文摘
Purpose Monitoring of plasma methotrexate (MTX) concentrations allows for therapeutic adjustments in treating childhood acute lymphoblastic leukemia (ALL) or non-Hodgkin lymphoma (NHL) with high-dose MTX (HDMTX). We tested the hypothesis that assessment of creatinine clearance (CrCl) and/or serum Cr may be a suitable means of monitoring plasma MTX concentrations. Methods All children in the study had ALL or NHL, were in complete remission, and received HDMTX (3 or 5?g/m2)+leucovorin. Plasma MTX concentrations were measured at 24, 48, and 96?h. CrCl was determined at 24 and 48?h. Correlations between 24- and 48-h plasma MTX concentrations and CrCl and serum Cr concentrations were determined. CrCl and serum Cr concentrations were compared over time between children who had delayed and non-delayed MTX elimination. Results A total of 105 children were included. There were significant negative correlations between CrCl at 24 and 48?h and plasma MTX concentrations at 24 (both p?<?0.001) and 48?h (both p?<?0.001). There were significant positive correlations between serum Cr concentrations at both 24 and 48?h and plasma MTX concentrations at 24 (both p?<?0.001) and 48?h (both p?<?0.001). There were 88 (30.2?%) instances of elimination delay. Children with elimination delay had significantly lower CrCl and higher Cr concentrations at 24 and 48?h compared with children without elimination delay (all p?<?0.05). Conclusion Our findings suggest that, with further refinement, assessment of renal function may be a useful means of monitoring plasma MTX concentrations during HDMTX for ALL and NHL.