Çocukluk Çağı Akut Lenfoblastik Lösemili Olgularda Yüksek Doz Methotreksat Uygulamasının Oral Glukoz Tolerans Testi Üzerine Etkileri

Abstract

Effects of High-Dose Methotrexate Therapy on Glucose Metabolism in Childhood Acute Lymphoblastic Leukemia Methotrexate (MTX) has been used in the treatment of childhood acute lymphoblastic leukemia (ALL) for over 40 years. A number of the acute toxicities are common with high dose methotrexate (HDMTX) infusion, including myelosuppression, vomiting, orointestinal mucositis, hepatic and renal toxicities, neurological disturbances. On the other hand, effect of HDMTX therapy on glucose metabolism was not known. Between 2001 and 2002, twenty children with acute lymphoblastic leukemia at the Dr. Sami Ulus Children's Hospital, Department of Pediatric Hematology and Oncology were treated according to the St. Jude ALL XIII protocol were eligible to this study. Dose of MTX (2 gr/m2) was infused over 24 hours. Orally glucose tolerance test was performed at before HDMTX therapy, 1 day and 1 week after the therapy. We found that HDMTX infusion did not significantly effect on orally glucose tolerance test during the first week. Methotreksat (MTX), akut lenfoblastik losemi (ALL) tedavisinde 40 yildan fazla suredir kullanilmaktadir. Yuksek doz MTX (YDMTX) tedavisine bagli myelosupresyon, kusma, mukozit, norolojik bozukluklar, hepatik ve renal toksisite bildirilmistir. Ancak, YDMTX tedavisinin oral glukoz tolerans testi uzerine etkileri bilinmemektedir. Dr. Sami Ulus Cocuk Sagligi ve Hastaliktan Merkezi Pediatrik Hematoloji ve Onkoloji bolumlerinde 2001 - 2002 tarihleri arasi ALL tanisi ile, St. Jude Total XIII ALL protokolunde bulunan ve YDMTX tedavisi almakta olan 20 hasta calismaya alindi. Yuksek DMTX tedavisi 2gr/m2 dozunda, 24 saatlik infizyon seklinde verildi. Tedavi oncesi (TO), tedavi sonrasi 1. gun (TS1G) ve tedavi sonrasi 7. gun (TS7G) oral glukoz tolerans testi (OGTT) uygulandi. Yuksek DMTX tedavisi sonrasindaki 1 hafta suresince glukoz metabolizmasinda belirgin bir degisiklik saptamadik.