Asian Oncol Nurs.  2014 Jun;14(2):93-99. 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

• Choi SH
• Kim KS
• Kim KE
• Kim JW

• KMID: 2269463
• DOI: http://doi.org/10.5388/aon.2014.14.2.93

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.

Keyword

Methotrexate; Acute Lymphoblastic Leukemia; Outpatient Setting

MeSH Terms

Adult
Antineoplastic Agents
Child*
Delivery of Health Care
Humans
Incidence
Inpatients*
Length of Stay
Leucovorin
Methotrexate*
Outpatients*
Precursor Cell Lymphoblastic Leukemia-Lymphoma*
Retrospective Studies
Sodium Bicarbonate
Antineoplastic Agents
Leucovorin
Methotrexate
Sodium Bicarbonate

Figure

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  Fig. 1 Design of study.

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