Effect of high-dose methotrexate on alkaline phosphatase in children with acute lymphoblastic leukemia

doi:10.12092/j.issn.1009-2501.2025.08.011

Abstract

Abstract: AIM: To investigate the effects of high-dose methotrexate (MTX) on alkaline phosphatase (ALP) and the effects of ALP changes on bone metabolism, bone marrow granulogram function, liver function and excretion. METHODS: Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and albumin (ALB) were used as liver function indicators, serum calcium (Ca) and phosphorus (P) were used as bone metabolism indicators, neutrophil (ANC) and white blood cell count (WBC) were used as bone marrow granuloline function indicators, and methotrexate C_48h concentration ≥1 μmol/L was used as the excretion delay. One-way ANOVA analysis was performed on the ALP levels before and after the first chemotherapy and the second chemotherapy, and the children were divided into normal group and low group according to the ALP level, and the seven indexes before and after chemotherapy were quantitatively and qualitatively analyzed, and univariate and multivariate Logistic regression analysis was performed on the concentration of methotrexate C_48h and the above indexes in the children treated with the second chemotherapy. RESULTS: After the first chemotherapy and the second chemotherapy, ALP was significantly decreased [(204.0±83.6) U/L vs.(172.8±67.3) U/L, (179.4±59.3) U/L vs. (169.6±57.1) U/L, all P<0.05], and the serum Ca, P, ANC, WBC, and ALB were significantly decreased (P<0.05), and AST and ALT were increased (P<0.05), and ALT was an independent risk factor for delayed excretion (OR=1.049, 95%CI 1.023-1.077, P<0.001), ALB was an independent protective factor for delayed excretion (OR=0.551, 95% CI 0.460-0.660, P<0.001), and ALP was not a significant contributor to MTX excretion delay. CONCLUSION: ALP is not a good predictor of liver function and bone marrow granulopathy function due to a significant decrease in ALP caused by high-dose MTX, and ALP together with serum calcium and phosphorus levels can constitute an early warning indicator of bone metabolism disorders.

Key words: high-dose methotrexate, acute lymphoblastic leukemia, alkaline phosphatase, bone metabolism, delayed excretion

CLC Number:

LI Xingui¹, XU Daliang², YU Biao¹, GU Yun¹, DENG Yan¹, ZHANG Shihai³. Effect of high-dose methotrexate on alkaline phosphatase in children with acute lymphoblastic leukemia[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2025, 30(8): 1099-1104.

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