{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:00:10Z","timestamp":1790172010802,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Conventional multi\u2010time point monitoring during high\u2010dose methotrexate (HD\u2010MTX) therapy is often impractical in low\u2010 and middle\u2010income countries (LMICs). A simplified single\u2010time\u2010point monitoring strategy may offer a feasible alternative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the proportion of patients achieving adequate MTX clearance (\u22640.4\u00a0\u00b5mol\/L) at 48\u00a0h following initiation of HD\u2010MTX.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>In this prospective observational study, children with high\u2010risk B\u2010lineage and T\u2010cell acute lymphoblastic leukemia receiving HD\u2010MTX were enrolled. Single time point MTX levels were measured 48 h from initiation of infusion. MTX level &gt;0.4\u00a0\u00b5mol\/L received intensified hydration and leucovorin rescue. Toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Patients with pre\u2010existing renal insufficiency or prior Grades 3 and 4 MTX toxicity were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010two children (age 2\u201312 years) undergoing 106 cycles of HD\u2010MTX were evaluated. MTX clearance at 48\u00a0h was achieved in 74.5% (79\/106). Delayed clearance normalized at 72\u00a0h in 5\/16 retested cycles. Age &gt;7 years (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.025) and higher baseline serum creatinine (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.022) predicted delayed clearance. Elevated 48\u2010h levels correlated with neutropenia (13%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.0096), transaminitis, mucositis, and acute kidney injury occurred in 10.4%, 7.5%, and 3.8% of cycles.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A single 48\u2010h MTX level can facilitate discharge decisions in approximately 75% of treatment cycles in a preselected cohort of patients. This approach may provide a pragmatic and cost\u2010effective strategy in resource\u2010limited settings, though its safety in unselected populations remains to be established. Validation in larger, unselected cohorts is needed before broad implementation can be recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70672","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:07:10Z","timestamp":1789049230000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prospective Evaluation of Single\u2010Time\u2010Point Methotrexate Monitoring During High\u2010Dose Therapy in Pediatric Leukemias and Lymphomas"],"prefix":"10.1002","volume":"73","author":[{"given":"Aamir","family":"Dogra","sequence":"first","affiliation":[{"name":"Paediatric Haematology Oncology Unit, Department of Paediatrics Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6096-3587","authenticated-orcid":false,"given":"Prateek","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Paediatric Haematology Oncology Unit, Department of Paediatrics Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1009-7649","authenticated-orcid":false,"given":"Deepak","family":"Bansal","sequence":"additional","affiliation":[{"name":"Paediatric Haematology Oncology Unit, Department of Paediatrics Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9071-7651","authenticated-orcid":false,"given":"Amita","family":"Trehan","sequence":"additional","affiliation":[{"name":"Paediatric Haematology Oncology Unit, Department of Paediatrics Postgraduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.01760"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13045\u2010023\u201001409\u20105"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/08880010050211321"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V71.4.866.866"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.2950160502"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015\u20100164"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpam.2016.08.008"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.66222"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.11\u20106\u2010694"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2021.22.7.2025"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.53.0808"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1998.16.5.1712"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399\u20103003.2000.15b25.x"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00262416"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27241"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28387"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/08880018.2020.1863535"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28394"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12288\u2010019\u201001144\u20103"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063\u2010022\u201006033\u20101"},{"key":"e_1_2_9_22_1","unstructured":"National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0U.S. Department of Health and Human Services 2017 https:\/\/dctd.cancer.gov\/research\/ctep\u2010trials\/for\u2010sites\/adverse\u2010events\/ctcae\u2010v5\u20105X7.pdf."},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24081"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00280\u2010026\u201004869\u2010x"},{"issue":"1","key":"e_1_2_9_25_1","first-page":"16","article-title":"High Dose Methotrexate in Children With Cancer Without Drug Level Monitoring\u2013133 Cycles Experience","volume":"1","author":"Gunasekaran V.","year":"2023","journal-title":"Kauverian Medical Journal"}],"container-title":["Pediatric Blood &amp; 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