亚叶酸钙解救疗法对儿童急性淋巴细胞白血病治疗中氨甲喋呤诱导的口腔黏膜炎的作用：系统评价。
The effect of leucovorin rescue therapy on methotrexate-induced oral mucositis in the treatment of paediatric ALL: A systematic review.
机构信息
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Clinical Chemistry, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
出版信息
Crit Rev Oncol Hematol. 2019 Oct;142:1-8. doi: 10.1016/j.critrevonc.2019.07.003. Epub 2019 Jul 9.
INTRODUCTION
This study aimed to determine the efficacy of different Leucovorin regimens to reduce oral mucositis in children with acute lymphoblastic leukemia after high-dose Methotrexate (HD-MTX).
METHODS
Twelve articles were included in a systematic literature review. Articles were categorized into low/medium/high risk of bias.
RESULTS
As no randomized controlled trial assessing the effect of Leucovorin has been performed, the efficacy of Leucovorin to reduce oral mucositis remains unknown. Leucovorin was initiated at 24, 36 or 42 h after HD-MTX at a dose of 15 or 30 mg/m. No meta-analysis could be performed as treatment regimens differed. When comparing studies with similar HD-MTX doses, we observed lower oral mucositis rates in regimens with higher cumulative doses of Leucovorin and early initiation of Leucovorin after MTX.
CONCLUSION
Even though future studies are necessary, higher cumulative Leucovorin doses and early initiation of Leucovorin after start of MTX seem to reduce oral mucositis.
介绍
本研究旨在确定不同亚叶酸钙方案对接受大剂量甲氨蝶呤（HD-MTX）治疗的急性淋巴细胞白血病患儿口腔黏膜炎的疗效。
方法
系统文献回顾纳入了 12 篇文章。文章分为低/中/高偏倚风险。
结果
由于尚未进行评估亚叶酸钙疗效的随机对照试验，因此尚不清楚亚叶酸钙是否能减少口腔黏膜炎。亚叶酸钙在 HD-MTX 后 24、36 或 42 小时开始使用，剂量为 15 或 30mg/m2。由于治疗方案不同，无法进行荟萃分析。当比较具有相似 HD-MTX 剂量的研究时，我们观察到在亚叶酸钙累积剂量更高和在 MTX 开始后更早开始使用亚叶酸钙的方案中，口腔黏膜炎发生率较低。
结论
尽管需要进一步研究，但更高的亚叶酸钙累积剂量和在 MTX 开始后尽早开始使用亚叶酸钙似乎可以减少口腔黏膜炎。
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