| Abstract [eng] |
Methotrexate is an antimetabolite, structurally similar to folic acid. Methotrexate interferes with purine and pyrimidine synthesis thus killing the cell. Folinic acid has to be co-administered when treating patients with methotrexate. Methotrexate is widely used to treat oncological and autoimmune diseases and is an integral part in the of the NOPHO ALL2008 protocol that is used to treat acute lymphoblastic leukemia. If used carelessly, methotrexate can cause a variety of toxic reactions, one of the most important being acute kidney injury. In the pursuit to minimize methotrexate toxicity a significant number of studies are trying to identify the risk factors of delayed methotrexate elimination. The NOPHO ALL2008 protocol was used in Lithuania between 2008 and 2018. During this period 168 pediatric acute lymphoblastic leukemia patients received 1210 doses of high dose methotrexate. In this study we analyzed this population and identified the following risk factors of delayed elimination of high dose methotrexate: male gender, T cell acute lymphoblastic leukemia, intermediate acute lymphoblastic leukemia risk group, treatment before the implementation of standardized supportive care with pre-hydration duration of 18 hours, older age. |
