The relationship between urine output and time to methotrexate clearance in pediatric leukemia patients receiving high-dose methotrexate therapy.

IF 3.4 2区医学 Q2 ONCOLOGY

BMC Cancer Pub Date : 2025-10-09 DOI:10.1186/s12885-025-15064-1

Yi-Lun Wang, Tsung-Yen Chang, Shih-Hsiang Chen, Yi-Wen Hsiao, Yu-Chuan Wen, Tang-Her Jaing

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引用次数: 0

Abstract

Background: High-dose methotrexate (HD-MTX) is a cornerstone of pediatric acute lymphoblastic leukemia (ALL) treatment but poses a risk for delayed clearance and associated toxicities. While hydration is standard to enhance methotrexate (MTX) excretion, the relationship between urine output (UO) and time to MTX clearance remains underexplored.

Methods: We conducted a retrospective study of pediatric ALL patients treated with HD-MTX at Chang Gung Memorial Hospital between August 2023 and February 2025. Patients were stratified into higher (H-UO) and lower urine output (L-UO) groups using a 5.0 mL/kg/hr cutoff. Clinical outcomes including time to MTX normalization, delayed MTX clearance, hospitalization duration, and use of adjunctive diuretics were analyzed.

Results: Thirty-nine patients were included. The H-UO group showed significantly faster MTX clearance (2.0 vs. 4.0 days, P = 0.0035), lower incidence of delayed clearance (18.2% vs. 70.6%, P = 0.0025), and shorter hospital stays (5.0 vs. 7.0 days, P = 0.019). Diuretic use was higher in the L-UO group, primarily as a reactive measure. No significant difference in MTX-related major toxicities was observed.

Conclusions: Higher UO is associated with more efficient time to MTX clearance and shorter hospitalization in pediatric ALL patients receiving HD-MTX. Prospective studies are warranted to optimize supportive care protocols.

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接受大剂量甲氨蝶呤治疗的儿科白血病患者尿量与甲氨蝶呤清除时间的关系

背景：大剂量甲氨蝶呤（HD-MTX）是儿童急性淋巴细胞白血病（ALL）治疗的基石，但存在延迟清除和相关毒性的风险。虽然水合作用是提高甲氨蝶呤（MTX）排泄的标准方法，但尿量（UO）与MTX清除时间之间的关系仍未得到充分研究。方法：我们对2023年8月至2025年2月在长庚纪念医院接受HD-MTX治疗的儿科ALL患者进行了回顾性研究。采用5.0 mL/kg/hr的临界值将患者分为高（H-UO）组和低尿量（L-UO）组。临床结果包括MTX正常化的时间、延迟的MTX清除、住院时间和辅助利尿剂的使用。结果：纳入39例患者。H-UO组MTX清除率明显加快（2.0 vs. 4.0 d, P = 0.0035），延迟清除率发生率较低（18.2% vs. 70.6%, P = 0.0025），住院时间较短（5.0 vs. 7.0 d, P = 0.019）。利尿剂的使用在L-UO组较高，主要作为一种反应性措施。甲氨蝶呤相关的主要毒性未见显著差异。结论：在接受HD-MTX治疗的儿科ALL患者中，较高的UO与更有效的MTX清除时间和更短的住院时间相关。有必要进行前瞻性研究以优化支持性护理方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Cancer 医学-肿瘤学

CiteScore

6.00

自引率

2.60%

发文量

1204

审稿时长

6.8 months

期刊介绍： BMC Cancer is an open access, peer-reviewed journal that considers articles on all aspects of cancer research, including the pathophysiology, prevention, diagnosis and treatment of cancers. The journal welcomes submissions concerning molecular and cellular biology, genetics, epidemiology, and clinical trials.