Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
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Delayed Elimination After High-dose Methotrexate in Pediatric Patients with Acute Lymphoblastic Leukemia and Non-Hodgkin Lymphoma

소아 급성림프모구백혈병 및 비호지킨림프종 환자에서 고용량 methotrexate 투여 후 배설지연

  • Yoon, Hye Won (Department of Pharmacy, Severance Hospital, Yon-sei University Health System) ;
  • Ree, Yoon Sun (Department of Pharmacy, Severance Hospital, Yon-sei University Health System) ;
  • Song, Hyo Sook (Department of Pharmacy, Severance Hospital, Yon-sei University Health System) ;
  • Kim, Jae Song (Department of Pharmacy, Severance Hospital, Yon-sei University Health System) ;
  • Son, Eun Sun (Department of Pharmacy, Severance Hospital, Yon-sei University Health System)
  • 윤혜원 (연세대학교 의과대학 세브란스병원 약무국) ;
  • 이윤선 (연세대학교 의과대학 세브란스병원 약무국) ;
  • 송효숙 (연세대학교 의과대학 세브란스병원 약무국) ;
  • 김재송 (연세대학교 의과대학 세브란스병원 약무국) ;
  • 손은선 (연세대학교 의과대학 세브란스병원 약무국)
  • Received : 2019.02.19
  • Accepted : 2019.05.08
  • Published : 2019.06.30
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Abstract

Background: High doses of methotrexate (MTX) are often used in various chemotherapy protocols to treat acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL) in children, but its delayed elimination increases the occurrence of adverse events, such as bone marrow suppression. The aim of this study was to investigate the elimination of MTX at 24 and 48 hours. Methods: We retrospectively analyzed electronic medical records of ALL or NHL pediatric patients who received $5g/m^2$ MTX infusion over 24 hours (between June, 2012 and July, 2018) at the Yonsei University Health System, Korea. The delayed elimination of MTX concentrations was assessed with 100 or $150{\mu}M$ MTX at 24 hours, and 2 or $5{\mu}M$ at 48 hours. Results: Among the 85 MTX cycles administered, 23 cycles were classified in delayed elimination group, and 62 cycles showed normal elimination. At 24 hours, the delayed elimination group with MTX concentration > $100{\mu}M$ showed higher percentage than group with MTX concentration < $100{\mu}M$ (45.8% vs. 19.7%, p = 0.015). However, no differences were observed at $150{\mu}M$ MTX (p = 0.66). At 48 hours, the delayed elimination was higher than the normal elimination at both concentration baselines (p < 0.001 at $2{\mu}M$, p = 0.024 at $5{\mu}M$). Conclusions: MTX concentrations greater than $100{\mu}M$ show high probability of delayed elimination at 24 hours. When MTX levels are above normal, leucovorin and hydration regimens should be continued to prevent delayed elimination.

Keywords

References

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