A single center retrospective analysis of a protocol for high-dose methotrexate and leucovorin rescue administration. (January 2019)

• Record Type: Journal Article
• Authors: Cerminara, Zak; Duffy, Alison; Nishioka, Jennifer; Trovato, James; Gilmore, Steven
• Is Part Of: Journal of oncology pharmacy practice. Volume 25:Number 1(2019)
• Page Start: 76
• Page End: 84
• Publication Date: 2019-01
• Subjects: High dose -- leucovorin -- methotrexate -- protocol; Cancer -- Chemotherapy -- Periodicals; Clinical pharmacology -- Periodicals; 616.994061
• DOI: 10.1177/1078155217729744
• Languages: English
• ISSNs: 1078-1552

Abstract

Background: Methotrexate has a wide dosing range. High-dose methotrexate is a dose of 1000 mg/m 2 or greater. In the 1970s, the incidence of mortality associated with High-dose methotrexate ranged from 4.6 to 6%. In 2012, the University of Maryland Medical Center implemented a standardized high-dose methotrexate protocol. The purpose of this study was to evaluate whether the institution followed recommendations based on the Bleyer nomogram for the administration of high-dose methotrexate more closely after the implementation of the protocol. Methods: In this retrospective chart review, 37 patients received 119 cycles of high-dose methotrexate before the protocol implementation (1 January 2009 through 31 December 2010) and 45 patients received 106 cycles of high-dose methotrexate after protocol implementation (1 January 2013 through 31 December 2014). Patient characteristics, protocol data, and complications were analyzed. Results: Protocol implementation significantly reduced the deviation of methotrexate level timing at 24, 48, and 72 h: median 7.47 vs. 1.46 h, 7.23 vs. 1.35 h, and 7.00 vs. 1.52 h before and after implementation, respectively (p < 0.0001 for each). The protocol significantly reduced deviation of the first dose of leucovorin administration: median 5.2 vs. 0.675 h before and after implementation, respectively (p<0.0001). After protocol implementation, there was an increase in the use of leucovorin prescriptions written appropriately for patients discharged before methotrexate levels reached a value of ≤0.05 µmol/L. Conclusions: Implementation of a protocol for the administration of high-dose methotrexate improved the adherence to consensus recommendations. Further analysis is needed to assess clinical pharmacist involvement and the cost savings implications within this protocol.