Administration of high-dose methotrexate in lymphoma linked to development of AKI

High-dose methotrexate (HDMTX; > 500 mg/m2) is an important component of lymphoma therapy. Serum MTX monitoring at 48 hours is the standard approach to identify those at increased risk of developing MTX toxicity. Our aim was to characterize the incidence of complications and their association with MTX levels.

• They identified 642 patients with 2,804 cycles of HDMTX. The incidence of AKI was 19.1% with AKI grade ≥ 2 making up 21% of cases.

• Rates of AKI, ICU admission, and 30-day mortality are associated with elevated 48-hour MTX levels.

• There was a significant increase in median LOS with elevated MTX levels (P < .001). Receiver operator characteristic curve analysis for AKI grade ≥ 2 demonstrated a 48-hour MTX level threshold of 1.28 μmol/L.

• Multivariate logistic regression analysis revealed age, male sex, elevated body surface area, higher MTX dose, monotherapy, and first cycle as independent factors.

Elevated MTX levels are associated with a significant increased rate of AKI, ICU admission, prolonged LOS, and 30-day mortality. Elevated 48-hour MTX levels, particularly > 1.28 μmol/L, should alert clinicians for complications and to initiate measures to reduce MTX levels.

Reference:

High-Dose Methotrexate in Patients With Lymphoma: Predictors of a Complicated Course Darragh F. O'Donoghue, Huong L. Truong, Heidi D. Finnes, Jennifer S. McDonald, Heather P. May, Stephen M. Ansell, N. Nora Bennani, Thomas M. Habermann, David J. Inwards, Patrick B. Johnston, Arushi Khurana, Yi Lin, Ivana N. Micallef, Grzegorz S. Nowakowski, Jonas Paludo, Luis F. Porrata, Gita Thanarajasingam, Carrie A. Thompson, Jose C. Villasboas, Yucai Wang, Thomas E. Witzig, and Nelson LeungJCO Oncology Practice 2022 18:12, e1908-e1917

Keywords:

Administration, high-dose, methotrexate, lymphoma, linked, development, AKI, JCO Oncology Practice, Darragh F. O'Donoghue, Huong L. Truong, Heidi D. Finnes, Jennifer S. McDonald, Heather P. May, Stephen M. Ansell, N. Nora Bennani, Thomas M. Habermann, David J. Inwards, Patrick B. Johnston, Arushi Khurana, Yi Lin, Ivana N. Micallef, Grzegorz S. Nowakowski, Jonas Paludo, Luis F. Porrata, Gita Thanarajasingam, Carrie A. Thompson, Jose C. Villasboas, Yucai Wang, Thomas E. Witzig, and Nelson Leung