Foster Jennifer H, Bernhardt Melanie B, Thompson Patrick A, Smith E OʼBrian, Schafer Eric S
*Baylor College of Medicine †Texas Children's Hospital, Houston, TX ‡University of North Carolina, Chapel Hill, NC.
J Pediatr Hematol Oncol. 2017 Jan;39(1):72-76. doi: 10.1097/MPH.0000000000000696.
We developed a bedside algorithm for individually adjusting the high-dose methotrexate (HDMTX) dose (5 g/m) given to patients with acute lymphoblastic leukemia at high risk for methotrexate toxicity. Data were reviewed for 8 patients receiving 21 cycles of HDMTX as per our algorithm. Eleven cycles began with 5 g/m, 10 cycles began with a preinfusion 20% to 25% dose reduction. Neither mean MTX AUC (2320.5±179.1 vs. 2080.4±161.7 μmol×h/L), mean Cpss (64.3±7.9 vs. 60.8±6.1 μM), nor toxicities were statistically different between groups. Our algorithm allowed the safe administration of HDMTX to patients at risk of MTX toxicities and obviated the need for preinfusion dose reduction.
我们开发了一种床旁算法，用于针对有甲氨蝶呤毒性高风险的急性淋巴细胞白血病患者，个体化调整给予的大剂量甲氨蝶呤（HDMTX）剂量（5 g/m²）。按照我们的算法，对8例接受21个周期HDMTX治疗的患者的数据进行了回顾。11个周期起始剂量为5 g/m²，10个周期起始剂量为输注前减少20%至25%。两组之间的平均甲氨蝶呤曲线下面积（2320.5±179.1 vs. 2080.4±161.7 μmol×h/L）、平均稳态血药浓度（64.3±7.9 vs. 60.8±6.1 μM）以及毒性均无统计学差异。我们的算法允许对有甲氨蝶呤毒性风险的患者安全给予HDMTX，并且无需输注前减少剂量。
