在治疗急性淋巴细胞白血病期间,儿童的上腺抑制超越诱导
Renée-Pier Fortin-Boudreault1, Alexandra Ahmet2, Sarah Lawrence2
1Division of Pediatric Hematology-Oncology.
Journal of pediatric hematology/oncology
|November 8, 2023
概括
患有急性淋巴细胞白血病 (ALL) 的儿童即使在初始治疗阶段之后,仍然存在上腺抑制 (AS) 的风险. 警至关重要,因为症状可能不存在,但在持续治疗期间可能发生上腺危机.
科学领域:
- 儿科瘤学 儿科瘤学
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 上腺抑制 (AS) 是葡萄糖皮质类药物治疗的严重并发症.
- 在儿童急性淋巴细胞白血病 (ALL) 的诱导治疗后,AS被识别为AS.
- 在ALL治疗的诱导后阶段,AS的风险尚不清楚.
研究的目的:
- 在诱导后治疗阶段,调查小儿ALL患者上腺抑制风险的持续性.
- 评估ALL治疗的诱导阶段以外的上腺抑制的患病率.
主要方法:
- 试点研究涉及儿童患者 (12个月至<18岁) 患有B或T-ALL.
- 排除复发或婴儿ALL病例.
- 进行了低剂量ACTH刺激测试 (LDST),测量皮质醇结合球蛋白和白蛋白,并进行症状查.
主要成果:
- 在24名注册患者中,一名患者表现出明显的上腺抑制.
- 另外五名患者表现出边界皮质醇峰值,这表明可能有轻度的AS.
- 非特异性症状无法可靠地区分正常,边缘或异常LDST结果的患者.
结论:
- 儿科ALL患者面临着超越诱导治疗的上腺抑制的持续风险.
- 风险虽然看上去很小,但需要医生保持警.
- 无症状患者在治疗期间仍然可能发生上腺危机,这凸显了持续监测的必要性.
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