Comparable efficacy with varying dosages of glucarpidase in pediatric oncology patients
Corresponding Author
Jeffrey R. Scott PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Correspondence to: Jeffrey R. Scott, Pharmaceutical Department, St. Jude Children's Research Hospital, Mailstop 150, Memphis, TN 38105.
Email: [email protected]
Search for more papers by this authorYinmei Zhou MS
Biostatistics Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorCheng Cheng PhD
Biostatistics Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorDeborah A. Ward PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorHope D. Swanson PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorAlejandro R. Molinelli PhD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorClinton F. Stewart PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorFariba Navid MD
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
Search for more papers by this authorCorresponding Author
Sima Jeha MD
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
Correspondence to: Jeffrey R. Scott, Pharmaceutical Department, St. Jude Children's Research Hospital, Mailstop 150, Memphis, TN 38105.
Email: [email protected]
Search for more papers by this authorMary V. Relling PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorKristine R. Crews PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorCorresponding Author
Jeffrey R. Scott PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Correspondence to: Jeffrey R. Scott, Pharmaceutical Department, St. Jude Children's Research Hospital, Mailstop 150, Memphis, TN 38105.
Email: [email protected]
Search for more papers by this authorYinmei Zhou MS
Biostatistics Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorCheng Cheng PhD
Biostatistics Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorDeborah A. Ward PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorHope D. Swanson PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorAlejandro R. Molinelli PhD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorClinton F. Stewart PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorFariba Navid MD
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
Search for more papers by this authorCorresponding Author
Sima Jeha MD
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
Correspondence to: Jeffrey R. Scott, Pharmaceutical Department, St. Jude Children's Research Hospital, Mailstop 150, Memphis, TN 38105.
Email: [email protected]
Search for more papers by this authorMary V. Relling PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorKristine R. Crews PharmD
Pharmaceutical Department, St. Jude Children's Research Hospital, Memphis, Tennessee
Search for more papers by this authorAbstract
Background
Glucarpidase rapidly reduces methotrexate plasma concentrations in patients experiencing methotrexate-induced renal dysfunction. Debate exists regarding the role of glucarpidase in therapy given its high cost. The use of reduced-dose glucarpidase has been reported, and may allow more institutions to supply this drug to their patients. This report explores the relationship between glucarpidase dosage and patient outcomes in pediatric oncology patients.
Methods
The authors evaluated data from 26 patients who received glucarpidase after high-dose methotrexate. Decrease in plasma methotrexate concentrations and time to renal recovery were evaluated for an association with glucarpidase dosage, which ranged from 13 to 90 units/kg.
Results
No significant relationship was found between glucarpidase dosage (units/kg) and percent decrease in methotrexate plasma concentrations measured by TDx (P > 0.1) or HPLC (P > 0.5). Patients who received glucarpidase dosages <50 units/kg had a median percent reduction in methotrexate plasma concentration of 99.4% (range, 98–100) measured by HPLC compared to a median percent reduction of 99.4% (range, 77.2–100) in patients who received ≥50 units/kg. Time to SCr recovery was not related to glucarpidase dosage (P > 0.8).
Conclusions
The efficacy of glucarpidase in the treatment of HDMTX-induced kidney injury was not dosage-dependent in this retrospective analysis of pediatric oncology patients. Pediatr Blood Cancer 2015;62:1518–1522. © 2015 Wiley Periodicals, Inc.
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