Patient population
During the study period, 196 HD-MTX doses were administered to 46 unique
patients. Overall, patients included in the analysis were 39%
non-Latino White, 33% Latino, and 24% non-Latino Black (Table 1). The
mean age of the cohort was 10.5 years at diagnosis, and a majority
patients were male (n=34; 74%). The most common oncologic diagnosis was
anaplastic large cell lymphoma (ALCL; n=25, 54%), followed by 21
patients (46%) with mature B-NHL, and one patient with peripheral
T-cell lymphoma, NOS. The median number of HD-MTX doses per patient was
4 (range: 1 to 6). All patients were treated on or according to one of
the following protocols: ALCL99, ANHL12P1, ANHL01P1, and ANHL1131.[8,
10, 12, 13] All patients received protocol-defined supportive care as
previously described,[8, 10, 12, 13] including intravenous hydration
with alkalinized intravenous fluids, urine pH and output goals,
scheduled leucovorin rescue, serum creatinine trending, and methotrexate
serum level monitoring at hours 24, 48 and at least every 24 hours until
methotrexate level <0.1 or 0.15 μM/L (per protocol).
Supportive care interventions for methotrexate clearance were adjusted
to achieve therapeutic goals per institutional practice or clinical
trial protocol. Patients were counseled on good oral care and given a
salt and soda mouthwash for mucositis prevention. Forty-one patients
were alive at the time of data extraction (89%). No patient died due to
methotrexate-related toxicity.