Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Bronx, New York 10467, USA.
Pediatr Blood Cancer. 2010 Dec 15;55(7):1296-9. doi: 10.1002/pbc.22772. Epub 2010 Oct 14.
We describe the safety, feasibility, and provide a cost-estimate of outpatient high-dose methotrexate administration (HDMTX) among an urban, underserved population.
A retrospective analysis of ambulatory HDMTX administration among osteosarcoma patients, at Montefiore Medical Center's Children's Hospital (Bronx, NY) was performed. HDMTX (12 g/m(2)) was given intravenously (IV) over 4 hr after urine alkalinization. Patients were discharged home to continue IV hydration and alkalinization delivered via a home infusion pump. Families were instructed to monitor urine pH overnight and management was adjusted according to our institution's treatment algorithm until MTX level ≤ 0.1 µmol/L. A cost estimate was performed to assess the difference in costs for outpatient versus hypothetical inpatient administrations.
Of the 97 ambulatory HDMTX administrations, 99% were successfully completed. One patient failed outpatient administration secondary to home infusion pump malfunction. This patient successfully completed subsequent courses as an outpatient. Most patients (72%) had a MTX level of < 10 µmol/L at 24 hr post-HDMTX. No patients were found to have a MTX level of > 50 µmol/L at 24 hr. About 26% of courses were associated with grade III or IV neutropenia, 4% were associated with grade III or IV thrombocytopenia and 1% were associated with grade III/IV leukopenia. Compared to a hypothetical hospital inpatient stay, the hospital costs for ambulatory HDMTX were an average of $1400 less per cycle.
Ambulatory HDMTX administration among an underserved, urban population is safe, feasible, and cost-effective.
我们描述了在城市服务不足人群中进行门诊高剂量甲氨蝶呤治疗（HDMTX）的安全性、可行性，并提供了成本估算。
对位于纽约布朗克斯的Montefiore 医疗中心儿童医院的骨肉瘤患者进行门诊 HDMTX 管理的回顾性分析。在尿液碱化后，静脉内（IV）给予 HDMTX（12 g/m²），持续 4 小时。患者被送回家中，通过家庭输液泵继续进行 IV 水化和碱化。告知家属监测尿液 pH 值过夜，并根据我们机构的治疗算法调整管理，直到 MTX 水平≤0.1 μmol/L。进行成本估算以评估门诊与假设住院治疗的成本差异。
在 97 次门诊 HDMTX 治疗中，99%的治疗成功完成。1 名患者因家庭输液泵故障而门诊治疗失败。该患者随后成功完成了门诊治疗。大多数患者（72%）在 HDMTX 后 24 小时 MTX 水平<10 μmol/L。没有患者在 24 小时内发现 MTX 水平>50 μmol/L。约 26%的疗程与 III 级或 IV 级中性粒细胞减少症有关，4%与 III 级或 IV 级血小板减少症有关，1%与 III/IV 级白细胞减少症有关。与假设的医院住院治疗相比，门诊 HDMTX 的医院成本平均每个周期降低 1400 美元。
在城市服务不足人群中进行门诊 HDMTX 治疗是安全、可行且具有成本效益的。
