Plasma creatinine as predictor of delayed elimination of high-dose methotrexate in childhood acute lymphoblastic leukemia: A Danish population-based study.
Adolescent
Antineoplastic Combined Chemotherapy Protocols
/ pharmacokinetics
Child
Child, Preschool
Creatinine
/ blood
Denmark
/ epidemiology
Female
Follow-Up Studies
Humans
Infant
Male
Mercaptopurine
/ administration & dosage
Metabolic Clearance Rate
Methotrexate
/ administration & dosage
Precursor Cell Lymphoblastic Leukemia-Lymphoma
/ blood
Prognosis
Retrospective Studies
Tissue Distribution
ALL
acute leukemias
chemotherapy
methotrexate
support care cancer pharmacology
Journal
Pediatric blood & cancer
ISSN: 1545-5017
Titre abrégé: Pediatr Blood Cancer
Pays: United States
ID NLM: 101186624
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
02
10
2018
revised:
04
01
2019
accepted:
07
01
2019
pubmed:
6
3
2019
medline:
19
12
2019
entrez:
6
3
2019
Statut:
ppublish
Résumé
Severely delayed elimination of methotrexate (MTX) is difficult to predict in patients treated with high-dose MTX (HD-MTX), but it may cause life-threatening toxicity. It has not been defined how an increase in plasma creatinine can be best used as a predictor for severely delayed MTX elimination, thus providing a guide for therapeutic interventions to minimize renal toxicity. Pharmacokinetic data were retrospectively collected on 218 Danish children with acute lymphoblastic leukemia treated with HD-MTX 5 or 8 g/m Median 42-hour plasma MTX was 0.61 μM (interquartile range, 0.4-1.06 μM). Of 1295 MTX infusions with 5 g/m A 25 μM increase or a 1.5-fold in plasma creatinine within 36 hours after start of an HD-MTX infusion can predict delayed MTX elimination, thus allowing intensification of hydration and alkalization to avoid further renal toxicity and promote the elimination of MTX.
Sections du résumé
BACKGROUND
Severely delayed elimination of methotrexate (MTX) is difficult to predict in patients treated with high-dose MTX (HD-MTX), but it may cause life-threatening toxicity. It has not been defined how an increase in plasma creatinine can be best used as a predictor for severely delayed MTX elimination, thus providing a guide for therapeutic interventions to minimize renal toxicity.
METHODS
Pharmacokinetic data were retrospectively collected on 218 Danish children with acute lymphoblastic leukemia treated with HD-MTX 5 or 8 g/m
RESULTS
Median 42-hour plasma MTX was 0.61 μM (interquartile range, 0.4-1.06 μM). Of 1295 MTX infusions with 5 g/m
CONCLUSIONS
A 25 μM increase or a 1.5-fold in plasma creatinine within 36 hours after start of an HD-MTX infusion can predict delayed MTX elimination, thus allowing intensification of hydration and alkalization to avoid further renal toxicity and promote the elimination of MTX.
Substances chimiques
Creatinine
AYI8EX34EU
Mercaptopurine
E7WED276I5
Methotrexate
YL5FZ2Y5U1
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e27637Informations de copyright
© 2019 Wiley Periodicals, Inc.