Outpatient High-dose Methotrexate Administered Safely in Select Patients With DLBCL

Outpatient administration of high-dose methotrexate (HD-MTX) was safe and effective in select patients with diffuse large B-cell lymphoma (DLBCL), according to research presented at the ASCO Quality Care Symposium.

HD-MTX is prophylaxis for central nervous system relapse in patients with DLBCL. Inpatient administration is typical “due to its complex supportive care regimen,” authors wrote.

Researchers conducted a single center retrospective cohort analysis of 6 outpatients receiving 14 cycles of HD-MTX infusions at Kingston Health Sciences Centre. Patients also received leucovorin and continuous intravenous hydration through ambulatory infusion pumps and returned each day for bloodwork and monitoring.

Outpatients were compared to 13 inpatients who received 28 cycles of HD-MTX. Toxicity was defined as “an elevation in serum creatinine or oral mucositis of grade III or higher, or development of febrile neutropenia.”

Key findings included the following:

• Significant toxicity occurred in one outpatient cycle compared to five inpatient cycles (7.1% vs 17.9%, P=.79).
• Average time to MTX clearance was 4.1 days for outpatients and 3.5 days for inpatients (P=.013).
• Only one outpatient was admitted to hospital, resulting in an average length of hospital stay of 0.5 days for outpatients compared to 4.96 days for inpatients.

Additionally, there were 2 delays (14.3%) in subsequent chemotherapy cycles in the outpatient group and 7 (25%) in the inpatient group.

Study authors concluded that “HD-MTX can be administered safely and effectively…in select patients with DLBCL.”

Reference:
Genge B, Carasco T, Young L, Laporte L, Baetz TD. Can high-dose methotrexate be safely administered to outpatients? J Clin Oncol. 2021;39(suppl 28; abstr 34). doi:10.1200/JCO.2020.39.28_suppl.034