Using a Bedside Algorithm to Individually Dose High-dose Methotrexate for Patients at Risk for Toxicity.
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.
*Baylor College of Medicine †Texas Children's Hospital, Houston, TX ‡University of North Carolina, Chapel Hill, NC.
Jennifer H
JH
Foster
Melanie B
MB
Bernhardt
Patrick A
PA
Thompson
E OʼBrian
EO
Smith
Eric S
ES
Schafer
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019540:Area Under Curve; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005440:Fluid Therapy; D006801:Humans; D007262:Infusions, Intravenous; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D052016:Mucositis / Q000139:chemically induced / Q000517:prevention & control; D009422:Nervous System Diseases / Q000139:chemically induced / Q000517:prevention & control; D019095:Point-of-Care Systems; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012189:Retrospective Studies
D008727:Methotrexate