Incidence and management of patients with methotrexate delayed elimination in the clinical practice: A Delphi study

Introduction High-dose methotrexate (HDMTX) is administered for the treatment of some cancers. HDMTX is usually safe but may crystallize in renal tubules causing acute kidney injury (AKI). Consequently, MTX elimination is delayed, resulting in a severe and life-threatening condition. No studies have...

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Autores: Gros, L, Roldan, A, Cabero-Martinez, A, Dominguez-Pinilla, N, de la Fuente, A, Gonzalez-Barca, E, Tasso, M, Torrent, M, Gallardo, E, del Cerro, I, Giro-Perafita, A, Badia, X
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
Repositorio:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
OAI Identifier:oai:isabial.fundanetsuite.com:p8463
Acceso en línea:https://isabial.portalinvestigacion.com/publicaciones8463
Access Level:acceso abierto
Palabra clave:High-dose methotrexate
acute kidney injury
methotrexate delayed elimination
clinical management
epidemiology
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spelling Incidence and management of patients with methotrexate delayed elimination in the clinical practice: A Delphi studyGros, LRoldan, ACabero-Martinez, ADominguez-Pinilla, Nde la Fuente, AGonzalez-Barca, ETasso, MTorrent, MGallardo, Edel Cerro, IGiro-Perafita, ABadia, XHigh-dose methotrexateacute kidney injurymethotrexate delayed eliminationclinical managementepidemiologyIntroduction High-dose methotrexate (HDMTX) is administered for the treatment of some cancers. HDMTX is usually safe but may crystallize in renal tubules causing acute kidney injury (AKI). Consequently, MTX elimination is delayed, resulting in a severe and life-threatening condition. No studies have been published about the impact of MTX toxicity in Spain. This study aims to estimate the incidence and management of MTX delayed elimination and toxicity. Methods A two-round Delphi study was performed to reach consensus between 10 medical experts on haemato-oncology and paediatric oncology with experience in the management of HDMTX treated patients from leading Spanish hospitals. An online questionnaire was developed based on national and international guidelines and previous evidence regarding HDMTX-related toxicity. Consensus was established at 80% agreement. Median and interquartile ranges were calculated, and incidence data were extrapolated to the Spanish general population. Results Out of 1.475 patients estimated to receive HDMTX treatment annually in Spain, 27.5% present MTX delayed elimination and 11.6% develop HDMTX-induced AKI (35.4% with severe systemic toxicities (>grade 3) and 18.8% develop chronic renal disease). Mortality is estimated in 4.2%. Immuno-enzymatic assay is used in most of the hospitals (90%) for MTX serum level monitoring. All experts use increased supportive care and high leucovorin as first-line treatment. Available treatments in experts' hospitals in case toxicity persists are haemodialysis (90% of hospitals), glucarpidase (60%) and hemofiltration (50%). Most prevalent non-renal systemic toxicities are haematologic and mucositis (21-40% of patients). Patients with HDMTX-induced AKI require from intensive care (5% of patients), more than 3 sessions and 4 days of dialysis, and about 8.5 days of hospitalization (non-ICU patients) and 12 days in case of patients requiring ICU. Conclusions These results are the first evidence regarding HDMTX-induced AKI in Spain. Incidence and mortality results are in line with previous studies. Clinical management is based on preventive measures and the treatment depend on the availability in the hospital. The need for effective, safe and rapid treatment for the reduction of MTX toxic levels and the improvement of monitoring methods were noted by experts as urgent needs. Further observational studies to validate these results would be needed.SAGE Publications2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://isabial.portalinvestigacion.com/publicaciones8463Journal of Oncology Pharmacy PracticeISSN: 1477092XISSNe: 10781552reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicanteinstname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)Inglésinfo:eu-repo/semantics/openAccessoai:isabial.fundanetsuite.com:p84632026-06-12T10:20:37Z
dc.title.none.fl_str_mv Incidence and management of patients with methotrexate delayed elimination in the clinical practice: A Delphi study
title Incidence and management of patients with methotrexate delayed elimination in the clinical practice: A Delphi study
spellingShingle Incidence and management of patients with methotrexate delayed elimination in the clinical practice: A Delphi study
Gros, L
High-dose methotrexate
acute kidney injury
methotrexate delayed elimination
clinical management
epidemiology
title_short Incidence and management of patients with methotrexate delayed elimination in the clinical practice: A Delphi study
title_full Incidence and management of patients with methotrexate delayed elimination in the clinical practice: A Delphi study
title_fullStr Incidence and management of patients with methotrexate delayed elimination in the clinical practice: A Delphi study
title_full_unstemmed Incidence and management of patients with methotrexate delayed elimination in the clinical practice: A Delphi study
title_sort Incidence and management of patients with methotrexate delayed elimination in the clinical practice: A Delphi study
dc.creator.none.fl_str_mv Gros, L
Roldan, A
Cabero-Martinez, A
Dominguez-Pinilla, N
de la Fuente, A
Gonzalez-Barca, E
Tasso, M
Torrent, M
Gallardo, E
del Cerro, I
Giro-Perafita, A
Badia, X
author Gros, L
author_facet Gros, L
Roldan, A
Cabero-Martinez, A
Dominguez-Pinilla, N
de la Fuente, A
Gonzalez-Barca, E
Tasso, M
Torrent, M
Gallardo, E
del Cerro, I
Giro-Perafita, A
Badia, X
author_role author
author2 Roldan, A
Cabero-Martinez, A
Dominguez-Pinilla, N
de la Fuente, A
Gonzalez-Barca, E
Tasso, M
Torrent, M
Gallardo, E
del Cerro, I
Giro-Perafita, A
Badia, X
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv High-dose methotrexate
acute kidney injury
methotrexate delayed elimination
clinical management
epidemiology
topic High-dose methotrexate
acute kidney injury
methotrexate delayed elimination
clinical management
epidemiology
description Introduction High-dose methotrexate (HDMTX) is administered for the treatment of some cancers. HDMTX is usually safe but may crystallize in renal tubules causing acute kidney injury (AKI). Consequently, MTX elimination is delayed, resulting in a severe and life-threatening condition. No studies have been published about the impact of MTX toxicity in Spain. This study aims to estimate the incidence and management of MTX delayed elimination and toxicity. Methods A two-round Delphi study was performed to reach consensus between 10 medical experts on haemato-oncology and paediatric oncology with experience in the management of HDMTX treated patients from leading Spanish hospitals. An online questionnaire was developed based on national and international guidelines and previous evidence regarding HDMTX-related toxicity. Consensus was established at 80% agreement. Median and interquartile ranges were calculated, and incidence data were extrapolated to the Spanish general population. Results Out of 1.475 patients estimated to receive HDMTX treatment annually in Spain, 27.5% present MTX delayed elimination and 11.6% develop HDMTX-induced AKI (35.4% with severe systemic toxicities (>grade 3) and 18.8% develop chronic renal disease). Mortality is estimated in 4.2%. Immuno-enzymatic assay is used in most of the hospitals (90%) for MTX serum level monitoring. All experts use increased supportive care and high leucovorin as first-line treatment. Available treatments in experts' hospitals in case toxicity persists are haemodialysis (90% of hospitals), glucarpidase (60%) and hemofiltration (50%). Most prevalent non-renal systemic toxicities are haematologic and mucositis (21-40% of patients). Patients with HDMTX-induced AKI require from intensive care (5% of patients), more than 3 sessions and 4 days of dialysis, and about 8.5 days of hospitalization (non-ICU patients) and 12 days in case of patients requiring ICU. Conclusions These results are the first evidence regarding HDMTX-induced AKI in Spain. Incidence and mortality results are in line with previous studies. Clinical management is based on preventive measures and the treatment depend on the availability in the hospital. The need for effective, safe and rapid treatment for the reduction of MTX toxic levels and the improvement of monitoring methods were noted by experts as urgent needs. Further observational studies to validate these results would be needed.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://isabial.portalinvestigacion.com/publicaciones8463
url https://isabial.portalinvestigacion.com/publicaciones8463
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv SAGE Publications
publisher.none.fl_str_mv SAGE Publications
dc.source.none.fl_str_mv Journal of Oncology Pharmacy Practice
ISSN: 1477092X
ISSNe: 10781552
reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
instname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
instname_str Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
reponame_str r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
collection r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
repository.name.fl_str_mv
repository.mail.fl_str_mv
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