Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Platelet count change by vincristine in maintenance phase of acute lymphoblastic leukemia chemotherapy

급성 림프구성 백혈병의 항암 유지요법 중 vincristine과 관련된 혈소판수의 변화

  • Lee, Sung Moon (Department of Pediatrics, Gil Medical Center, Gachon Medical School) ;
  • Ham, Soon Shik (Department of Pediatrics, Gil Medical Center, Gachon Medical School) ;
  • Jeon, In-sang (Department of Pediatrics, Gil Medical Center, Gachon Medical School)
  • 이성문 (가천의과대학교 길병원 소아과) ;
  • 함순식 (가천의과대학교 길병원 소아과) ;
  • 전인상 (가천의과대학교 길병원 소아과)
  • Received : 2005.08.11
  • Accepted : 2005.10.05
  • Published : 2006.02.15
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Abstract

Purpose : The hematologic change during the treatment of acute lymphoblastic leukemia(ALL) is critical as a prognostic determinant and a variable to determine the dose of chemotherapeutic agents. It is known that the dose of vincristine used in the maintenance phase of ALL is small enough to increase the count of platelet. To investigate the change of platelet count according to the vincristine administration in maintenance phase of ALL chemotherapy, we performed this study. Methods : Eleven patients eligible under the criteria of Children's Cancer Study Group(CCG)-1882 and who had completed chemotherapy were enrolled in this study. The count of platelets before vincristine administration was compared with those of vincristine administration 1, 2 and 3 weeks after the early and last periods of maintenance phases. The platelet count before vincristine administration was defined as 100 percent and that after vincristine were compared. In addition, we tentatively defined an enhancing effect of vincristine as positive when the relative count was more than 120 percent. Results : Platelet count did not differ according to the early and last periods of maintenance phase. Platelet count at first week after vincristine administration increased more significantly than that before vincristine in early and last periods. There was an enhancing effect in 10(90.9 percent) of 11 patients after 1 week vincristine administration both in the early and last periods of the maintenance phase. Conclusion : Vincristine, used in ALL maintenance phases as a low dose, increased platelet count 1 week after administration. The increased platelet count resumed to the previous level 2-3 weeks later. However, the thrombocytosis observed in the maintenance phase by vincristine was not high enough to induce thrombosis. In addition, vincristine is known to reduce the activity of platelets. Therefore, the risk of thrombosis in the maintenance phase of ALL chemotherapy would be low.

목 적 : ALL 치료 중의 혈액학적 변화는 예후인자로써 뿐만 아니라 항암제의 용량을 결정짓는 중요한 변수이다. ALL의 유지요법 기간 중에 투여되는 vincristine의 용량은 저용량으로 혈소판수를 증가시키기에는 충분하다. ALL의 유지요법 기간 중에 vincristine 투여에 따른 혈소판의 변화를 알아보기 위하여 연구를 시행하였다. 방 법 : 가천의과대학교 길병원 소아과에서 고위험군 ALL로 진단받고 CCG-1882에 기초한 항암치료를 모두 마친 11명의 환아를 대상으로 유지요법 기간을 처음 6개월간의 초기, 마지막 6개월간의 후기로 나누어, vincristine 투여(0.05 mg/kg) 전과 투여 1, 2, 3주 후의 혈소판수를 비교 분석하였다. Vincristine 투여 전의 혈소판수를 100%로 하여 투여 후의 혈소판수를 percent로 환산하여 비교 분석하였으며, 투여 전에 비해 20% 이상 혈소판수가 증가한 경우를 의미 있는 증가로 하여 총례 및 각 개인별로 혈소판수를 비교 분석하였다. 결 과 : 유지요법 기간별로 혈소판수를 비교한 결과 유지요법 후기로 갈수록 전체 혈소판수는 증가하였으나 통계학적으로 의미 있는 차이는 없었다. 초기와 후기 모두 vincristine 투여 1주후 혈소판수는 최고가 되었다. 초기 6개월 유지요법 기간 중 vincristine 투여 전에 비해 투여 1, 2주 후에 통계학적으로 의미 있게 혈소판수가 증가하였으며 3주 후에는 투여 전 수준으로 되었다. Vincristine 투여 전에 비해 투여 1주 후에 혈소판수가 20% 이상 증가한 경우가 전체 11명 중 10명(90.9%)으로 통계학적으로 의미 있게 많았다. 후기 6개월 유지요법 기간 중 vincristine 투여 전에 비해 투여 1주 후에 통계학적으로 의미 있게 혈소판수가 증가하였으며 2주 후에는 투여 전과 비교해 통계학적으로 의미 있는 차이는 없었다. 후기에도 vincristine 투여 전에 비해 투여 후 혈소판수가 20% 이상 증가한 경우가 전체 11명 중 10명(90.9%)으로 통계학적으로 의미 있게 많았다. 결 론 : ALL의 유지요법에 사용되는 저용량의 vincristine은 투여 1주 후에 혈소판수를 최고로 증가시키며, 2-3주 후에 혈소판수는 투여 전 수준으로 돌아간다. 그러나 혈소판수의 증가는 혈전증을 일으킬 정도는 되지 않으며, vincristine에 의해 혈소판의 기능저하로 ALL의 항암요법의 유지요법 중 혈액 응고가 발생할 위험성은 낮아 보인다.

Keywords

References

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