Rask et al identified risk factors for oral mucositis in children with acute lymphoblastic leukemia (ALL) treated with high dose methotrexate (MTX). The authors are from Aarhus University Hospital in Denmark and Karolinska Hospital in Stockholm.
Molecular weight MTX: 454.45 g
Doses of MTX: 5 or 8 grams per square meter BSA infused over 24 hours
Risk factors for oral mucositis with WHO Grade 1 or higher:
(1) high plasma methotrexate concentration (in µmol/L) at 28 hours
(2) low ratio of plasma 7-hydroxy-MTX to MTX at 66 hours after starting the transfusion
(3) low systemic clearance of MTX (in mL per min per square meter) during steady state
These findings indicate slow elimination with drug accumulation.
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