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KMID : 0350519930460031015
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Journal of Catholic Medical College
1993 Volume.46 No. 3 p.1015 ~ p.1021
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The Influence of Trimethoprim-Sulfamethoxazole and Methotrexate on Folic Acid Concentration in Children with Acute Lymphocytic Leukemia
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Abstract
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Acute lymphocytic loukemia(ALL) is the most common childhood cancer with well responsiveness to chemotherapy. All modern ALL chemotherapy regimens consist of 2 main therapeutic scbedules : remission induction and maintenance therapy.
Trimethoprim-sulfamethoxazole(TMP-SMX) has been used in preventing the opportunistic infections of the bowel and respiratory organisms, and Pneumocystis carinii pneumonitis. Methotrexate (MTX) is commonly used in maintenance chemotherapy with
mercaptopurine. There is some controversy that long-ter use of these two drugs can influence on the folic acid concentration and result in megaloblastic anemia.
In present study, we evaluated the influence of TMP-SMX and MTX on the folic acid concentration of ALL patients(19 at diagnosis, 17 after TMP-SMX administration and 13 after MTX administration) by peripheral red blood cell volume distrbution
width(RDW),
man corpuscular volume(MCV), and serum folic acid level. Peripheral RDW and MCV were measured with a Coulter counter, and folic acid level was measured by radioassay using 125I.
@ES The results were compared to 18 healthy control populations.
@EN 1. The RDWs of patients at ALL diagnosis, patients after TMP-SMX therapy and, patients after MTX therapy were 15.5±0.7 %, 19.0±2.9 %, 17.7±2.,2 %, respectively and were significantly in creased compared to that of the contol
group(12.7±0.7
%)
(P<0.01).
2. The MCV of patients at ALL diagnosis(84.7±6.4 fl) was not different from that of the control group(85.0±3.8 fl), but the MCVs of patients after TMP-SMX therapy and patients after MTX therapy were 93.3±3.9 fl, 97.9±7.9 fl. Respectively and
were
significantly increased compared to that of control group(P<0.01).
3. The folic acid level of patients at ALL diagnosis(3.5±0.7 ng/ml) was not different from that of the control group(3.9±1.1 ng/ml), but the folic acidlevels of patients after TMP-SMX therapy, and patients after MX therapy were 2.1±1.7 ng/ml,
1.8±0.7 ng/ml, respectively and were significantly decreased compared to that of the control group(P<0.01).
4. The correlation between the MCV and the folie acid level in ALL patients shows a negative correlation(P<0.01).
These results suggest that long-that long-term TMP-SMX and MTX therapy may contribute to megaloblastic anemia due to folic acid deficiency.
In conclusion, monitoring of the folic acid level in ALL patients will be a guide to make differential diagnosis for patients with anemic symptoms.
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KEYWORD
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