Outpatient administration of high-dose methotrexate in adults without drug monitoring – a case-control study of risk factors for acute kidney injury
Introduction: High-dose methotrexate (HDMTX) is an essential part of chemotherapy regimens for hematologic neoplasms. The incidence of acute kidney injury (AKI) after HDMTX in unmonitored outpatient infusion had not been reported in adults yet. In this study, we evaluated toxicity data after outpati...
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Elsevier
2024-12-01
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| Series: | Hematology, Transfusion and Cell Therapy |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2531137923025993 |
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| author | Camila Alves Juliana Pereira Eduardo M Rego Vanderson Rocha Wellington F Silva |
| author_facet | Camila Alves Juliana Pereira Eduardo M Rego Vanderson Rocha Wellington F Silva |
| author_sort | Camila Alves |
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| description | Introduction: High-dose methotrexate (HDMTX) is an essential part of chemotherapy regimens for hematologic neoplasms. The incidence of acute kidney injury (AKI) after HDMTX in unmonitored outpatient infusion had not been reported in adults yet. In this study, we evaluated toxicity data after outpatient administration of HDMTX without drug monitoring. Methods: Patients 16 years old or over with acute lymphoblastic leukemia and non-Hodgkin lymphoma who received at least one outpatient infusion of HDMTX without drug level monitoring were included. This is a retrospective, nested case-control study, in which the cases comprised patients who developed AKI after HDMTX. Results: Overall, 302 patients were included, encompassing 840 infusions. Hospitalization occurred in 8.6 %. A total of 25 patients presented AKI after HDMTX administration, corresponding to 3 % of the methotrexate (MTX) infusions and 8.3 % of the patients. HIV-associated Burkitt lymphoma was more common in patients who presented AKI (18 vs. 6.8 %, p = 0.03). Baseline factors related to AKI after HDMTX were age > 44 y, body surface area ≥ 1.76 m2, body mass index (BMI) ≥ 23.8 kg/m2, glomerular filtration rate, and thrombocytopenia (< 150×109/L). Multivariable analysis for adjusting such factors found that BMI was independently related to AKI after HDMTX (OR 3.8). Death after AKI occurred in 56 %. Conclusion: Our data showed a similar rate of AKI after HDMTX to that reported in the literature, even without drug monitoring. However, patients who developed AKI in our cohort fared worse than expected, with more hospitalizations and death. A higher BMI was associated with the MTX-induced AKI in our cohort, suggesting a differential drug clearance and the need for specific guidelines for obese patients. |
| format | Article |
| id | doaj-art-5258e17f5faf4dbd9939084277e0f9ca |
| institution | OA Journals |
| issn | 2531-1379 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
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| series | Hematology, Transfusion and Cell Therapy |
| spelling | doaj-art-5258e17f5faf4dbd9939084277e0f9ca2025-08-20T02:32:19ZengElsevierHematology, Transfusion and Cell Therapy2531-13792024-12-0146S36S4010.1016/j.htct.2023.10.005Outpatient administration of high-dose methotrexate in adults without drug monitoring – a case-control study of risk factors for acute kidney injuryCamila Alves0Juliana Pereira1Eduardo M Rego2Vanderson Rocha3Wellington F Silva4Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, BrazilLaboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Division of Hematology and Cell Therapy, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, BrazilLaboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Division of Hematology and Cell Therapy, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, BrazilLaboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Division of Hematology and Cell Therapy, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, BrazilLaboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Division of Hematology and Cell Therapy, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; Corresponding author at: Instituto do Câncer do Estado de São Paulo, Av Dr Arnaldo, 251, 1 andar, CEP 01246000, Cerqueira Cesar, São Paulo, SP, Brazil.Introduction: High-dose methotrexate (HDMTX) is an essential part of chemotherapy regimens for hematologic neoplasms. The incidence of acute kidney injury (AKI) after HDMTX in unmonitored outpatient infusion had not been reported in adults yet. In this study, we evaluated toxicity data after outpatient administration of HDMTX without drug monitoring. Methods: Patients 16 years old or over with acute lymphoblastic leukemia and non-Hodgkin lymphoma who received at least one outpatient infusion of HDMTX without drug level monitoring were included. This is a retrospective, nested case-control study, in which the cases comprised patients who developed AKI after HDMTX. Results: Overall, 302 patients were included, encompassing 840 infusions. Hospitalization occurred in 8.6 %. A total of 25 patients presented AKI after HDMTX administration, corresponding to 3 % of the methotrexate (MTX) infusions and 8.3 % of the patients. HIV-associated Burkitt lymphoma was more common in patients who presented AKI (18 vs. 6.8 %, p = 0.03). Baseline factors related to AKI after HDMTX were age > 44 y, body surface area ≥ 1.76 m2, body mass index (BMI) ≥ 23.8 kg/m2, glomerular filtration rate, and thrombocytopenia (< 150×109/L). Multivariable analysis for adjusting such factors found that BMI was independently related to AKI after HDMTX (OR 3.8). Death after AKI occurred in 56 %. Conclusion: Our data showed a similar rate of AKI after HDMTX to that reported in the literature, even without drug monitoring. However, patients who developed AKI in our cohort fared worse than expected, with more hospitalizations and death. A higher BMI was associated with the MTX-induced AKI in our cohort, suggesting a differential drug clearance and the need for specific guidelines for obese patients.http://www.sciencedirect.com/science/article/pii/S2531137923025993MethotrexateDrug-induced nephrotoxicityLeukemiaLymphomaBody mass index |
| spellingShingle | Camila Alves Juliana Pereira Eduardo M Rego Vanderson Rocha Wellington F Silva Outpatient administration of high-dose methotrexate in adults without drug monitoring – a case-control study of risk factors for acute kidney injury Hematology, Transfusion and Cell Therapy Methotrexate Drug-induced nephrotoxicity Leukemia Lymphoma Body mass index |
| title | Outpatient administration of high-dose methotrexate in adults without drug monitoring – a case-control study of risk factors for acute kidney injury |
| title_full | Outpatient administration of high-dose methotrexate in adults without drug monitoring – a case-control study of risk factors for acute kidney injury |
| title_fullStr | Outpatient administration of high-dose methotrexate in adults without drug monitoring – a case-control study of risk factors for acute kidney injury |
| title_full_unstemmed | Outpatient administration of high-dose methotrexate in adults without drug monitoring – a case-control study of risk factors for acute kidney injury |
| title_short | Outpatient administration of high-dose methotrexate in adults without drug monitoring – a case-control study of risk factors for acute kidney injury |
| title_sort | outpatient administration of high dose methotrexate in adults without drug monitoring a case control study of risk factors for acute kidney injury |
| topic | Methotrexate Drug-induced nephrotoxicity Leukemia Lymphoma Body mass index |
| url | http://www.sciencedirect.com/science/article/pii/S2531137923025993 |
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