Implementation of an Outpatient HD-MTX Initiative.

Area of Science:

• Oncology
• Pharmacology

Background:

• High-dose methotrexate (HDMTX) is used for various conditions.
• Inpatient administration is standard, but outpatient settings offer patient-centered care.
• Developing safe and effective outpatient HDMTX protocols is crucial.

Purpose of the Study:

• To describe the development of an outpatient HDMTX protocol.
• To evaluate the initial safety and feasibility of this outpatient approach.

Main Methods:

• Patients received initial HDMTX cycle inpatient for monitoring and training.
• Outpatient protocol included IV sodium bicarbonate, oral leucovorin, and acetazolamide.
• Daily clinic visits for labs and methotrexate levels, with clear admission criteria for toxicity or delayed clearance.

Main Results:

• Two patients completed the safety run-in phase and tolerated treatment well.
• No toxicity was observed, and methotrexate cleared within 3 days for all cycles.
• Patients adhered to medication schedules and monitoring, reporting adequate teaching.

Conclusions:

• An outpatient protocol for HDMTX was successfully developed and implemented.
• Initial safety evaluation indicates feasibility, but further study is needed.
• Larger patient cohorts and more treatment cycles are required to fully assess outpatient HDMTX efficacy.