Comparison of High Dose Methotrexate Administration Between the Inpatient and Outpatient Setting in Children with Acute Lymphoblastic Leukemia

Abstract

연구의 필요성2010년) administration in either the inpatient (N = 70) or outpatient setting (N = 70) from January to July 2012 were included. In the outpatient setting, HD-MTX was administered intravenously (IV) over 6 hours and included hydration with sodium bicarbonate (2000 ml/m 2 / for 12 hours). Daily visits to the outpatient setting followed. Leucovorin was given 24 hours after MTX at a standard dose (15 mg/m 2 IV bolus) every 6 hours. We compared the serum drug levels of MTX, hematologic and renal toxicity, hepatotoxicity, frequency of subsequent unscheduled outpatient visits and readmission episodes, medical expenses and duration of hospital stay between the two groups. Results: HD-MTX administrations were successfully completed in both groups. No significant differences were found between the two groups for the parameters studied. Patients who received HD-MTX in the inpatient setting had 2.37 times and 2.24 times greater medical expenses and duration of hospital stay respectively than outpatient recipients. Conclusion: This study suggests that HD-MTX administration done with aggressive monitoring in the outpatient setting is safe and efficient, without a greater incidence of major toxicities.

Letting Kids Be Kids: A Quality Improvement Project to Deliver Supportive Care at Home After High-Dose Methotrexate in Pediatric Patients With Acute Lymphoblastic Leukemia

“…Current evidence is informative on the safety of ambulatory supportive care for HD MTX and its financial benefits. The transition to ambulatory care for HD MTX and supportive care is safe and effective (Choi et al, 2014;Holdsworth et al, 1997;Lange et al, 1988;Lashlee & O'Hanlon Curry, 2007;Lippert et al, 2017;Mahadeo et al, 2010;Newton & Ingram, 2014;Sive et al, 2012;Zelcer et al, 2008). Mahadeo et al (2010) identified that of the 97 ambulatory HD MTX administrations 99% were successfully completed outpatient; zero had elevated MTX levels at 24 hours, 26% experienced typical neutropenia, 4% experienced thrombocytopenia, and 1% experienced leukopenia.…”

Treatment of Acute Leukemia During COVID-19: Focused Review of Evidence

“…( 42 ) In extreme situations and with close monitoring, administration of high dose methotrexate on outpatient basis has also been found safe. ( 43 ) An individualized decision to continue subsequent cyclophosphamide, cytarabine or etoposide on outpatient basis can be made if patients are expected to comply with instructions on neutropenic care and regular follow up. ( 44 ) As ALL is curable disease in many age groups, it is recommended that priority be given to minimizing treatment delays.…”

Experience with ambulatory high-dose methotrexate administration as CNS prophylaxis in patients with non-Hodgkin lymphoma

“…8 This outpatient protocol presents the results of a quality improvement project conducted to analyze the methods used in our hospital to provide urinary alkalinization and hematological rescue to patients with NHL undergoing treatment with HDMTX. 11,12 In this study, the aim is to analyze the feasibility of an oral alkalinization and leucovorin rescue regimen that ensures the safety of outpatient treatment with HDMTX for CNS prophylaxis in NHL patients.…”