1. Ambulatory high-dose methotrexate administration as central nervous system prophylaxis in patients with aggressive lymphoma
- Author
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E. Miekoutima, L. Aguinaga, Emeline Perrial, Isabelle Madelaine, Sophie Bernard, Catherine Thieblemont, Pauline Brice, J. F. Diasonama, Hannah Moatti, L. Hachon, and C. Madaoui
- Subjects
Central Nervous System ,Male ,Vindesine ,Leucovorin ,Aggressive lymphoma ,Kidney Function Tests ,Gastroenterology ,Liver Function Tests ,Antineoplastic Combined Chemotherapy Protocols ,Ambulatory Care ,Infusions, Intravenous ,(n = 5, < 6) ,Lymphoma, Non-Hodgkin ,Outpatient ,Hematology ,General Medicine ,Middle Aged ,High-dose methotrexate ,Vincristine ,Ambulatory ,Original Article ,Female ,Kidney Diseases ,Lymphoma, Large B-Cell, Diffuse ,Chemical and Drug Induced Liver Injury ,Rituximab ,medicine.drug ,Adult ,medicine.medical_specialty ,Antimetabolites, Antineoplastic ,Outpatient Clinics, Hospital ,Monitoring ,Adolescent ,Neutropenia ,Bleomycin ,Young Adult ,Internal medicine ,medicine ,Humans ,Neoplasm Invasiveness ,Adverse effect ,Cyclophosphamide ,Retrospective Studies ,Performance status ,business.industry ,medicine.disease ,CNS prophylaxis ,Hematologic Diseases ,Regimen ,Methotrexate ,Doxorubicin ,Prednisone ,business ,Diffuse large B-cell lymphoma - Abstract
High-dose methotrexate (HD-MTX) at 3 g/m2 is one of the strategies for central nervous system (CNS) prophylaxis in the first-line treatment of aggressive lymphomas, especially in diffuse large B cell lymphoma patients with high-risk CNS-International Prognostic Index. The objective of our study was to retrospectively analyze the safety of 2 cycles of systemic HD-MTX administered as an ambulatory regimen. Between January 2013 and December 2016, 103 patients were carefully selected on 6 criteria, including age 34, performance status 0 or 1, normal renal and hepatic functions, good understanding of practical medical guidance, and no loss of weight. Strict procedures of HD-MTX infusion were observed including alkalinization, urine pH monitoring, and leucovorin rescue. Renal and hepatic functions were monitored at days 2 and 7. MTX clearance was not monitored. Toxicities and grades of toxicity were collected according to the NCI-CTCAE (version 4.0). Among the 103 selected patients, 92 (89%) patients successfully completed the planned 2 cycles of HD-MTX on an outpatient basis. Eleven patients completed only 1 cycle, 3 because of lymphoma progression and 8 because of toxicity including 3 grade II hepatotoxicity, 2 grade I/II renal toxicity, 1 grade III neutropenia, 1 active herpetic infection, and 1 grade III ileus reflex. Reported adverse events (AE) included 92 (84%) grade I/II and 18 (16%) grade III/IV. Grade III hepatotoxicity, mostly cytolysis, was the most frequent AE observed with 8 (8%) events. Grade III/IV hematologic toxicities concerned 9 patients with 8 grade III/IV neutropenia and 1 thrombocytopenia. Renal toxicity was rare, mild, and transient, observed with 4 (4%) grade I/II events. Ambulatory administration of HD-MTX at 3 g/m2 without MTX clearance monitoring is safe with strict medical guidance. It requires careful selection of patients before administration, and a renal and hepatic monitoring after the administration.
- Published
- 2021