碘己醇清除率和生物标志物分析预测急性淋巴细胞白血病和淋巴瘤患者接受高剂量甲氨蝶呤的毒性。

IF 0.9 4区 医学 Q4 HEMATOLOGY
Amy L Walz, Masha Kocherginsky, Monica Newmark, Ellen Brooks, David Walterhouse
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引用次数: 0

摘要

背景:大剂量甲氨蝶呤(HDMTX)仍然是急性淋巴细胞白血病/淋巴瘤(ALL)治疗不可或缺的药物。然而,高浓度MTX可导致急性肾损伤(KI)和其他毒性。我们研究了与使用估计GFR (eGFR)的标准护理相比,通过碘己醇清除率测量GFR (mGFR)是否能更好地预测MTX的延迟排泄和/或毒性。我们还研究了KI生物标志物(尿KIM-1和聚集素、血清胱抑素C和血浆FGF23)是否比单独的血清肌酐(sCr)更能识别KI。操作步骤:所有患者均接受4剂HDMTX加碱化静脉输液、亚叶酸素抢救和MTX清除。我们在HDMTX剂量1和4之前获得了mGFRs。使用Schwartz公式计算eGFR,并在每次HDMTX剂量周围收集KI的生物标志物。结果:总体而言,mGFR/生物标志物与KI和其他毒性之间存在一定的相关性,但mGFR没有发现比eGFR更好地预测MTX延迟清除或毒性。生物标志物并不比单独使用sCr更频繁地预测KI的发展。结论:在本研究的基础上,没有证据表明HDMTX给药前或给药后确定GFR的现行护理标准应进行调整。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Iohexol Clearance and Biomarker Analysis to Predict Toxicity in Patients With Acute Lymphoblastic Leukemia and Lymphoma Receiving High-Dose Methotrexate.

Background: High-dose methotrexate (HDMTX) remains integral to acute lymphoblastic leukemia/lymphoma (ALL) treatment. However, high MTX concentrations can lead to acute kidney injury (KI) and other toxicities. We investigated whether measured GFR (mGFR) by iohexol clearance better predicts delayed MTX excretion and/or toxicity compared with standard of care using an estimated GFR (eGFR). We also examined if KI biomarkers (urine KIM-1 and clusterin, serum cystatin C, and plasma FGF23) identify KI more frequently than serum creatinine (sCr) alone.

Procedure: ALL patients receive 4 doses of HDMTX with alkalinized IV fluids, leucovorin rescue, and MTX clearance per the standard of care. We obtained mGFRs before HDMTX doses 1 and 4. eGFR was calculated using the Schwartz formula and biomarkers of KI were collected around each HDMTX dose.

Results: Overall, there were some associations between the mGFR/biomarkers with KI and other toxicities, but mGFR was not found to be a better predictor of delayed MTX clearance or toxicity than eGFR. The biomarkers did not predict KI development more frequently than sCr alone.

Conclusions: On the basis of this study, there is no evidence that the current standard of care for determining the GFR in advance of HDMTX administration, nor postadministration management, should be adjusted.

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来源期刊
CiteScore
1.90
自引率
8.30%
发文量
415
审稿时长
2.5 months
期刊介绍: ​Journal of Pediatric Hematology/Oncology (JPHO) reports on major advances in the diagnosis and treatment of cancer and blood diseases in children. The journal publishes original research, commentaries, historical insights, and clinical and laboratory observations.
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