{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:49:59Z","timestamp":1788569399492,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:00Z","timestamp":1760140800000},"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;amp; Cancer"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Methotrexate (MTX) is essential for treating lymphoblastic leukemia, but high doses (5\u00a0g\/m\n                      <jats:sup>2<\/jats:sup>\n                      corporal surface) can cause significant gastrointestinal, renal, hepatic, and hematological toxicity. Body composition, particularly high body fat mass, can function as a third space and may increase toxicity by prolonging the drug's circulation time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To analyze the associations between body composition (body fat mass, visceral fat area, and skeletal muscle mass) and the incidence of MTX toxicity in patients with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A cohort of patients aged 6\u201318 years diagnosed with ALL and lymphoblastic lymphoma who received high\u2010dose MTX without prior toxicity was included. Patients with preexisting renal failure or liver failure before MTX administration were excluded. Body composition was assessed using a multifrequency bioimpedance device.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Regarding MTX toxicity, 30.2% of events occurred early, and this figure increased to 58.7% for late toxicity. Patients with a visceral fat area (VFA) \u226547 cm\n                      <jats:sup>2<\/jats:sup>\n                      had a significantly higher risk of late toxicity (RR 2.8 (1.3\u20135.5),\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01), as did those with high body fat mass (RR 2.0 (1.1\u20133.4),\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01). For severe late toxicity, a VFA \u226547 cm\n                      <jats:sup>2<\/jats:sup>\n                      was strongly correlated (RR 5.6 (1.3\u201322.6),\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003), and high body fat mass remained a significant risk factor (RR 2.3 (1.03\u20135.5),\n                      <jats:italic>p<\/jats:italic>\n                      = 0.03). No significant associations were found with low phase angle, low skeletal muscle index, or overweight body mass index.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      A VFA \u2265 47 cm\n                      <jats:sup>2<\/jats:sup>\n                      and a high percentage of body fat mass were associated with an increased risk of late MTX toxicity and severe late toxicity.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.32108","type":"journal-article","created":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T08:54:48Z","timestamp":1760172888000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Visceral Fat and Body Fat as Risk Factors for Methotrexate Toxicity in Pediatric Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma"],"prefix":"10.1002","volume":"73","author":[{"given":"Alda Daniela","family":"Garc\u00eda\u2010Guzm\u00e1n","sequence":"first","affiliation":[{"name":"Servicio De Oncolog\u00eda M\u00e9dica Instituto Nacional de Pediatr\u00eda  Mexico City Mexico"},{"name":"Escuela De Medicina y Ciencias De La Salud Tecnol\u00f3gico De Monterrey Campus Ciudad de M\u00e9xico  Monterrey Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ximena Monserrat","family":"Torreblanca\u2010Garc\u00eda","sequence":"additional","affiliation":[{"name":"Servicio De Oncolog\u00eda M\u00e9dica Instituto Nacional de Pediatr\u00eda  Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4221-7971","authenticated-orcid":false,"given":"Sandra Nayeli","family":"Becerra\u2010Morales","sequence":"additional","affiliation":[{"name":"Departamento De Metodolog\u00eda de La Investigaci\u00f3n Instituto Nacional de Pediatr\u00eda  Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torres\u2010Lastra","family":"Andrea del Carmen","sequence":"additional","affiliation":[{"name":"Servicio De Oncolog\u00eda M\u00e9dica Instituto Nacional de Pediatr\u00eda  Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela Assenet","family":"Moctezuma\u2010Sandoval","sequence":"additional","affiliation":[{"name":"Escuela De Medicina y Ciencias De La Salud Tecnol\u00f3gico De Monterrey Campus Ciudad de M\u00e9xico  Monterrey Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karla","family":"Maldonado\u2010Silva","sequence":"additional","affiliation":[{"name":"Subdirecci\u00f3n Hemato\u2010Oncolog\u00eda Instituto Nacional de Pediatr\u00eda  Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4027-2329","authenticated-orcid":false,"given":"Isabel","family":"Medina\u2010Vera","sequence":"additional","affiliation":[{"name":"Escuela De Medicina y Ciencias De La Salud Tecnol\u00f3gico De Monterrey Campus Ciudad de M\u00e9xico  Monterrey Mexico"},{"name":"Departamento De Metodolog\u00eda de La Investigaci\u00f3n Instituto Nacional de Pediatr\u00eda  Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5882-2187","authenticated-orcid":false,"given":"Liliana","family":"Velasco\u2010Hidalgo","sequence":"additional","affiliation":[{"name":"Servicio De Oncolog\u00eda M\u00e9dica Instituto Nacional de Pediatr\u00eda  Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"1","volume-title":"Tratado de oncolog\u00eda Pedi\u00e1trica: Enfermedades malignas del ni\u00f1o y Adolescente","author":"Peris Bonet R.","year":"2006"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/08880018.2016.1276236"},{"key":"e_1_2_9_4_1","first-page":"9","volume-title":"Rutas Cr\u00edticas en la Evaluaci\u00f3n y Tratamiento de los Ni\u00f1os con C\u00e1ncer","author":"Luna R.","year":"2009"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2\u20106\u2010374"},{"key":"e_1_2_9_6_1","first-page":"54","volume-title":"En Farmacolog\u00eda b\u00e1sica y cl\u00ednica","author":"Edward C.","year":"2021"},{"issue":"3","key":"e_1_2_9_7_1","first-page":"175","article-title":"Incidencia y Gravedad de Reacciones Adversas a Metotrexato en Relaci\u00f3n con la Ingesta Diet\u00e9tica de folatos en Pacientes con leucemia linfobl\u00e1stica aguda","volume":"17","author":"Marqu\u00e9s\u2010Maldonado A. 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