Department of Pediatrics, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, China.
Biomed Res Int. 2022 Aug 21;2022:7580642. doi: 10.1155/2022/7580642. eCollection 2022.
To explore the efficacy, safety, and clinical value of 6-TG versus 6-MP when treating childhood acute lymphoblastic leukemia (ALL).
The study period was from January 2017 to June 2021. The subjects of this study were 100 children with ALL who were treated in our hospital. According to different intervention methods, the children who received 6-MP maintenance therapy were selected as the control group, with a total of 57 cases. Children with TG maintenance therapy were included in the research group, a total of 43 cases. The ICNS recurrence rate, non-ICNS recurrence rate, first remission mortality rate, secondary malignant tumor, and other indicators were compared.
First of all, we compared the effective rate: complete remission (CR), partial remission, and nonremission in the study group, and the effective rate was 87.5%. In the control group, there were CR, partial remission, and no remission, and the effective rate was 65.5%. The effective rate of the study group was higher, and the difference between groups was statistically significant ( < 0.05). There were 55 cases of failure in the study group, with an incidence of 21.91%. There were 42 cases of total failure events in the control group, the incidence rate was 18.02%, and there exhibited no remarkable difference ( > 0.05). In the study group, 6 cases died in the first remission, with a fatality rate of 2.39%, while there exhibited no death in the control group. The mortality in the first remission period in the study group was lower ( < 0.05). The overall recurrence rate of the study group was 5.57%, while that of the control group was 11.15%. The overall recurrence rate of the study group was lower, and the difference between groups was statistically significant ( < 0.05). The recurrence rate of ICNS was 2.14% in the study group and 2.98% in the control group, and there exhibited no remarkable difference ( > 0.05). The non-ICNS recurrence rate was 3.43% in the study group and 7.17% in the control group. There exhibited no remarkable difference ( > 0.05). The incidence of secondary malignant tumor events was 0.85% in the study group and 1.59% in the control group. There exhibited no remarkable difference ( > 0.05). The incidence of hepatic vein occlusive disease was 7.29% in the study group and 2.39% in the control group. The incidence of hepatic vein occlusive disease in the study group was higher, and the difference between groups was statistically significant ( < 0.05). Finally, we compared the incidence of adverse reactions. In the study group, there were 12 cases of oral mucosal damage, 7 cases of liver function damage, 6 cases of infection, 10 cases of myelosuppression, 9 cases of gastrointestinal reaction, and 4 cases of skin damage; the incidence rate was 23.17%. In the control group, there were 12 cases of oral mucosal damage, 7 cases of liver function damage, 6 cases of infection, 10 cases of myelosuppression, 9 cases of gastrointestinal reaction, and 4 cases of skin damage, with an incidence of 19.12%. There exhibited no remarkable difference in the incidence of adverse reactions ( > 0.05).
6-TG maintenance therapy in children with ALL can enhance the overall effective rate, can reduce the first remission mortality and the total recurrence rate, and will not increase the overall incidence of adverse reactions, but the incidence of reversible or irreversible hepatic veno-occlusive disease is remarkably increased, which has a certain clinical value.
Treatment-related hepatotoxicity and myelosuppression remain formidable challenges for clinicians. Pharmacokinetic studies found that 6-TG has a more direct intracellular activation pathway, shorter cytotoxic time, and stronger potency than 6-MP. Therefore, this study investigated the efficacy, safety, and clinical value of 6-TG and 6-MP in the treatment of children with ALL.
探讨 6-巯基嘌呤（6-TG）与 6-巯基鸟嘌呤（6-MP）治疗儿童急性淋巴细胞白血病（ALL）的疗效、安全性和临床价值。
研究期间为 2017 年 1 月至 2021 年 6 月。选择我院收治的 100 例 ALL 患儿为研究对象，根据不同的干预方法，将接受 6-MP 维持治疗的患儿作为对照组，共 57 例；将接受 TG 维持治疗的患儿纳入研究组，共 43 例。比较两组患儿的累积无事件复发率（EFS）、非累积无事件复发率（NCR）、首次缓解期死亡率、继发恶性肿瘤等指标。
首先，我们比较了有效率：研究组的完全缓解（CR）、部分缓解和未缓解，有效率为 87.5%。对照组的 CR、部分缓解和未缓解，有效率为 65.5%。研究组的有效率更高，组间差异有统计学意义（<0.05）。研究组有 55 例失败，发生率为 21.91%。对照组总失败事件 42 例，发生率为 18.02%，组间差异无统计学意义（>0.05）。研究组首次缓解期死亡 6 例，死亡率为 2.39%，对照组无死亡。研究组首次缓解期死亡率较低（<0.05）。研究组的总体复发率为 5.57%，对照组为 11.15%。研究组的总体复发率较低，组间差异有统计学意义（<0.05）。研究组 CNS 复发率为 2.14%，对照组为 2.98%，组间差异无统计学意义（>0.05）。非 CNS 复发率为 3.43%，对照组为 7.17%，组间差异无统计学意义（>0.05）。继发恶性肿瘤事件发生率为 0.85%，对照组为 1.59%，组间差异无统计学意义（>0.05）。肝静脉闭塞病发生率为 7.29%，对照组为 2.39%，研究组的发生率较高，组间差异有统计学意义（<0.05）。最后，我们比较了不良反应的发生率。研究组口腔黏膜损伤 12 例，肝功能损害 7 例，感染 6 例，骨髓抑制 10 例，胃肠道反应 9 例，皮肤损伤 4 例，发生率为 23.17%；对照组口腔黏膜损伤 12 例，肝功能损害 7 例，感染 6 例，骨髓抑制 10 例，胃肠道反应 9 例，皮肤损伤 4 例，发生率为 19.12%。两组不良反应发生率差异无统计学意义（>0.05）。
6-TG 维持治疗儿童 ALL 可提高总体有效率，降低首次缓解期死亡率和总复发率，不会增加不良反应的总体发生率，但会显著增加可逆或不可逆的肝静脉阻塞性疾病的发生率，具有一定的临床价值。
治疗相关的肝毒性和骨髓抑制仍然是临床医生面临的巨大挑战。药代动力学研究发现，6-TG 具有更直接的细胞内激活途径，细胞毒性时间更短，效力比 6-MP 更强。因此，本研究探讨了 6-TG 和 6-MP 在治疗儿童 ALL 中的疗效、安全性和临床价值。
