Using a Bedside Algorithm to Individually Dose High-dose Methotrexate for Patients at Risk for Toxicity

• Published in: Journal of pediatric hematology/oncology Vol. 39; no. 1; pp. 72 - 76
• Main Authors: Foster, Jennifer H, Bernhardt, Melanie B, Thompson, Patrick A, Smith, E OʼBrian, Schafer, Eric S
• Format: Journal Article
• Language: English
• Published: United States 01-01-2017
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - prevention & control; Algorithms; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Area Under Curve; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Monitoring; Fluid Therapy; Humans; Infusions, Intravenous; Methotrexate - administration & dosage; Methotrexate - adverse effects; Methotrexate - pharmacokinetics; Mucositis - chemically induced; Mucositis - prevention & control; Nervous System Diseases - chemically induced; Nervous System Diseases - prevention & control; Point-of-Care Systems; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Retrospective Studies
• ISSN: 1077-4114; 1536-3678
• DOI: 10.1097/MPH.0000000000000696

We developed a bedside algorithm for individually adjusting the high-dose methotrexate (HDMTX) dose (5 g/m) given to patients with acute lymphoblastic leukemia at high risk for methotrexate toxicity. Data were reviewed for 8 patients receiving 21 cycles of HDMTX as per our algorithm. Eleven cycles began with 5 g/m, 10 cycles began with a preinfusion 20% to 25% dose reduction. Neither mean MTX AUC (2320.5±179.1 vs. 2080.4±161.7 μmol×h/L), mean Cpss (64.3±7.9 vs. 60.8±6.1 μM), nor toxicities were statistically different between groups. Our algorithm allowed the safe administration of HDMTX to patients at risk of MTX toxicities and obviated the need for preinfusion dose reduction.