Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/30204
Title: Toxicity associated with high-dose intravenous methotrexate for hematological malignancies.
Austin Authors: Wight, Joel C ;Ku, Matthew;Garwood, Melissa;Carradice, Duncan;Lasica, Masa;Keamy, Louise;Hawkes, Eliza A ;Grigg, Andrew P 
Affiliation: Austin Health
Olivia Newton-John Cancer Research Institute
Western Health, Melbourne, Australia
Box Hill Hospital, Melbourne, Australia
Townsville University Hospital, Townsville, Australia
St Vincent's Hospital, Melbourne, Australia
The University of Melbourne, Melbourne, Australia
Monash University, Melbourne, Australia
Issue Date: 16-May-2022
Date: 2022
Publication information: Leukemia & Lymphoma 2022; 63(10): 2375-2382
Abstract: Intravenous high-dose methotrexate (HD-MTX) is a critical chemotherapeutic agent in hematological malignancies, however, data are lacking on how to predict and prevent toxicities such as kidney injury. We retrospectively analyzed 539 episodes of HD-MTX (≥1 g/m2) delivered to 144 patients for treatment of prophylaxis of CNS hematological malignancy across three Australian institutions and correlated risk factors with toxicity. Clinically relevant (CTCAE v4.03 grade 2-4) nephrotoxicity occurred on 36 (7%) occasions and was mostly grade 2. Multivariate analysis revealed that doses ≥6 g/m2 (HR 5.02, 95%CI 1.46-17.2, p = 0.01) and interacting/nephrotoxic drugs (HR: 7.15, 91%CI: 2.18-23.512, p = 0.001) were the only factors associated with nephrotoxicity. 48-hour methotrexate level, hypoalbuminemia and increasing age were associated with prolonged clearance but not nephrotoxicity. Mucositis, liver dysfunction and cytopenias were transient and mild in most cases. We have demonstrated that the most common risk factors for nephrotoxicity are modifiable which may assist clinical decision-making when administering this important drug.
URI: https://ahro.austin.org.au/austinjspui/handle/1/30204
DOI: 10.1080/10428194.2022.2074987
ORCID: 0000-0002-3216-2392
0000-0002-9289-1335
0000-0002-0376-2559
0000-0001-5743-3171
Journal: Leukemia & Lymphoma
PubMed URL: 35575146
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/35575146/
Type: Journal Article
Subjects: Methotrexate
hematological malignancy
nephrotoxicity
Appears in Collections:Journal articles

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