Therapeutic Drug Monitoring of methotrexate in plasma using U-HPLC-MS/MS: necessary after administration of glucarpidase in methotrexate intoxications

Therapeutic Drug Monitoring of methotrexate in plasma using U-HPLC-MS/MS: necessary after administration of glucarpidase in methotrexate intoxications

High-dose methotrexate (HD-MTX) is used to treat a variety of cancers. In all patients receiving HD-MTX, plasma MTX levels are monitored mainly to anticipate rescue therapy to prevent adverse events. We present two children treated with HD-MTX and afterward treated with glucarpidase at different tim...

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Bibliographic Details
Published in:Therapeutic drug monitoring
Main Authors: Mulder, Midas B, Huisman, Ruud, Engels, Frederike K, van der Sluis, Inge M, Koch, Birgit C P
Format: Journal Article
Language:English
Published: United States 03-04-2018
Online Access:Get full text
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Summary:High-dose methotrexate (HD-MTX) is used to treat a variety of cancers. In all patients receiving HD-MTX, plasma MTX levels are monitored mainly to anticipate rescue therapy to prevent adverse events. We present two children treated with HD-MTX and afterward treated with glucarpidase at different time-points after their HD-MTX infusions. After the administration of glucarpidase, a non-toxic metabolite of MTX cross-reacts with MTX in the standard immunoassay (Abbott Diagnostics, Hoofddorp, The Netherlands) resulting in an artificially elevated MTX level. An artificially elevated MTX level results in unnecessarily long folinic acid administration, which decreases the effectivity of MTX. This grand round highlights the importance of measuring plasma MTX levels after the administration of glucarpidase with a U-HPLC-MS/MS method instead of with an immunoassay.
ISSN:1536-3694