0.03）和化疗中断的较长持续时间（P = 0.009）相关。携带MTHFR 1298突变的儿童需要更多的红细胞输血（P = 0.03）。所有3例死亡病例均见于叶酸缺乏的儿童。
结论
叶酸缺乏与大剂量甲氨蝶呤治疗期间较高的并发症发生率相关，这一发现的意义重大，尤其是在叶酸缺乏患病率较高的资源匮乏地区。
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