Saturday, May 14, 2011

Methotrexate infusion regimens Weaknesses's More Economical for ALL in Children

A study shows that shortening the duration of high-dose intravenous methotrexate (high-dose methotrexate, HDMTX) from 24 hours to just 4 hours in cases of acute limfoblastik leukemia (acute lymphoblastic leukemia, ALL) in children was reduced drug accumulation in leukemia cells, thereby reducing the effects of methotrexate antileukemik. With a shorter duration of infusion, the advantage, therapy can be given to patients outpatient thus saving time and cost for hospitalization. "Changing methods of administration of cancer chemotherapy so that treatment becomes more practical and, perhaps, less expensive for patients seeking treatment in reality the road can cause serious consequences of adverse response to therapy," says Dr. William E. Evans of St. Jude Children's Research Hospital, Memphis, Tennessee. Dr. Evans and colleagues conducted research with the design of randomized comparative studies to determine the presence or absence of adverse consequences of therapeutic strategies "saving" them.

So far, there has never been studies that examine the effects of HDMTX infusion duration of therapy response in patients, patients with ALL. Dr Research Report. Evans and colleagues published online in the Journal of Clinical Oncology in March 2011. The study involved 356 children newly diagnosed ALL and have started to undergo chemotherapy intravenous HDMTX (1 g/m2). The children were divided into two groups randomly; the first group received infusion duration of 24 hours (200 mg/m2 in the first 5 minutes, then 800 mg/m2 in 23 hours 55 minutes later), while the second group received constant infusion duration of 4 hours .

The researchers found that 24-hour infusion of methotrexate resulted poliglutamat a far more active in leukemia cells in bone marrow infusion than 4 hours (p = 0.0059), determined through a calculation of the ALL cells in the circulation for 3 days. Thus, infusion of 24 hours of course antileukemik produce a better effect than infusion of 4 hours. MTX poliglutamat measurable accumulation was lower in ALL cells associated with the risk of relapse 3 times higher than the accumulation of active drug measured moderate or high. However, giving only one dose MTX intravenously 4 h did not cause adverse consequences for patients in this study, all other doses given intravenously 24 hours.
"For most subtypes of ALL in children, the duration of infusion should not be shortened, but can reduce the need for hospitalization," Dr. Evans concluded. There is one exception, according to scientists who conduct this research, that is ALL with chromosomal translocation t (12; 21) / (ETV6-RUNX1); on this subtype, duration of infusion did not have a significant impact on the accumulation of MTX or antileukemik effect.
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