{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:51:23Z","timestamp":1791568283296,"version":"4.3.4"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"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>Glucarpidase 50 units per kilogram (units\/kg) intravenously is indicated for high-dose methotrexate (HDMTX) toxicity, however lower doses are often used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case series<\/jats:title>\n                    <jats:p>\n                      Three patients with Acute Lymphoblastic Leukemia were administered HDMTX 5g\/m\n                      <jats:sup>2<\/jats:sup>\n                      intravenously over 24\u2005h, developed toxicity, and required glucarpidase. Retrospective data collection included methotrexate (MTX) and creatinine levels and toxicity management. An acute kidney injury developed for all patients with serum creatinine increasing from 79 micromol\/L to 172 micromol\/L for patient A, 76 micromol\/L to 130 micromol\/L for patient B, and 67 micromol\/L to 117 micromol\/L for patient C. Forty-two hour MTX levels returned as 11, 13, 8.6 micromol\/L (target is &lt;1 micromol\/L) and serum creatinine peaked at 250, 164, and 125 micromol\/L for patients A, B, and C, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management and outcome<\/jats:title>\n                    <jats:p>Calcium folinate, fluids, sodium bicarbonate, and diuretics were administered as indicated. All patients received glucarpidase 2000 units within 56\u2005h of HDMTX commencing. MTX levels took an average of 12 days to fall to &lt;0.1 micromol\/L. Regain of normal renal function post-glucarpidase took 25 and 8 days for patients A and C respectively; patient B was lost to follow up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>With evidence of efficacious glucarpidase dosing lower than 50 units\/kg, including in this case series (2000 units), combined with its pharmacokinetic properties, 1000 units should be considered for adult patients less than 200 kilograms with a supratherapeutic MTX level of 200 micromol\/L or less, from 24\u2005h or 36\u2005h (depending on the protocol used) to 60\u2005h post-HDMTX commencement. This necessitates one 1000 units vial, reducing cost and potentially improving access.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10781552261492219","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:06:31Z","timestamp":1791389191000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fixed-dose glucarpidase use for high-dose methotrexate toxicity: A case series in Acute Lymphoblastic Leukemia"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7620-0076","authenticated-orcid":false,"given":"Michael","family":"Whordley","sequence":"first","affiliation":[{"name":"Princess Alexandra Hospital"},{"name":"The University of Queensland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Morris","sequence":"additional","affiliation":[{"name":"Princess Alexandra Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Centaine L","family":"Snoswell","sequence":"additional","affiliation":[{"name":"Princess Alexandra Hospital"},{"name":"The University of Queensland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Swain","sequence":"additional","affiliation":[{"name":"Princess Alexandra Hospital"},{"name":"Fraser institute, Translational Research Institute, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Rowan","sequence":"additional","affiliation":[{"name":"Peter MacCallum Cancer Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9223-0740","authenticated-orcid":false,"given":"Marissa","family":"Ryan","sequence":"additional","affiliation":[{"name":"Princess Alexandra Hospital"},{"name":"The University of Queensland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/bcp.70044"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0164"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2017-0243"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI118409"},{"key":"e_1_3_2_6_2","unstructured":"New South Wales Cancer Institute. Management of high-dose methotrexate toxicity: eviQ; 2022. Available from: https:\/\/www.eviq.org.au\/clinical-resources\/side-effect-and-toxicity-management\/prophylaxis-and-treatment\/3535-management-of-high-dose-methotrexate-toxicity#management. (Accessed 02\/01\/2026)."},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.60.0734"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-021-04361-8"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1495705"},{"key":"e_1_3_2_10_2","unstructured":"Food and Drugs Administration (FDA). Voraxaze (glucarpidase). FDA: 2012. Available from: VORAXAXE (glucarpidase) Label (Accessed 02\/02\/2026)."},{"key":"e_1_3_2_11_2","volume-title":"Clinical Commissioning Policy: Glucarpidase for the urgent treatment of toxic plasma methotrexate concentration due to delayed methotrexate elimination","author":"National Health Service (NHS)","year":"2024","unstructured":"National Health Service (NHS). Clinical Commissioning Policy: Glucarpidase for the urgent treatment of toxic plasma methotrexate concentration due to delayed methotrexate elimination. 3RD edition. NHS England, 2024.","edition":"3"},{"key":"e_1_3_2_12_2","unstructured":"European Medicines Agency. Voraxaze (glucarpidase). 2026. Available at: Voraxaze | European Medicines Agency (EMA) (Accessed 02\/02\/2026)."},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/hem3.70291"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021005576"},{"key":"e_1_3_2_15_2","first-page":"732","article-title":"Glucarpidase (voraxaze), a carboxypeptidase enzyme for methotrexate toxicity","volume":"38","author":"Rattu MA","year":"2013","unstructured":"Rattu MA, Shah N, Lee JM, et al. Glucarpidase (voraxaze), a carboxypeptidase enzyme for methotrexate toxicity. 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