PMID- 31308758
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220409
IS  - 1179-1322 (Print)
IS  - 1179-1322 (Electronic)
IS  - 1179-1322 (Linking)
VI  - 11
DP  - 2019
TI  - Identifying risk factors for high-dose methotrexate-induced toxicities in 
      children with acute lymphoblastic leukemia.
PG  - 6265-6274
LID - 10.2147/CMAR.S207959 [doi]
AB  - BACKGROUND: Whether monitoring of the methotrexate (MTX) concentrations after 
      high-dose MTX (HD-MTX) infusion can predict toxicities is still controversial, 
      especially when HD-MTX therapy is used in the treatment of children with acute 
      lymphoblastic leukemia (ALL), which is different than the previous schedules. The 
      relationship between patient characteristics and severe adverse events (AEs) has 
      yet to be determined. OBJECTIVE: To analyze the relationship between the MTX 
      concentration and toxicities and to identify the risk predictors from patient 
      characteristics for severe AEs during HD-MTX therapy in children with ALL. 
      METHODS: We conducted a retrospective study on children with ALL who were treated 
      with 388 HD-MTX infusions. The chi-square test and univariate and logistic 
      regression analyses were used to analyze the relationship between the MTX 
      concentrations and toxicities and to identify predictors for severe AEs. RESULTS: 
      Febrile neutropenia (P=0.000) and vomiting (P=0.034) were more likely to occur if 
      the infusion had an MTX level >/=1 mumol/L at 44 h, but other toxicities had no 
      correlations with MTX concentration. Predictive factors for toxicities were as 
      follows: higher risk stratification and higher values of albumin (ALB) for 
      leucopenia, higher values of white blood cell count (WBC) for anemia, higher 
      values of ALB and creatinine (Cr) for neutropenia, higher risk stratification and 
      higher 44-h MTX concentration for febrile neutropenia, higher values of alanine 
      transferase (ALT) for elevated ALT, higher values of ALT for elevated aspartate 
      transferase (AST), and higher values of total bilirubin (TBil) for vomiting. 
      CONCLUSION: Routine monitoring of 44-h MTX concentrations is essential to 
      identify patients at high risk of developing febrile neutropenia and vomiting. 
      This study may provide a reference for clinicians to distinguish patients with a 
      relatively high risk of severe AEs based on certain characteristics before HD-MTX 
      infusion.
FAU - Li, Xiao
AU  - Li X
AD  - Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, 
      Qingdao, Shandong 266003, People's Republic of China.
FAU - Sui, Zhongguo
AU  - Sui Z
AD  - Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, 
      Qingdao, Shandong 266003, People's Republic of China.
FAU - Jing, Fanbo
AU  - Jing F
AD  - Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, 
      Qingdao, Shandong 266003, People's Republic of China.
FAU - Xu, Wen
AU  - Xu W
AD  - Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, 
      Qingdao, Shandong 266003, People's Republic of China.
FAU - Li, Xiangpeng
AU  - Li X
AD  - Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, 
      Qingdao, Shandong 266003, People's Republic of China.
FAU - Guo, Qie
AU  - Guo Q
AD  - Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, 
      Qingdao, Shandong 266003, People's Republic of China.
FAU - Sun, Shuhong
AU  - Sun S
AD  - Department of Clinical Pharmacy, The Affiliated Hospital of Qingdao University, 
      Qingdao, Shandong 266003, People's Republic of China.
FAU - Bi, Xiaolin
AU  - Bi X
AD  - Department of Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, 
      Shandong, 266003, People's Republic of China.
LA  - eng
PT  - Journal Article
DEP - 20190705
PL  - New Zealand
TA  - Cancer Manag Res
JT  - Cancer management and research
JID - 101512700
PMC - PMC6615715
OTO - NOTNLM
OT  - acute lymphoblastic leukemia
OT  - high-dose methotrexate
OT  - methotrexate concentration
OT  - patient characteristics
OT  - risk predictors
OT  - toxicities
COIS- The authors report no conflicts of interest in this work.
EDAT- 2019/07/17 06:00
MHDA- 2019/07/17 06:01
PMCR- 2019/07/05
CRDT- 2019/07/17 06:00
PHST- 2019/03/07 00:00 [received]
PHST- 2019/06/06 00:00 [accepted]
PHST- 2019/07/17 06:00 [entrez]
PHST- 2019/07/17 06:00 [pubmed]
PHST- 2019/07/17 06:01 [medline]
PHST- 2019/07/05 00:00 [pmc-release]
AID - 207959 [pii]
AID - 10.2147/CMAR.S207959 [doi]
PST - epublish
SO  - Cancer Manag Res. 2019 Jul 5;11:6265-6274. doi: 10.2147/CMAR.S207959. eCollection 
      2019.