儿童急性淋巴细胞白血病短疗程6-巯基嘌呤相关低血糖发生情况及其危险因素分析OA

Objective To analyze the incidence of 6-mercaptopurine(6MP)-related hypoglycemia in childhood acute lymphoblastic leukemia(ALL)during a short course of therapy.Methods Forty-eight children with ALL during treatment with the CAM regimen(containing cyclophosphamide,cytarabine and 6MP)were consecutively enrolled from Jan.2020 to May 2021(6MP group),and 21 children during treatment with the AML consolidation regimen 1,which did not contain 6MP,were also enrolled as controls(no-6MP group).Incidence of hypoglycemia and the related clinical data during the treatment were collected and the risk factors for developing hypoglycemia were analyzed.Results No hypoglycemia was observed in the no-6MP group,and the incidence of hypoglycemia was 39.6％in the 6MP group,of which only 10.5％had hypoglycemic symptoms;the median age of the hypoglycemia subgroup was significantly lower than that of the no-hypoglycemia subgroup(3.6 and 6.0 years old,P＜0.001),and the median values of glutamic oxalate aminotransferase were also higher in the hypoglycemia subgroup(123.3 U/L and 87.4 U/L,P=0.040),but there was no statistical difference in the median values of total bilirubin(16.8 μ mol/L and 15.0 μ mol/L,P=0.05 2).Logistic regression analysis showed that younger age and liver damage were the risk factors for developing hypoglycemia.Conclusion Hypoglycemia is also common in children receiving short-term exposure to 6-MP.Younger age with liver function impairment is the risk factor for developing hypoglycemia.Most hypoglycemic symptoms are insidious and clinically overlooked.Therefore,sufficient attention should be paid to them to avoid hypoglycemia in ALL children during 6MP treatment,and thus avoid negative impact on children's brain development.