Abstract
Introduction
Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, and high-dose methotrexate (HDMTX) is a key chemotherapeutic agent. HDMTX can cause nephrotoxicity. This study aimed to identify prognostic indicators of HDMTX-related severe nephrotoxicity in children with ALL.
Methods
A retrospective review of children with ALL treated at Chiang Mai University Hospital (2016–2020) was conducted. Demographic, clinical, and treatment-related factors associated with HDMTX-related severe nephrotoxicity were analyzed using multivariable multilevel logistic regression, reported as adjusted odds ratio (aOR).
Results
A total of 61 children with ALL underwent 243 HDMTX infusion cycles. HDMTX-related severe nephrotoxicity occurred in 37.7% (23/61) of patients and 12.3% (30/243) of infusion cycles. No significant differences in baseline characteristics were observed. Concurrent amikacin use was an independent risk factor (aOR = 17.693 [1.613–194.032] P = 0.019), while higher baseline urine pH was protective (aOR = 0.190 [0.082–0.440] P < 0.001). A baseline urine pH < 7.0 was identified as the optimal cutoff for predicting HDMTX-related severe nephrotoxicity (area under the ROC curve = 0.72 [0.63–0.81]). All nephrotoxic events resolved completely.
Conclusions
Concurrent amikacin use and low baseline urine pH are significant predictors of HDMTX-related severe nephrotoxicity in children with ALL. Identification of these factors is crucial for preventing nephrotoxicity.
Get full access to this article
View all access options for this article.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
