Preliminary Study on Prediction Model of Adverse Reactions in Patients with Lymphatic Tumors After Chemotherapy with High Dose Methotrexat

OBJECTIVE To investigate the influencing factors of adverse reactions in patients with lymphatic tumors after high-dose methotrexate (HD-MTX) chemotherapy, and to establish a prediction model of adverse reactions, to provide evidence for personalized medicine of methotrexate. METHODS Clinical cases of 180 patients with lymphatic cancer were collected from June 2014 to December 2016 in pediatric and hematology center of the First Affiliated Hospital of Xinjiang Medical University, the data was analyzed by unconditional univariate and multivariate Logistic regression, and the test of the model were assessed by the area under the ROC curve. RESULTS Logistic regression analysis showed that, the influencing factors of hepatic impair include age (OR=3.280), 24 h volume hydration before chemotherapy (OR=2.045), alanine aminotransferase (ALT, OR=5.120) and aspartate transaminase (AST, OR=12.962) before chemotherapy, predictive equation:a=-1.479+1.188(age)+0.715(24 h volume hydration before chemotherapy)+1.633(ALT before chemotherapy)+2.562(AST before chemotherapy), the ROC (AUC)=0.774;The influencing factors of myelosuppression include boby surface area (OR=0.497), the number of white blood cell (WBC) before chemotherapy (OR=2.416), alkaline phosphatase before chemotherapy (ALP, OR=10.248) and dosage of methotrexate (OR=0.593), predictive equation:a=1.695-0.700(boby surface area)+0.882(WBC before chemotherapy)+2.327(ALP before chemotherapy)-0.522(dosage of methotrexate), the ROC (AUC)=0.762;The influencing factors of mucositis include MTHFR A1298C (OR=4.147), more than three courses of HD-MTX (OR=0.375), predictive equation:a=-0.356+1.422(MTHFR A1298C)+0.641(x3)-0.982(x4), the ROC (AUC)=0.765;The influencing factors of gastrointestinal reaction include MTHFR A1298C (OR=11.060), predictive equation:a=-1.773+2.403(MTHFR A1298C), the ROC (AUC)=0.808. CONCLUSION When use HD-MTX in clinic, the medical staff shall pay more attention to the factors that age, body surface area, the number of courses, dosage of methotrexate, volume hydration, MTHFR A1298C, liver function or blood routine before chemotherapy, and to prevent the occurrence of adverse events.