Safety and Efficiency of Ambulatory High-dose Methotrexate Administration among Hematological Malignancy Patients in a Tertiary Care Center

Abstract: BACKGROUND: High-dose methotrexate (HDMTX) is commonly used in solid malignancies, such as osteosarcoma, and hematological malignancies, such as acute lymphoblastic leukemia and non-Hodgkin’s lymphoma. Urine alkalinization with intravenous sodium bicarbonate and calcium folinate to facilitate the clearance of MTX is a crucial step in MTX clearance and avoiding or minimizing side effects such as nephrotoxicity and hepatotoxicity. OBJECTIVES: The objective of the study is to assess the safety and efficiency of ambulatory HDMTX administration in adult patients with hematological malignancies in a tertiary care center. PATIENTS AND METHODS: This study aimed to evaluate the safety of HDMTX administration in an outpatient setting in patients with hematological malignancies in a tertiary care center. RESULTS: Forty-three cycles were completed in 21 patients. Approximately 72.09% of the cycles were for diffuse large B-cell lymphoma patients. 48.84% of the total cycles achieved MTX level < 0.1 μmol/L by 48 h, and 90.70% achieved the same level by 72 h. By 72 h, 20.93% had a reversible asymptomatic elevation of creatinine, and all were mostly Grade 1. By 72 h, approximately 30.23% had reversible asymptomatic hepatotoxicity, and all were mostly Grade 1. CONCLUSION: Ambulatory HDMTX is safe, cost-effective, and comfortable for patients. These results encourage the use of this approach more frequently, as it decreases hospitalization and thus reduces costs, increases patient satisfaction, and helps solve the issue of bed crisis.