{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:45:14Z","timestamp":1777934714877,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Oncol Pharm Pract"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, and high-dose methotrexate (HDMTX) is a key chemotherapeutic agent. HDMTX can cause nephrotoxicity. This study aimed to identify prognostic indicators of HDMTX-related severe nephrotoxicity in children with ALL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review of children with ALL treated at Chiang Mai University Hospital (2016\u20132020) was conducted. Demographic, clinical, and treatment-related factors associated with HDMTX-related severe nephrotoxicity were analyzed using multivariable multilevel logistic regression, reported as adjusted odds ratio (aOR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 61 children with ALL underwent 243 HDMTX infusion cycles. HDMTX-related severe nephrotoxicity occurred in 37.7% (23\/61) of patients and 12.3% (30\/243) of infusion cycles. No significant differences in baseline characteristics were observed. Concurrent amikacin use was an independent risk factor (aOR = 17.693 [1.613\u2013194.032]\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u20090.019), while higher baseline urine pH was protective (aOR = 0.190 [0.082\u20130.440]\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u20090.001). A baseline urine pH\u2009&lt;\u20097.0 was identified as the optimal cutoff for predicting HDMTX-related severe nephrotoxicity (area under the ROC curve\u2009=\u20090.72 [0.63\u20130.81]). All nephrotoxic events resolved completely.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Concurrent amikacin use and low baseline urine pH are significant predictors of HDMTX-related severe nephrotoxicity in children with ALL. Identification of these factors is crucial for preventing nephrotoxicity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10781552251403953","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:05:32Z","timestamp":1765209932000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Revisiting predictors of high-dose methotrexate related severe nephrotoxicity in children with acute lymphoblastic leukemia"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2520-1162","authenticated-orcid":false,"given":"Chane","family":"Choed-Amphai","sequence":"first","affiliation":[{"name":"Chiang Mai University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9023-0923","authenticated-orcid":false,"given":"Jiraporn","family":"Khorana","sequence":"additional","affiliation":[{"name":"Chiang Mai University"},{"name":"Center of Clinical Epidemiology and Clinical Statistic, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand"},{"name":"Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand"},{"name":"Department of Biomedical Informatics and Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4774-259X","authenticated-orcid":false,"given":"Lalita","family":"Sathitsamitphong","sequence":"additional","affiliation":[{"name":"Chiang Mai University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8200-8652","authenticated-orcid":false,"given":"Supawadee","family":"Maneekesorn","sequence":"additional","affiliation":[{"name":"Chiang Mai University"},{"name":"Thalassemia and Hematology Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0975-0081","authenticated-orcid":false,"given":"Supapitch","family":"Chanthong","sequence":"additional","affiliation":[{"name":"Chiang Mai University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9840-3443","authenticated-orcid":false,"given":"Rungrote","family":"Natesirinilkul","sequence":"additional","affiliation":[{"name":"Chiang Mai University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9123-9177","authenticated-orcid":false,"given":"Pimlak","family":"Charoenkwan","sequence":"additional","affiliation":[{"name":"Chiang Mai University"},{"name":"Thalassemia and Hematology Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23169"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1400972"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0164"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10637-005-4541-1"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.62.4544"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)30035-3"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2013.840780"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/1078155215594417"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.7314\/APJCP.2015.16.11.4609"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-024-06068-1"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S172117"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-024-03725-z"},{"key":"e_1_3_5_14_2","unstructured":"National Cancer Institute. 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