Concurrent Imatinib Dosing With High-dose Methotrexate Leads to Acute Kidney Injury and Delayed Methotrexate Clearance in Pediatric Patients With Philadelphia Chromosome-positive B-Cell Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2021 Mar 01;43(2):e296-e300
Date
05/14/2020Pubmed ID
32398599DOI
10.1097/MPH.0000000000001816Scopus ID
2-s2.0-85085508892 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
Imatinib, a tyrosine kinase inhibitor has improved survival in pediatric patients with Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia. There are no formal drug interactions listed between methotrexate and tyrosine kinase inhibitors. Four pediatric patients with Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia had delayed methotrexate clearance during their first cycle of high-dose methotrexate while receiving imatinib, resulting in acute kidney injury. For subsequent high-dose methotrexate cycles, imatinib was withheld resulting in decreased acute kidney injury, shorter time to methotrexate clearance, less toxicity, and shorter hospitalizations. For pediatric patients with acute lymphoblastic leukemia receiving imatinib, we recommend escalated supportive care measures including increased hyperhydration and leucovoruin frequency. For patients with toxicities secondary to delayed clearance or need for glucarpidase, we recommend holding imatinib with subsequent high-dose methotrexate courses.
Author List
Pommert L, Liberio N, Ng JS, Egelund TA, Siver MJ, Katzenstein HM, Burke MJAuthor
Michael James Burke MD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Acute Kidney InjuryAdolescent
Adult
Antineoplastic Combined Chemotherapy Protocols
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Imatinib Mesylate
Leukemia, B-Cell
Male
Methotrexate
Philadelphia Chromosome
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Prognosis
Young Adult
