延迟高剂量甲氨蝶呤消除的预测因素:弥漫性大b细胞淋巴瘤患者的一个实际问题。

IF 1 4区 医学 Q4 ONCOLOGY
Margot Vattaire-Hervé, Antoine Le Bozec, Justine Clarenne, Guillaume Cohet, Violaine Lepage, Chloé Gossery, Elise Michelet-Huot, Anne Quinquenel, Isabelle Madelaine, Eric Durot, Florian Slimano
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引用次数: 0

摘要

目的高剂量甲氨蝶呤(HD-MTX)方案(bbb10 1 g/m2)是预防和治疗弥漫性大b细胞淋巴瘤(DLBCL)中枢神经系统(CNS)侵袭的标准护理方案。延迟消除HD-MTX可导致严重的毒性。白蛋白是一种预测延迟消除的生物标志物。本研究旨在评估血清白蛋白是否可作为预测因素。方法回顾性双中心研究纳入2016年6月30日至2023年12月31日使用CHIMI0v5.9接受HD-MTX治疗的DLBCL患者。收集的数据包括人口统计、生物学、临床和治疗。符合条件的患者年龄大于18岁,诊断为DLBCL, HD-MTX治疗前血清白蛋白可用,血浆甲氨蝶呤治疗药物监测可用。单因素和多因素分析比较延迟消除和不延迟消除的患者。结果共纳入68例患者,其中延迟消除15例。单因素分析显示,男性和体表面积≥2 m²(BSA)的患者更容易出现延迟清除(p = 0.01;p = 0.05)。多因素分析证实与男性性别相关(p = 0.01)。多数低白蛋白血症患者为1级或2级。低白蛋白血症患者接受较低剂量的MTX。血清白蛋白水平与延迟消除无显著相关性(p = 0.8)。结论总体而言,与延迟消除相关的主要是生物特征因素,突出了基于体表的处方习惯问题。白蛋白血症的作用仍有争议,本研究没有提供结论,因为低白蛋白血症患者接受的HD-MTX剂量较低。研究应考虑与炎症、营养和特定生物标志物(前白蛋白)相关的因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictive factors for delayed high-dose methotrexate elimination: A practical issue for diffuse large B-cell lymphoma patients.

PurposeThe high-dose methotrexate (HD-MTX) regimen (>1 g/m2) is the standard of care for preventing and managing central nervous system (CNS) invasion in diffuse large B-cell lymphoma (DLBCL). Delayed elimination of HD-MTX can lead to severe toxicity. Albumin is a suggested biological marker to predict delayed elimination. This study aims to evaluate whether serum albumin can be used as a predictive factor.MethodsThis retrospective bicentric study includes DLBCL patients, receiving HD-MTX from 06.30.2016 to 12.31.2023 using CHIMI0v5.9. Data collected included demographic, biological, clinical and therapeutic. Eligible patients were over 18 years, with DLBCL diagnosis, available serum albumin before HD-MTX, with therapeutic drug monitoring of plasma methotrexate available. Univariate and multivariate analysis compared patients with and without delayed elimination.ResultsA total of 68 patients were included, with 15 suffering delayed elimination. Univariate analysis showed that male and Body Surface Area ≥ 2 m² (BSA) patients were more likely to have delayed clearance (respectively p = 0.01; p = 0.05). The association with male sex was confirmed in multivariate analysis (p = 0.01). Most cases of hypoalbuminemia were classified as grade 1 or 2. Patients with hypoalbuminemia received lower doses of MTX. Serum albumin level was not significantly associated with delayed elimination (p = 0.8).ConclusionsOverall, mainly biometric factors are associated with delayed elimination, highlighting the problem of prescribing habits based on body surface area. Albuminemia's role remains debated, and this study does not provide a conclusion, as patients with hypoalbuminemia received lower HD-MTX doses. Studies should account factors related to inflammation, nutrition and specific biomarkers (prealbumin).

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来源期刊
CiteScore
2.70
自引率
7.70%
发文量
276
期刊介绍: Journal of Oncology Pharmacy Practice is a peer-reviewed scholarly journal dedicated to educating health professionals about providing pharmaceutical care to patients with cancer. It is the official publication of the International Society for Oncology Pharmacy Practitioners (ISOPP). Publishing pertinent case reports and consensus guidelines...
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