Table 3.
HD-MTX Hydration Strategies.
| Reference | Demographics | Hydration and alkalinization measures |
|---|---|---|
| Studies reporting hydration/alkalinization strategies: | ||
| Relling et al. 1994105 | N = 134 patients with 481 HD-MTX cycles MTX dose: 1.5 gm/m2 or adjusted per individual clearance | Pre-hydration 2 hr before HD-MTX with D5W with 40 mEq/m2/L NaHCO3 at 100 mL/m2/hr to continue at least 42 hours from start of MTX |
| Hempel et al. 2003106 | N = 58 Adult and pediatric patients Diseases: ALL, NHL, osteosarcoma, brain tumor MTX dose: 1, 5, or 12 gm/m2 | Pre-hydration 4 hr before HD-MTX with 2 mEq/kg NaHCO3 8.4% followed by 250 mL NaCl 0.9% plus D5W with 40 mEq NaHCO3 8.4% With HD-MTX infusion given 3 L/m2/d of NaCl 0.9% plus glucose 5% (1:1) and NaHCO3 8.4% 180 mEq/m2/d for at least 3 days |
| Zelcer et al. 2008.107 | N = 708 MTX courses Pediatric patients MTX dose: 12 gm/m2 | MTX mixed in 1L D5W with 50 mEq/L of NaHCO3 IV NaHCO3 bolus of 1 mEq/kg (max 100 mEq, may repeat); oral NaHCO3 3 tablets q6h, plus 3 additional tablets if urine pH < 7, plus IV hydration with D5W with 50 mEq/L NaHCO3 to maintain urine output 3–4 L/m2 |
| Mir et al. 2010108 | N = 26 for 344 courses Ages: 18 years (15–25) Disease: osteosarcoma MTX dose: 8–12 gm/m2 | NaHCO3 8.4% 500 mL / 500 mEq given 1 hour pre-MTX on day I then daily for three days Oral hydration of 2 L/d recommended |
| Kintzel et al. 2011109 | N = 10 for 79 courses Adults | D5W with NaHCO3 at I00-I50 mEq/L to attain urine pH > 7 or 7.5 and UOP above 100 mL/hr versus Oral NaHCO3 1300 mg every 4 hours beginning the morning of chemotherapy admission |
| Studies comparing hydration/alkalinization strategies: | ||
| Christensen et al. I988.110 | N = 100 pediatric patients Disease: acute lymphocytic leukemia MTX dose: 2 gm/m2 | 75–165 mL/m2 for 5 hours with 2.5 gm/m2 NaHCO3 starting 2 hours before HD-MTX versus 200 mL/m2/h with 5.4 gm/m2 NaHCO3 starting 8 hours before HD-MTX More alkaline regimen associated with lower MTX levels and fewer severe toxicities |
| Ferrari et al. 1992.111 | Disease: osteosarcoma MTX dose: 8 gm/m2 | 2 L/m2 versus 1.5 L/m2 hydration No difference in MTX toxicities |
| Yanagimachi et al. 2013.112 | N = 51 patients for 127 courses Disease: acute lymphoblastic leukemia MTX dose: 3 gm/m2 | 2.5–3 L/m2/d of alkalinized hydration given 4 hours versus 12 hours pre-MTX Shorter time was associated with prolonged high MTX concentrations and incidence of renal toxicity |
| Karremann et al. 2014.113 | N = 17 pediatric patients with 66 cycles Diseases: acute lymphocytic leukemia or lymphoblastic lymphoma MTX dose: 5 gm/m2 | 1 hour pre-MTX NaHCO3 2 mM/kgfollowed by 1.5 L/m2/d hydration (70 mM NaCl, 2.5% glucose, 20 mM potassium chloride, and 60 mM NaHCO3) versus 16–20 hour pre-hydration of the same fluid and rate No difference in MTX clearance or toxicities |
| Mikkelsen et al. 2014.114 | Pediatric patients Diseases: acute lymphoblastic leukemia, non-Hodgkin lymphoma MTX dose: 5 or 8 gm/m2 |
4 versus 12 hours of 5% glucose with 40 mM NaHCO3 and 20 mM potassium chloride at 125–150 mL/m2/h No impact on MTX clearance or renal toxicity |
| Rouch et al. 2017.115 | N = 118 adult and pediatric patients MTX dose: median ~ 6 gm/m2 | Oral NaHCO3 tablets plus sodium citrate/citric acid solution versus IV NaHCO3 (mEq/rate unspecified) No difference in time to alkalinization, time to MTX clearance, or incidence of MTX toxicities |