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Pediatrics

High-Dose Methotrexate Therapy in Pediatric Acute Lymphoblastic Leukemia: Research Highlights Faster Clearance and Reduced Hospital Stays

Strategic Insights

— 1 min read

Researchers at Chang Gung University have conducted a study on the relationship between urine output and time to methotrexate clearance in pediatric leukemia patients receiving high-dose methotrexate therapy. The study found that patients with higher urine output showed significantly faster methotrexate clearance, lower incidence of delayed clearance, and shorter hospital stays. These findings suggest that optimizing supportive care protocols, particularly with regards to urine output, may improve clinical outcomes for pediatric ALL patients.

Key Takeaways:

  • The study included 39 pediatric ALL patients treated with high-dose methotrexate at Chang Gung Memorial Hospital between August 2023 and February 2025.
  • Patients were stratified into higher (H-UO) and lower urine output (L-UO) groups using a 5.0 mL/kg/hr cutoff.
  • The H-UO group showed significantly faster methotrexate clearance (2.0 vs. 4.0 days, P = 0.0035) and lower incidence of delayed clearance (18.2% vs. 70.6%, P = 0.0025).
  • High urine output was associated with shorter hospital stays (5.0 vs. 7.0 days, P = 0.019) and reduced use of adjunctive diuretics.
  • Diuretic use was higher in the L-UO group, primarily as a reactive measure.
  • No significant difference in methotrexate-related major toxicities was observed.

Statistics:

  • 39 patients were included in the study.
  • The H-UO group showed a median time to methotrexate clearance of 2.0 days (range: 1.0-3.0 days) compared to 4.0 days (range: 2.0-6.0 days) in the L-UO group (P = 0.0035).
  • The incidence of delayed methotrexate clearance was 18.2% in the H-UO group and 70.6% in the L-UO group (P = 0.0025).
  • Hospital stays were significantly shorter in the H-UO group (mean: 5.0 days, range: 3-7 days) compared to the L-UO group (mean: 7.0 days, range: 5-10 days, P = 0.019).

Sources:

  • The relationship between urine output and time to methotrexate clearance in pediatric leukemia patients receiving high-dose methotrexate therapy. BMC Cancer, 2025;25(1):1545.
  • Chang Gung University, Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
  • Tsung-Yen Chang, Yi-Lun Wang, Shih-Hsiang Chen, Yi-Wen Hsiao, Yu-Chuan Wen, and Tang-Her Jaing.

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