叶酸预防异基因造血干细胞移植术中甲氨蝶呤引起的口腔黏膜炎的临床疗效

目的观察叶酸（FA）预防白血病患者异基因造血干细胞移植（Allo—HSCT）术中甲氨蝶呤（MTX）引起的口腔黏膜炎（OM）的临床疗效。方法103例白血病患者从2003年6月至2008年12月在我科接受了白细胞抗原（HLA）同胞全相合Allo—HSCT，采用的预处理方案均为静脉用马利兰联合环磷酰胺，预防急性移植物抗宿主病（aGVHD）的方案也相同为：环孢素A2．5mg／（kg·d），静脉滴注，移植前7d开始联合吗替麦考酚酯0．25g，口服，每日2次和MTX（10mg／m^2，静脉滴注，＋1d、＋3d、＋6d、＋11d）。将所有患者分为对照组（49例）和观察组（54例）两组：观察组患者在每次MTX应用后24h，应用FA（15mg／m^2）；对照纽不用FA。观察两纽患者在中性粒细胞获得临床造血前OM的发生情况及干细胞回输100d内aGVHD的发生情况。结果在中性粒细胞获得临床造血前，对照组有33例发生OM、发生率为67．3％，而观察组只有14例发生OM，发生率为25．9％，两组之间OM的发生率比较差异有统计学意义（P〈0．05）；干细胞回输100d内，对照组有17例出现aGVHD、发生率为34．6％，观察组有16例，发生率为30．1％．两组之间aGVHD的发生率比较差异无统计学意义（P〉0．05）。结论叶酸可显著降低Allo—HSCT术中OM的发生率，同时并不增加aGVHD的发生，所以临床上用其来预防MTX引起的OM安全、有效。

Clinical effect of folic acid to prevent oral mucositis caused by methotrexate in patients with allogeneic haemopoietic stem cell transplantation

Objective To investigate the clinical effect of folic acid（FA） to prevent oral mucositis （OM） caused by methotrexate （MTX） in patients with allo - geneic haemopoietic stem cell transplantation （Allo - HSCT）. Methods One hundred and three cases of leukemia patients accepted HLA identical sibling Allo - HSCT from June 2003 to December 2008 at our division. Cyclophosphamide combined with bulsulfan was used as conditioning regimen for all patients. Cyclosporin A 2.5 mg/（ kg · d） in combination with mycophenolate and MTX （ 10 mg/m^2, ＋ 1 d, ＋ 3 d, ＋ 6 d, ＋ 11 d） was the same regimen for the prophylaxis of acute graft versus host disease （aGVHD）. All patients were divided into control group （ n =49） and observation group （ n = 54 ）. FA was administered 24 h after MTX at a dose of 15 mg/m^2 in observation group and not for the control grouP. The occurrence of OM was observed before neutrophil reconstruction and the incidence of aGVHD was investigated in 100 days after transplantation. Results Before neutrophil reconstruction after transplantation, OM happened to 33 patients and the incidence rate was 67.3 percent in the observation group, but in the control group, the incidence rate of OM was only 25.9 percent. The comparison of incidence rate of OM between two groups was positive （ P 〈 0.05 ）. During 100 days after transplantation, the incidence of aGVHD were 34.6 percent in the observation group and 30.1 percent in the control group and the difference of incidence between two groups was no statistically significant difference （ P 〉 0.05）. Conclusions Folic acid can significantly reduce the incidence of OM induced by MTX without increasing aGVHD. So it can be used as the prophylaxis for OM safely and effectively.