{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T02:28:23Z","timestamp":1789093703478,"version":"build-2803163510"},"reference-count":16,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,8,19]],"date-time":"2020-08-19T00:00:00Z","timestamp":1597795200000},"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":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>High\u2010dose methotrexate (HDMTX) is recommended to be administered with serial monitoring of methotrexate (MTX) levels, which may not be universally feasible in resource\u2010limited settings. In this study, we evaluated the overall experience of administration of HDMTX at our center by monitoring a single drug level at 54\u00a0h from the start of MTX infusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study was performed at a tertiary level hospital in north India, over a 5\u2010year period (2011\u20102015). All patients &lt;18\u00a0years of age with newly diagnosed acute lymphoblastic leukemia (ALL) and T\u2010non\u2010Hodgkin lymphoma (T\u2010NHL) were enrolled in the study. Details of HDMTX and all significant toxicities requiring prolonged or repeat hospitalization were retrieved from the medical records. All eligible patients received HDMTX as per the recommendations followed by at least three doses of leucovorin rescue, before drug levels were sent at 54\u00a0h. Subsequent leucovorin doses were adjusted accordingly.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The records of 598 cycles of HDMTX in 184 patients were reviewed. A total of 531 of 598 cycles (88.7%) were managed with monitoring only a single plasma drug level at 54\u00a0h from the beginning of infusion. Delayed MTX clearance was seen in 260 of 598 cycles (43.5%). Only three episodes (0.5%) were associated with significant toxicity. There were no deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The strategy of monitoring MTX concentration at 54\u00a0h was safe in our cohort. Although recommended, dynamic monitoring of plasma drug levels may not always predict toxicity.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.28394","type":"journal-article","created":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T08:59:47Z","timestamp":1598605187000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Safe administration of high\u2010dose methotrexate with minimal drug level monitoring: Experience from a center in north India"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8492-6115","authenticated-orcid":false,"given":"Himani","family":"Dhingra","sequence":"first","affiliation":[{"name":"Senior Resident Department of Pediatric Hematology\u2010oncology and BMT, Indraprastha Apollo Hospital  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manas","family":"Kalra","sequence":"additional","affiliation":[{"name":"Senior Consultant Department of Pediatric Hematology\u2010oncology and BMT, Sir Gangaram Hospital  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amita","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Senior Consultant and head of the Department of Pediatric Hematology\u2010Oncology and BMT Indraprastha Apollo Hospital  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM194806032382301"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.11-6-694"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25305"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0164"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27241"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-12-322909"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.62.4544"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200645120-00007"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-007-0550-4"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-04-1616"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-013-2319-2"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-002-0552-1"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/08880018.2015.1087612"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/751703"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2013.08.027"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24081"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.28394","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pbc.28394","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.28394","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T20:54:24Z","timestamp":1693860864000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.28394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,19]]},"references-count":16,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1002\/pbc.28394"],"URL":"https:\/\/doi.org\/10.1002\/pbc.28394","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,19]]},"assertion":[{"value":"2020-08-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e28394"}}