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[Adverse effects of high-dose methotrexate therapy]
Qing Sun1, Yao Xie, Wei-Hong Zhao
1Department of Pediatrics, Peking University First Hospital, Beijing 100034, China. zhaowh3212@126.com.
Summary
High-dose methotrexate (HDMTX) therapy in children causes significant bone marrow suppression and digestive issues. Adverse effects like oral mucositis and proteinuria increase with higher doses, necessitating careful clinical management.
Area of Science:
- Pediatric Oncology
- Pharmacology
- Hematology
Background:
- High-dose methotrexate (HDMTX) is crucial for treating pediatric cancers like acute lymphoblastic leukemia and non-Hodgkin lymphoma.
- Understanding HDMTX's adverse effects is vital for optimizing treatment protocols and patient outcomes.
Purpose of the Study:
- To investigate the adverse effects associated with high-dose methotrexate (HDMTX) therapy in pediatric cancer patients.
- To establish a theoretical foundation for refining clinical treatment strategies involving HDMTX.
Main Methods:
- Retrospective analysis of clinical data from 120 children undergoing 601 HDMTX treatments.
- Adverse effects were categorized using the World Health Organization (WHO) criteria for anticancer drug toxicity.
Main Results:
- Bone marrow suppression and granulocytopenia were nearly universal. Elevated glutamic-pyruvic transaminase (60.4%) and proteinuria (9.2%) were common digestive and urinary toxicities.
- Higher HDMTX doses (5 g/m² vs. 3 g/m²) correlated with increased plasma MTX levels, reduced hemoglobin and platelets, and higher rates of oral mucositis, proteinuria, and skin symptoms (P<0.05).
Conclusions:
- Serious adverse effects of HDMTX primarily impact the blood and digestive systems.
- Bone marrow suppression, oral mucositis, proteinuria, and skin symptoms exhibit a dose-dependent relationship with HDMTX treatment.
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