{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T12:35:27Z","timestamp":1790253327467,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2010,10,14]],"date-time":"2010-10-14T00:00:00Z","timestamp":1287014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2010,12,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We describe the safety, feasibility, and provide a cost\u2010estimate of outpatient high\u2010dose methotrexate administration (HDMTX) among an urban, underserved population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>A retrospective analysis of ambulatory HDMTX administration among osteosarcoma patients, at Montefiore Medical Center's Children's Hospital (Bronx, NY) was performed. HDMTX (12\u2009g\/m<jats:sup>2<\/jats:sup>) was given intravenously (IV) over 4\u2009hr after urine alkalinization. Patients were discharged home to continue IV hydration and alkalinization delivered via a home infusion pump. Families were instructed to monitor urine pH overnight and management was adjusted according to our institution's treatment algorithm until MTX level \u22640.1\u2009\u00b5mol\/L. A cost estimate was performed to assess the difference in costs for outpatient versus hypothetical inpatient administrations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 97 ambulatory HDMTX administrations, 99% were successfully completed. One patient failed outpatient administration secondary to home infusion pump malfunction. This patient successfully completed subsequent courses as an outpatient. Most patients (72%) had a MTX level of &lt;10\u2009\u00b5mol\/L at 24\u2009hr post\u2010HDMTX. No patients were found to have a MTX level of &gt;50\u2009\u00b5mol\/L at 24\u2009hr. About 26% of courses were associated with grade III or IV neutropenia, 4% were associated with grade III or IV thrombocytopenia and 1% were associated with grade III\/IV leukopenia. Compared to a hypothetical hospital inpatient stay, the hospital costs for ambulatory HDMTX were an average of $1400 less per cycle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Ambulatory HDMTX administration among an underserved, urban population is safe, feasible, and cost\u2010effective. Pediatr Blood Cancer. 2010;55:1296\u20131299. \u00a9 2010 Wiley\u2010Liss, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.22772","type":"journal-article","created":{"date-parts":[[2010,10,14]],"date-time":"2010-10-14T19:34:37Z","timestamp":1287084877000},"page":"1296-1299","source":"Crossref","is-referenced-by-count":31,"title":["Ambulatory high\u2010dose methotrexate administration among pediatric osteosarcoma patients in an urban, underserved setting is feasible, safe, and cost\u2010effective"],"prefix":"10.1002","volume":"55","author":[{"given":"Kris M.","family":"Mahadeo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Santizo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan O'Hanlon","family":"Curry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Gorlick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam S.","family":"Levy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2010,10,14]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1A446"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21419"},{"key":"e_1_2_6_4_2","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1542\/peds.95.6.896","article-title":"A prospective, controlled evaluation of home chemotherapy for children with cancer","volume":"95","author":"Close P","year":"1995","journal-title":"Pediatrics"},{"key":"e_1_2_6_5_2","first-page":"318","volume-title":"General principles of chemotherapy: Principles and practices of pediatric oncology","author":"Adamson PC","year":"2006"},{"key":"e_1_2_6_6_2","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1093\/clinchem\/42.8.1322","article-title":"Concepts in the use of high\u2010dose methotrexate therapy","volume":"42","author":"Treon SP","year":"1996","journal-title":"Clin Chem"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.14.7793"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70309-7"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197906)43:6<2163::AID-CNCR2820430602>3.0.CO;2-S"},{"key":"e_1_2_6_10_2","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/BLO.0b013e318142b27d","article-title":"Time dependency of prognostic factors in patients with stage II osteosarcomas","volume":"463","author":"Kim MS","year":"2007","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_6_11_2","first-page":"201","article-title":"The role of high\u2010dose methotrexate in osteogenic sarcoma in sarcomas in soft tissue and bone in childhood","volume":"56","author":"Jaffe N","year":"1981","journal-title":"Natl Cancer Inst Monogr"},{"key":"e_1_2_6_12_2","first-page":"745","article-title":"Incidence of drug\u2010related deaths secondary to high\u2010dose methotrexate and citrovorum factor administration","volume":"61","author":"Von Hoff DD","year":"1977","journal-title":"Cancer Treat Rep"},{"key":"e_1_2_6_13_2","first-page":"695","article-title":"Weekly methotrexate\u2010calcium leucovorin rescue: Effect of alkalinization on nephrotoxicity; 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