Effect of high-dose methotrexate on alkaline phosphatase in children with acute lymphoblastic leukemia
10.12092/j.issn.1009-2501.2025.08.011
- VernacularTitle:大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病对碱性磷酸酶的影响
- Author:
Xingui LI
1
;
Daliang XU
;
Biao YU
;
Yun GU
;
Yan DENG
;
Shihai ZHANG
Author Information
1. 安徽省儿童医院临床药学部
- Publication Type:Journal Article
- Keywords:
high-dose methotrexate;
acute lym-phoblastic leukemia;
alkaline phosphatase;
bone metabolism;
delayed excretion
- From:
Chinese Journal of Clinical Pharmacology and Therapeutics
2025;30(8):1099-1104
- CountryChina
- Language:Chinese
-
Abstract:
AIM:To investigate the effects of high-dose methotrexate(MTX)on alkaline phosphatase(ALP)and the effects of ALP changes on bone me-tabolism,bone marrow granulogram function,liver function and excretion.METHODS:Aspartate ami-notransferase(AST),alanine aminotransferase(ALT)and albumin(ALB)were used as liver function indi-cators,serum calcium(Ca)and phosphorus(P)were used as bone metabolism indicators,neutro-phil(ANC)and white blood cell count(WBC)were used as bone marrow granuloline function indica-tors,and methotrexate C48h concentration ≥1 μmol/L was used as the excretion delay.One-way ANOVA analysis was performed on the ALP levels before and after the first chemotherapy and the second chemotherapy,and the children were divided into normal group and low group according to the ALP level,and the seven indexes before and after che-motherapy were quantitatively and qualitatively an-alyzed,and univariate and multivariate Logistic re-gression analysis was performed on the concentra-tion of methotrexate C48h and the above indexes in the children treated with the second chemothera-py.RESULTS:After the first chemotherapy and the second chemotherapy,ALP was significantly de-creased[(204.0±83.6)U/L vs.(172.8±67.3)U/L,(179.4±59.3)U/L vs.(169.6±57.1)U/L,all P＜0.05],and the serum Ca,P,ANC,WBC,and ALB were sig-nificantly decreased(P＜0.05),and AST and ALT were increased(P＜0.05),and ALT was an indepen-dent risk factor for delayed excretion(OR=1.049,95％CI 1.023-1.077,P＜0.001),ALB was an indepen-dent protective factor for delayed excretion(OR=0.551,95％CI 0.460-0.660,P＜0.001),and ALP was not a significant contributor to MTX excretion de-lay.CONCLUSION:ALP is not a good predictor of liv-er function and bone marrow granulopathy func-tion due to a significant decrease in ALP caused by high-dose MTX,and ALP together with serum calci-um and phosphorus levels can constitute an early warning indicator of bone metabolism disorders.
