Comparison of High Dose Methotrexate Administration Between the Inpatient and Outpatient Setting in Children with Acute Lymphoblastic Leukemia

Sun Hee Choi; Kwang Sung Kim; Kyung Eon Kim; Jae Won Kim

doi:10.5388/aon.2014.14.2.93

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Choi, Kim, Kim, and Kim: Comparison of High Dose Methotrexate Administration Between the Inpatient and Outpatient Setting in Children with Acute Lymphoblastic Leukemia

Original Article

Asian Oncology Nursing 2014; 14(2): 93-99.

Published online: 30 June 2014

DOI: https://doi.org/10.5388/aon.2014.14.2.93

Comparison of High Dose Methotrexate Administration Between the Inpatient and Outpatient Setting in Children with Acute Lymphoblastic Leukemia

Sun Hee Choi, Kwang Sung Kim, Kyung Eon Kim, Jae Won Kim

BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to: Kim, Kwang Sung. BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-2786, Fax: +82-2-2258-2780, bm.coor@cmcnu.or.kr

Received 27 March 2014 Revised 8 May 2014 Accepted 20 June 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Methotrexate (MTX) is one of the most widely used anticancer agents, with indications and established protocols in a range of childhood and adult cancers. High dose MTX (HD-MTX) requires aggressive care to prevent toxicity. Limited inpatient conditions are forcing major changes in health care delivery patterns and decisions. We conducted a retrospective study to describe the safety, feasibility and cost-effectiveness of HD-MTX administration in the outpatient setting.

Methods

Patients with acute lymphoblastic leukemia who underwent HD-MTX (3 g/m²) administration in either the inpatient (N=70) or outpatient setting (N=70) from January to July 2012 were included. In the outpatient setting, HD-MTX was administered intravenously (IV) over 6 hours and included hydration with sodium bicarbonate (2000 ml/m²/for 12 hours). Daily visits to the outpatient setting followed. Leucovorin was given 24 hours after MTX at a standard dose (15 mg/m² IV bolus) every 6 hours. We compared the serum drug levels of MTX, hematologic and renal toxicity, hepatotoxicity, frequency of subsequent unscheduled outpatient visits and readmission episodes, medical expenses and duration of hospital stay between the two groups.

Results

HD-MTX administrations were successfully completed in both groups. No significant differences were found between the two groups for the parameters studied. Patients who received HD-MTX in the inpatient setting had 2.37 times and 2.24 times greater medical expenses and duration of hospital stay respectively than outpatient recipients.

Conclusion

This study suggests that HD-MTX administration done with aggressive monitoring in the outpatient setting is safe and efficient, without a greater incidence of major toxicities.

Keywords: Methotrexate, Acute Lymphoblastic Leukemia, Outpatient Setting

Figures and Tables

Fig. 1

Design of study.

Table 1

General and Clinical Characteristics of Subject (N=140)

ECOG=Eastern Cooperative Oncology Group; ANC=Absolute Neutrophil Count.

^*Fisher's exact test.

Table 2

Differences of MTX Level Variables between Two Groups (N=140)

^*Paired t-test; ^†Unpaired t-test.

Table 3

Differences in Dependent Variables between Two Groups (N=140)

ANC=Absolute neutrophil count; ^a-dunpaired t-test=Means with the same letter are significantly different; ^e-kBonferroni test=Means with the same letter is significant difference.

Table 4

Side Effects and Medical Expense, Duration between Two Groups (N=140)

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