{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T02:28:21Z","timestamp":1789093701600,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,5,13]],"date-time":"2020-05-13T00:00:00Z","timestamp":1589328000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The standard practice during high\u2010dose methotrexate (HD\u2010MTX) in acute lymphoblastic leukemia (ALL) to mitigate toxicity is to serially monitor levels till serum MTX\u00a0&lt;\u00a00.01\u00a0\u03bcmol\/L. Most resource\u2010limited centers lack in\u2010house access to MTX levels, and therefore repeated monitoring is costly and cumbersome. We studied the efficacy and safety of \u201csolitary 36\u00a0hours post HD\u2010MTX levels (MTX<jats:sub>36<\/jats:sub>).\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>This prospective observational study consecutively enrolled children with ALL receiving HD\u2010MTX. Cycles with unavailable MTX<jats:sub>36<\/jats:sub> and MTX<jats:sub>36\u00a0<\/jats:sub>&gt;\u00a010\u00a0\u03bcmol\/L were excluded. HD\u2010MTX was administered over 24 hours (BFM\u20102009 protocol) with 12 hours of prehydration. MTX<jats:sub>36<\/jats:sub> were performed at other centers. Leucovorin was given in six hourly doses 36 hours post HD\u2010MTX. Hydration was continued until the last dose of leucovorin. MTX toxicities, including change of creatinine from baseline at 36 hours (\u2206Cr<jats:sub>36<\/jats:sub>), were noted. Two groups depending on MTX<jats:sub>36<\/jats:sub>(\u22641\u00a0\u03bcmol\/L vs\u00a0&gt;\u00a01\u00a0\u03bcmol\/L) received six versus eight doses of leucovorin, and toxicities were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010nine children with median age five years (1\u201011) who received 100 HD\u2010MTX cycles with a median MTX dose of 3 g\/m<jats:sup>2<\/jats:sup> (2\u20105) were analyzed. The median MTX<jats:sub>36<\/jats:sub> level was 1.165\u00a0\u03bcmol\/L (0.1\u20107.32). Toxicities of HD\u2010MTX (CTCAE\u20104.0): transaminitis\u201022%; creatinine elevation \u2265 1.25 times baseline\u201024%; cytopenias\u201016%; mucositis\u201017%; acute kidney injury (AKI)\u20106%. All toxicities were \u2264CTCAE grade 3. Creatinine elevation, AKI, and mucositis were significantly higher in the group with higher MTX<jats:sub>36<\/jats:sub>. There was no correlation (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.3) between \u2206Cr<jats:sub>36<\/jats:sub> and MTX<jats:sub>36<\/jats:sub>. MTX<jats:sub>36<\/jats:sub> was thrice more economical than the standard protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>MTX<jats:sub>36<\/jats:sub> is a potential cost\u2010effective, efficacious, and safe limited sample strategy to monitor HD\u2010MTX, particularly in centers where in\u2010house MTX levels are unavailable.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.28387","type":"journal-article","created":{"date-parts":[[2020,5,13]],"date-time":"2020-05-13T09:55:06Z","timestamp":1589363706000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Solitary serum methotrexate level 36\u00a0hours post high\u2010dose methotrexate: A safe, efficacious, and cost\u2010effective strategy to monitor methotrexate toxicities in childhood leukemia in resource\u2010limited centers"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4754-8340","authenticated-orcid":false,"given":"Sanjeev","family":"Khera","sequence":"first","affiliation":[{"name":"Department of Pediatrics Army Hospital Research and Referral  Delhi 110010 India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajan","family":"Kapoor","sequence":"additional","affiliation":[{"name":"Department of Hematology Command Hospital Kolkata  Kolkata West Bengal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suman Kumar","family":"Pramanik","sequence":"additional","affiliation":[{"name":"Department of Hematology Army Hospital Research and Referral  Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,13]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-04-1616"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2401973"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0164"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.11-6-694"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00262416"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-007-0550-4"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27241"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-013-2319-2"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.20032"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.48.6522"},{"key":"e_1_2_9_12_1","unstructured":"Tietz Textbook of Clinical Chemistry(1999) 3rd Edition W.B. Saunders Company pp.896\u2013897."},{"key":"e_1_2_9_13_1","unstructured":"Common Terminology Criteria for Adverse Events (CTCAE).CTCAE are standard criteria published by United States department of health and human services in collaboration with National Institute of Health and National Cancer Institute and is updated regularly.2017;147."},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511550089.060"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24081"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.4172\/Clinical-Investigation.1000134"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0305-7372(77)80007-8"},{"key":"e_1_2_9_18_1","unstructured":"methods\u2010guide\u2010addendum\u2010cost\u2010comparison.pdf [Internet].https:\/\/www.nice.org.uk\/Media\/Default\/About\/what-we-do\/NICE-guidance\/NICE-technology-appraisals\/methods-guide-addendum-cost-comparison.pdf[accessed 2019 Sep 21]."},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2404404"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-013-2206-x"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-016-2795-7"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fpbc.28387","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.28387","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pbc.28387","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.28387","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T04:19:15Z","timestamp":1693282755000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.28387"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,13]]},"references-count":20,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2020,7]]}},"alternative-id":["10.1002\/pbc.28387"],"URL":"https:\/\/doi.org\/10.1002\/pbc.28387","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,13]]},"assertion":[{"value":"2020-02-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-04-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e28387"}}