1. Clinical Risk Factors for High‐Dose Methotrexate‐Induced Oral Mucositis Following Individualized Dosing
- Author
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Zhongbo Hu, Andrea M. Escalera‐Joy, Emily Ashcraft, Rushil Acharya, Sima Jeha, Cheng Cheng, and Ching‐Hon Pui
- Subjects
acute kidney injury ,acute lymphoblastic leukemia ,delayed methotrexate clearance ,high‐dose methotrexate ,oral mucositis ,risk factors ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
ABSTRACT Background Oral mucositis affects about 20% of children undergoing high‐dose methotrexate (HDMTX) for acute lymphoblastic leukemia (ALL), despite existing management strategies. Personalized HDMTX dosing, adjusted by pharmacokinetics and leukemia risk, has reduced mucositis incidence, but variations still occur with similar 24‐h methotrexate levels. Methods This retrospective study investigated risk factors for oral mucositis under individualized methotrexate protocols. Data from patients with ≥ Grade 2 oral mucositis (CTCAE v4.0) were analyzed from the St. Jude Children's Research Hospital total 16 trial. A 1:1 case–control matching method considered age, sex, risk classification, immunophenotype, and methotrexate course. McNemar's, Bowker's symmetry, and Wilcoxon signed‐rank tests were used for statistical analyses. Risk factors for recurrent mucositis were identified in a case‐only analysis. Results The study found significant associations between methotrexate‐induced mucositis and new‐onset skin rashes (p = 0.0027), fever (p = 0.0016), neutropenic fever (p = 0.0008), lower absolute neutrophil count (p
- Published
- 2024
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