Statistical analysis of relation between plasma methotrexate concentration and toxicity in high‐dose methotrexate therapy of childhood nonHodgkin lymphoma

Tsurusawa, Masahito; Gosho, Masahiko; Mori, Tetsuya; Mitsui, Tetsuo; Sunami, Shosuke; Kobayashi, Ryōji; Fukano, Reiji; Tanaka, Fumiko; Fujita, Naoto; Inada, Hiroko; Koh, Katsuyoshi; Takimoto, Tetsuya; Saito, Akiko; Fujimoto, Junichiro; Nakazawa, Atsuko; Horibe, Keizo

doi:10.1002/pbc.25305

Cited by 34 publications

(26 citation statements)

References 26 publications

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“…Ip et al (16) did not find an association between the blood levels of creatinine and the presence of Moderate to Severe oral mucositis during the initial period of chemotherapy. This increase was expected in blood creatinine, which previous studies have identified as a risk factor; this increase has also been shown to enhance the cytotoxicity of anticancer drugs (23)(24)(25). blood level of creatinine.…”

Section: Discussionmentioning

confidence: 61%

Oral Mucositis in Pediatric Oncology Patients: A Nested Case-Control to a Prospective Cohort

et al. 2020

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This study aimed to evaluate the factors associated with the occurrence of severe oral mucositis (SOM) in pediatric oncology patients during the chemotherapeutic treatment. This is a nested case-control to a prospective cohort that monitored 105 patients for 10 consecutive weeks after the beginning of the chemotherapy treatment. Logistic regression was used to identify the factors associated with SOM, by group of malignancy (hematologic or solid tumors) (Sig.=5%). To patients with hematologic tumors were found factors associated with SOM in two weeks of treatment: in the 6th week (increase in frequency of chemotherapy doses (OR=3.02)) and in the 7th week (female sex (OR=21.28); and increase in frequency of chemotherapy doses (OR=2.51)); and to patients with solid tumors were found factors associated with SOM in five weeks of treatment: in the 1st week (female sex (OR=14.43); age increase (OR=1.24)); in the 2nd week (Miscellany (OR=6.39)); in the 5th week (Antimetabolites (OR=17.44); Miscellany (OR=45.42); and platelets reduction (OR=1.12)); in the 6th week (creatinine increase (OR=1.63)); and in the 7th week (creatinine increase (OR=2.39)). For patients with hematologic tumors, to be female, and the increase in the frequency of chemotherapy doses increased the risk for SOM and for patients with solid tumors, to be female, the increase in age and in level blood concentration of creatinine, the reduction in number of platelets and the use of chemotherapy with miscellany and antimetabolites agents were associated with an increase in risk for occurrence of SOM.

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Section: Discussionmentioning

confidence: 61%

Oral Mucositis in Pediatric Oncology Patients: A Nested Case-Control to a Prospective Cohort

et al. 2020

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“…Serum methotrexate concentrations should be monitored with ongoing adjustments in hydration, alkalinization, and leucovorin rescue until the target of less than 0.05-0.1 mM is reached [1]. Plasma methotrexate monitoring is a reliable indicator specifically of nephrotoxicity but may be a limited predictor of other toxicities [59]. However, in centers where methotrexate levels cannot be monitored, assiduous monitoring of urine pH and output, serum creatinine, and twice-daily examination of mucosal membranes for evidence of inflammation can allow safe administration of HDMTX for most patients; indeed, this practice in Recife, Brazil, where methotrexate levels were not available, allowed for safe administration of hundreds of courses of HDMTX [60].…”

Section: Monitoring During Treatment With High-dose Methotrexatementioning

confidence: 99%

Preventing and Managing Toxicities of High-Dose Methotrexate

et al. 2016

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High-dose methotrexate (HDMTX), defined as a dose higher than 500 mg/m2, is used to treat a range of adult and childhood cancers. Although HDMTX is safely administered to most patients, it can cause significant toxicity, including acute kidney injury. This article provides comprehensive recommendations for prevention of toxicity from HDMTX, along with detailed treatment guidance to mitigate acute kidney injury and subsequent toxicity.

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“…TLS is potentially fatal [11]. Also High-dose MTX is a major cause of toxicities as gastroenteritis, MTX encephalopathy [12,13].…”

Section: Discussionmentioning

confidence: 99%

Effect of Second Cycle Pre-induction Chemotherapy in Critically Ill Burkitt’s Lymphoma Children

Moussa¹

2019

CRJ

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Advanced stage Burkiit's lymphoma (BL) is associated with tumor burden. Toxicities from intensive therapies are significant. The objectives of this study were to analyze the outcome of patients who could not receive induction chemotherapy on time, and were given a 2 nd pre-phase (CVP), and to measure the impact of delay on disease outcome. It is a retrospective non randomized study included pediatric patients, suffering from Burkitt's Lymphoma over 8 years period in CCHE. The result showed that, four hundred and eight patients were diagnosed as Burkitt's Lymphoma from July 2007 till October 2015, 286 patients (70.1%) received induction on time as per protocol, while 122 patients (29.9%) were not fit to receive their induction chemotherapy on due time. The delay ranged from 6-45 days. While forty five patients (36.88%) out of the delayed patients received 2 nd CVP, 16 patients (13.1%) showed relapse/progression. OS among delayed patients who received 2 nd CVP versus those who were delayed and were able to receive full induction chemotherapy was (76.1%), (88.7%) respectively. OS in patients who were delayed versus those who were not delayed was (84%), (85.9%) respectively. In conclusion, in critically ill patients delay of chemotherapy in induction phase is important to reduce morbidity and mortality. The delay of chemotherapy has no impact on OS in Burkitt's lymphoma children. A second pre-phase therapy in our opinion should not be adopted for all critical ill patients who will not tolerate intensive therapy during early phases of treatment, but instead we recommend a recovery from organ toxicity and starting intensive therapy (COPADM) rather than giving 2 nd CVP with careful surveillance of disease progression.

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Statistical analysis of relation between plasma methotrexate concentration and toxicity in high‐dose methotrexate therapy of childhood nonHodgkin lymphoma

Abstract: Our results suggest that plasma MTX level is not a reliable predictor for adverse events except for nephrotoxicity in multiple HDMTX therapy courses in childhood B-NHL. Pediatr Blood Cancer 2015;62:279-284. © 2014 Wiley Periodicals, Inc.

Cited by 34 publications

References 26 publications

Oral Mucositis in Pediatric Oncology Patients: A Nested Case-Control to a Prospective Cohort

Oral Mucositis in Pediatric Oncology Patients: A Nested Case-Control to a Prospective Cohort

Preventing and Managing Toxicities of High-Dose Methotrexate

Effect of Second Cycle Pre-induction Chemotherapy in Critically Ill Burkitt’s Lymphoma Children

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