Analysis of adverse reactions with vincristine combined with triazole antifungal drugs in acute lymphoblastic leukemia children during remission induction chemotherapy in a single-center
Analysis of adverse reactions with vincristine combined with triazole antifungal drugs in acute lymphoblastic leukemia children during remission induction chemotherapy in a single-center
Objective To study the clinical characteristics of side effects in acute lymphoblastic leukemia(ALL)children combined with vincristine and triazole drugs during induction remission chemotherapy.Methods To summarize and analyze the combined application of vincristine and triazole drugs in children with acute lymphoblastic leukemia diagnosed by the Hematology Center of Beijing Children's Hospital from January 1,2010 to December 31,2013 during the induction remission chemotherapy.All children were divided into itraconazole combination group,voriconazole combination group,fluconazole combination group,and no combination group.The incidence of side effects and the prognosis after treatment in the four groups of patients were analyzed.Results 708 ALL admitted to the Beijing Children's Hospital during this period.Among them.The median age was 8(1-16)years.There were 215 children in the vincristine and triazole antifungal drug group,including 79 cases in the combination with itraconazole group,36 cases in the combination with voriconazole group,and 100 cases in the combination with fluconazole group.There were 493 cases in the non-combination medication group.The related complications in the combined medication group included 37 cases(17.2％)of hypertension,39 cases(18.1％)of toe numbness,4 cases(1.8％)of tendon reflex retardation,42 cases(19.5％)of abdominal pain and abdominal distension,5 cases(2.3％)of intestinal obstruction,and 43 cases(20％)of hyponatremia.The incidence of related complications in the combined medication group was higher than that in the non-combined medication group(P＜0.05).For the incidence of hypertension,bradyreflexia,and hyponatremia in the combination drug group,there was no difference between the itraconazole group and the voriconazole group(P＞0.05),but it was higher than the fluconazole group(P＜0.05).The incidence of numbness in the toe tip,abdominal pain,and abdominal distension was higher in the itraconazole group than in the voriconazole group,which was higher than the fluconazole group(P＜0.05).The incidence of intestinal obstruction was higher in the voriconazole group than in the itraconazole group,which was higher than in the fluconazole group(P＜0.05).For the side effects that occurred,relevant symptomatic treatment was given,and after adjusting the medication,the related complications were alleviated and disappeared.Conclusions During the induction and remission treatment of children with ALL,the combination of triazole drugs and vincristine may aggravate the occurrence of side effects.Compared with fluconazole,itraconazole and voriconazole may be more likely to aggravate vincristine toxicity.Therefore,it is recommended to avoid the simultaneous use of triazole antifungal drugs and vincristine during the treatment process.
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