Abstract
Therapeutic drug monitoring (TDM) of methotrexate is widely recommended during high-dose administration (> 1 g/m2) in various chemotherapy protocols. This study aims to analyze the blood concentration methotrexate profile to detect delayed elimination in patients monitored at the toxicology department of the University Hospital of Sétif for MTX blood testing. A retrospective descriptive monocentric study was conducted, including all adult patients over 15 years old treated for malignant hematologic disorders with HD-MTX (> 1 g/m2) during their initial therapy. The results revealed that out of 189 monitored patients, only 79 underwent MTX level assessment at 48 hours and 72 hours. Among them, 77.2% exhibited elimination delays at 48 hours and 52% at 72 hours. The analysis of risk factors associated with elimination delay (age, gender, and dosage) did not show any statistically significant correlation. Considering the risk associated with elimination delay in potentiating the toxic effect of MTX, pharmacological therapeutic monitoring remains essential to adjust rescue measures through folinic acid administration and/or intensification of alkaline hydration. This approach aims to enhance the safety and efficacy of HD-MTX-based treatments.
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