Comparable efficacy with varying dosages of glucarpidase in pediatric oncology patients

Background Glucarpidase rapidly reduces methotrexate plasma concentrations in patients experiencing methotrexate‐induced renal dysfunction. Debate exists regarding the role of glucarpidase in therapy given its high cost. The use of reduced‐dose glucarpidase has been reported, and may allow more inst...

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Bibliographic Details
Published in:Pediatric blood & cancer 2015-09, Vol.62 (9), p.1518-1522
Main Authors: Scott, Jeffrey R., Zhou, Yinmei, Cheng, Cheng, Ward, Deborah A., Swanson, Hope D., Molinelli, Alejandro R., Stewart, Clinton F., Navid, Fariba, Jeha, Sima, Relling, Mary V., Crews, Kristine R.
Format: Article
Language:English
Subjects:
Acute Kidney Injury - blood
Acute Kidney Injury - chemically induced
Acute Kidney Injury - drug therapy
Adolescent
Antimetabolites, Antineoplastic - administration & dosage
Antimetabolites, Antineoplastic - adverse effects
Antimetabolites, Antineoplastic - pharmacokinetics
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Bone Neoplasms - blood
Bone Neoplasms - complications
Bone Neoplasms - drug therapy
carboxypeptidase
Child
Child, Preschool
Creatinine - blood
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Costs
Drug Evaluation
Female
gamma-Glutamyl Hydrolase - administration & dosage
gamma-Glutamyl Hydrolase - economics
gamma-Glutamyl Hydrolase - therapeutic use
glucarpidase
Hematologic Neoplasms - blood
Hematologic Neoplasms - complications
Hematologic Neoplasms - drug therapy
Hematology
Humans
Inactivation, Metabolic - drug effects
Infusions, Intravenous
Injections, Intravenous
Leucovorin - administration & dosage
Male
methotrexate
Methotrexate - administration & dosage
Methotrexate - adverse effects
Methotrexate - antagonists & inhibitors
Methotrexate - pharmacokinetics
nephrotoxicity
Oncology
Osteosarcoma - blood
Osteosarcoma - complications
Osteosarcoma - drug therapy
pediatric
Pediatrics
Plasma
Recombinant Proteins - administration & dosage
Recombinant Proteins - economics
Recombinant Proteins - therapeutic use
Recovery of Function
Retrospective Studies
Young Adult
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Summary:Background Glucarpidase rapidly reduces methotrexate plasma concentrations in patients experiencing methotrexate‐induced renal dysfunction. Debate exists regarding the role of glucarpidase in therapy given its high cost. The use of reduced‐dose glucarpidase has been reported, and may allow more institutions to supply this drug to their patients. This report explores the relationship between glucarpidase dosage and patient outcomes in pediatric oncology patients. Methods The authors evaluated data from 26 patients who received glucarpidase after high‐dose methotrexate. Decrease in plasma methotrexate concentrations and time to renal recovery were evaluated for an association with glucarpidase dosage, which ranged from 13 to 90 units/kg. Results No significant relationship was found between glucarpidase dosage (units/kg) and percent decrease in methotrexate plasma concentrations measured by TDx (P > 0.1) or HPLC (P > 0.5). Patients who received glucarpidase dosages  0.8). Conclusions The efficacy of glucarpidase in the treatment of HDMTX‐induced kidney injury was not dosage‐dependent in this retrospective analysis of pediatric oncology patients. Pediatr Blood Cancer 2015;62:1518–1522. © 2015 Wiley Periodicals, Inc.
ISSN:1545-5009
1545-5017
DOI:10.1002/pbc.25395