Text Box: NURSING STRATEGIES TO PREVENT MUCOSITIS FOR CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA DURING THE TREATMENT OF HIGH-DOSE METHOTREXATE 
Shen Guomei, Gao YJ, Lu FJ, Wu Y
Children¡¯s Hospital, Fudan University, Shanghai, China

Objective: To evaluation the role of nursing strategies in children with acute lymphoblastic leukemia (ALL) during the course of high-dose methotrexate (HD-MTX) treatment. 
Method: Mucositis was evaluated in 26 children with ALL (70 courses) treated with HD-MTX (3g/m2 intravenously over 12 hours) between Jan.2000 and Dec.2000. From Jan.2000 to Jun. 2000, hydration (2000~3000ml/m2.d) was performed after the finish of 12-hour HD-MTX infusion; 44h-MTX concentrations weren¡¯t measured (Protocol A, 24 courses). During the period Jun.2000~Dec.2000, we modified the schedule, including hydration-alkalization synchronized the initiation of HD-MTX infusion and 44-hour MTX concentration measurement (Protocol B, 46 courses).
Results: 10/24 courses developed mucositis in Protocol A, compared with 2/46 courses in Protocol B (p<0.05); 3 courses in Protocol A presented severe mucositis (III0), but none in Protocol B (p<0.05). 
Conclusion: Strictly administration the hydration-alkalization regimen and measurement of MTX concentration are crucial to reduce the severity and frequency of HD-MTX related mucositis; intensification of mucosal nursing (including oral cavity and perianal nursing) in the patients with abnormal 44-hour MTX concentration is help to mucositis healing.

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