Reduced dose folinic acid rescue after rapid high-dose methotrexate clearance is not associated with increased toxicity in a pediatric cohort

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Fältnamn	Indikatorer	Metadata
000		04302naa a2200457 4500
001		oai:DiVA.org:uu-469027
003		SwePub
008		220314s2022 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4690272 URI
024	7	a https://doi.org/10.1007/s00520-021-06395-32 DOI
040		a (SwePub)uu
041		a engb eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Niinimäki, Riittau Oulu Univ Hosp, Dept Children & Adolescents, Oulu, Finland.;Univ Oulu, PEDEGO Res Unit, Oulu, Finland.4 aut
245	1 0	a Reduced dose folinic acid rescue after rapid high-dose methotrexate clearance is not associated with increased toxicity in a pediatric cohort
264		c 2021-07-08
264	1	b Springer Nature,c 2022
338		a electronic2 rdacarrier
520		a PurposeLow doses of folinic acid (FA) rescue after high-dose methotrexate (HD-MTX) have been associated with increased toxicity, whereas high doses may be related to a decreased antileukemic effect. The optimal dosage and duration of FA rescue remain controversial. This study was designed to investigate, whether a shorter duration of FA rescue in the setting of rapid HD-MTX clearance is associated with increased toxicity.MethodsWe reviewed the files of 44 children receiving a total of 350 HD-MTX courses during treatment for acute lymphoblastic leukemia according to the NOPHO ALL-2000 protocol. Following a 5 g/m2 HD-MTX infusion, pharmacokinetically guided FA rescue commenced at hour 42. As per local guidelines, the patients received only one or two 15 mg/m2 doses of FA in the case of rapid MTX clearance (serum MTX ≤ 0.2 μmol/L at hour 42 or hour 48, respectively). Data on MTX clearance, FA dosing, inpatient time, and toxicities were collected.ResultsRapid MTX clearance was observed in 181 courses (51.7%). There was no difference in the steady-state MTX concentration, nephrotoxicity, hepatotoxicity, neutropenic fever, or neurotoxicity between courses followed by rapid MTX clearance and those without. One or two doses of FA after rapid MTX clearance resulted in a 7.8-h shorter inpatient time than if a minimum of three doses of FA would have been given.ConclusionA pharmacokinetically guided FA rescue of one or two 15 mg/m2 doses of FA following HD-MTX courses with rapid MTX clearance results in a shorter hospitalization without an increase in toxic effects.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Medicinska och farmaceutiska grundvetenskaperx Farmakologi och toxikologi0 (SwePub)301022 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Basic Medicinex Pharmacology and Toxicology0 (SwePub)301022 hsv//eng
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Pediatrik0 (SwePub)302212 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Pediatrics0 (SwePub)302212 hsv//eng
653		a Acute lymphoblastic leukemia
653		a Methotrexate
653		a Folinic acid
653		a Toxicity
700	1	a Aarnivala, Henriu Oulu Univ Hosp, Dept Children & Adolescents, Oulu, Finland.;Univ Oulu, PEDEGO Res Unit, Oulu, Finland.4 aut
700	1	a Banerjee, Joannau Helsinki Univ Hosp, Children & Adolescents Hosp, Helsinki, Finland.4 aut
700	1	a Pokka, Tyttiu Oulu Univ Hosp, Dept Children & Adolescents, Oulu, Finland.4 aut
700	1	a Vepsäläinen, Kaisau Kuopio Univ Hosp, Dept Pediat, Kuopio, Finland.4 aut
700	1	a Harila-Saari, Arjau Uppsala universitet,Barnonkologisk och neurologisk forskning4 aut0 (Swepub:uu)arjha456
710	2	a Oulu Univ Hosp, Dept Children & Adolescents, Oulu, Finland.;Univ Oulu, PEDEGO Res Unit, Oulu, Finland.b Helsinki Univ Hosp, Children & Adolescents Hosp, Helsinki, Finland.4 org
773	0	t Supportive Care in Cancerd : Springer Natureg 30:1, s. 127-133q 30:1<127-133x 0941-4355x 1433-7339
856	4	u https://doi.org/10.1007/s00520-021-06395-3y Fulltext
856	4	u https://uu.diva-portal.org/smash/get/diva2:1644406/FULLTEXT01.pdfx primaryx Raw objecty fulltext:print
856	4	u https://link.springer.com/content/pdf/10.1007/s00520-021-06395-3.pdf
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-469027
856	4 8	u https://doi.org/10.1007/s00520-021-06395-3

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