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

Written By : Dr. Shravani Dali |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-01-09T09:45:58+05:30 | Updated On 9 Jan 2023 2:04 PM IST

Administration of high-dose methotrexate in lymphoma linked to the development of AKI suggests a recent study published in JCO Oncology Practice

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.

A retrospective review of our institutional electronic medical record was conducted to identify patients with lymphoma who received HDMTX between January 1, 2002, and December 31, 2018. We characterized the incidence of acute kidney injury (AKI), intensive care unit (ICU) admission, length of hospital stay (LOS), and 30-day mortality across 48-hour MTX levels. To establish an association between 48-hour MTX levels and the complications listed, we performed chi-square analysis for dichotomous variables and Kruskal-Wallis for nonparametric data. Receiver operator characteristic curve analysis was performed to identify the MTX level where AKI grade ≥ 2 was more likely. Multivariate logistic regression analysis was performed to identify risk factors for this MTX level.

RESULTS:

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

JCO Oncology Practicelymphomamethotrexate

Source : JCO Oncology Practice

Dr. Shravani Dali

Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751