Application Of CCR And Renogram In High Dose Methotrexate Chemotherapy For Children With Acute Lymphoblastic Leukemia

ObjectiveTo explore the application of 24 hour creatinine clearance-rate(CCR)and radionuclide renal imaging(renogram)in high-dose methotrexate(HD-MTX)chemotherapy for acute lymphoblastic leukemia(ALL)in children.MethodsThe clinical treatment of 105 children with ALL who were diagnosed in the Department of Pediatrics of the South Hospital of the Southern Medical University from August 2020 to December 2022 and were treated with CCCG-ALL-2020 protocol was analyzed retrospectively.The children who adjusted the MTX dose according to the results of creatinine clearance within 24 hours were divided into CCR group,the children who adjusted the MTX dose according to the results of radionuclide renal imaging were divided into renogram group,the children who did not undergo renal function evaluation before chemotherapy,and the children who received chemotherapy according to the initial dose of chemotherapy protocol were divided into control group.Compare the clinical efficacy,blood concentration of methotrexate,calcium folinate(CF)rescue,incidence of adverse reactions,recurrence and death of the three groups of children,and complete the final data analysis by SPSS26.0.Result1.Compare the number of cases in which the serum MTX level reached the effective anti-leukemia concentration in CCR group,renogram group and control group at 20 hours.There was no significant difference among the three groups(P>0.05).2.There was no significant difference in the incidence of delayed excretion of 44 hours and 68 hours between CCR group,renogram group and control group(P>0.05).3.The analysis showed that the dose of MTX was related to the delayed-excretion of MTX.The incidence of delayed excretion of MTX in the 5g group was significantly different from that in the<5g group(P<0.05).4.Compare the CF rescue times,rescue dose and rescue time of CCR group,renogram group and control group.There was no significant difference among the three groups(P>0.05).5.Compared with CCR group,renogram group and control group,the difference of skin toxicity and side effects among the three groups was statistically significant(P<0.05),The difference of toxicity and side effects of other systems was not statistically significant(P>0.05).6.There was no statistical difference in the incidence of side effects of each system between the 5g group and the<5g group(P>0.05).7.In this study,HD-MTX was used to treat children with ALL,a total of 3 people recurred,with a total recurrence rate of 2.85%.There was no significant difference in the recurrence rate between CCR group,renogram group and control group(P>0.05).Conclusion1.There was no significant difference in the incidence of delayed excretion and recurrence rate of serum MTX level reaching effective anti-leukemia concentration after moderately adjusting the MTX dose according to CCR or renogram results.2.There is no significant difference in CF rescue times,rescue dose and rescue time after moderately adjusting MTX dose according to CCR or renogram results.3.After moderately adjusting the MTX dose according to the CCR or renogram results,the incidence of toxic and side effects on the skin of CCR group is high,while the toxic and side effects of other systems are not significantly different.4.After moderately adjusting the MTX dose according to the CCR or renogram results,compared with<5g group,the incidence of 44-hour delayed excretion was significantly higher in the 5g group,and there was no significant difference in the toxicity and side effects of each system.5.In CCCG-ALL-2020,HD-MTX chemotherapy is safe.