| Objective :To observe the influencing factors of drug metabolism in patients with acute lymphoblastic leukemia(ALL)after high-dose methotrexate(HD-MTX)infusion,and to analyze the relationship between drug metabolism and related adverse reactions.Methods :ALL patients who received HD-MTX treatment during hospitalization in Shaanxi Provincial People ’s Hospital from January 2017 to October 2022 were selected.Gender,age,body mass index(BMI),diagnosis,MTX dose,chemotherapy regimen,rescue regimen,average urine volume / 24 h after treatment,MTX metabolism-related gene(ABCB1 C3435 T,MTHFR C677 T,MTHFR A1298C)polymorphism and MTX metabolism in vivo after infusion were collected,and their correlation was analyzed.At the same time,the drug-related adverse reactions after treatment were recorded,and the relationship between drug metabolism and related adverse reactions was analyzed.SPSS25.0 statistical software was used to analyze the collected data,and P < 0.05 was considered statistically significant.Results :1.A total of 36 patients were included in this study,including 63.88 %(23 / 36)males and 36.11 %(13 / 36)females,with a male to female ratio of 1.77 : 1;the age ranged from 13 to 81 years,with a median age of 33 years.The range of BMI was14.69-28.73 kg / m2,and the median BMI was 20.45 kg / m2.83.33 %(30 / 36)patients were diagnosed as B-ALL and 16.67 %(6 / 36)patients were diagnosed as T-ALL.A total of 36 patients completed 103 cycles of HD-MTX treatment;2.The 103 treatment cycles were divided into normal excretion group and delayed excretion group according to the concentration of MTX at 48 h.At 48 h after treatment,87.4 %(90 / 103)of patients had no effect on the concentration of MTX at 48 h within the safe range(P < 0.05).Multivariate analysis showed that the average urine volume /24h(P = 0.008)after treatment had a statistically significant effect on the delayed excretion of MTX at 48 h.3.Delayed MTX excretion at 48 h was associated with mucosal injury(P = 0.049)and gastrointestinal side effects(P = 0.013).It was not related to the occurrence of bone marrow suppression,liver function injury and renal function injury(P > 0.05).Conclusion :The urine excretion of ALL patients treated with HD-MTX is related to the metabolism of MTX during the treatment.Patients with more urine excretion are less likely to have delayed excretion of MTX than patients with less urine excretion,which can reduce the mucosal damage and gastrointestinal related adverse reactions caused by MTX retention in the body. |
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