급성 림프모구성 백혈병 환아의 입원과 외래에서 고용량메토트렉세이트 투여에 관한 비교
Comparison of High Dose Methotrexate Administration Between the Inpatient and Outpatient Setting in Children with Acute Lymphoblastic Leukemia
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Purpose: Methotrexate (MTX) is one of the most widely used anticancer agents, with indications and established protocols in a rangeof childhood and adult cancers. High dose MTX (HD-MTX) requires aggressive care to prevent toxicity. Limited inpatient conditionsare forcing major changes in health care delivery patterns and decisions. We conducted a retrospective study to describe the safety, feasibilityand cost-effectiveness of HD-MTX administration in the outpatient setting. Methods: Patients with acute lymphoblastic leukemiawho underwent HD-MTX (3 g/m2) administration in either the inpatient (N=70) or outpatient setting (N=70) from Januaryto July 2012 were included. In the outpatient setting, HD-MTX was administered intravenously (IV) over 6 hours and included hydrationwith sodium bicarbonate (2000 ml/m2/ for 12 hours). Daily visits to the outpatient setting followed. Leucovorin was given 24hours after MTX at a standard dose (15 mg/m2 IV bolus) every 6 hours. We compared the serum drug levels of MTX, hematologicand renal toxicity, hepatotoxicity, frequency of subsequent unscheduled outpatient visits and readmission episodes, medical expensesand duration of hospital stay between the two groups. Results: HD-MTX administrations were successfully completed in bothgroups. No significant differences were found between the two groups for the parameters studied. Patients who received HD-MTX inthe inpatient setting had 2.37 times and 2.24 times greater medical expenses and duration of hospital stay respectively than outpatientrecipients. Conclusion: This study suggests that HD-MTX administration done with aggressive monitoring in the outpatient settingis safe and efficient, without a greater incidence of major toxicities.
Abstract
Purpose: Methotrexate (MTX) is one of the most widely used anticancer agents, with indications and established protocols in a rangeof childhood and adult cancers. High dose MTX (HD-MTX) requires aggressive care to prevent toxicity. Limited inpatient conditionsare forcing major changes in health care delivery patterns and decisions. We conducted a retrospective study to describe the safety, feasibilityand cost-effectiveness of HD-MTX administration in the outpatient setting. Methods: Patients with acute lymphoblastic leukemiawho underwent HD-MTX (3 g/m2) administration in either the inpatient (N=70) or outpatient setting (N=70) from Januaryto July 2012 were included. In the outpatient setting, HD-MTX was administered intravenously (IV) over 6 hours and included hydrationwith sodium bicarbonate (2000 ml/m2/ for 12 hours). Daily visits to the outpatient setting followed. Leucovorin was given 24hours after MTX at a standard dose (15 mg/m2 IV bolus) every 6 hours. We compared the serum drug levels of MTX, hematologicand renal toxicity, hepatotoxicity, frequency of subsequent unscheduled outpatient visits and readmission episodes, medical expensesand duration of hospital stay between the two groups. Results: HD-MTX administrations were successfully completed in bothgroups. No significant differences were found between the two groups for the parameters studied. Patients who received HD-MTX inthe inpatient setting had 2.37 times and 2.24 times greater medical expenses and duration of hospital stay respectively than outpatientrecipients. Conclusion: This study suggests that HD-MTX administration done with aggressive monitoring in the outpatient settingis safe and efficient, without a greater incidence of major toxicities.
참고문헌 (25)
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