OBJECTIVE

2

To discuss the factors affecting the blood concentration of high-dose methotrexate （HD-MTX） and the occurrence of adverse drug reactions （ADR） when treating lymphoma with HD-MTX.

METHODS

2

From July 2020 to November 2021， the information of HD-MTX patients who had been monitored for HD-MTX blood drug concentration in the First Affiliated Hospital of Guangdong Pharmaceutical University was collected by retrospective analysis， such as medical record number， age， sex， height， body mass， chemotherapy plan， dosage； test indexes such as alanine transaminase， aspartate transaminase， total bilirubin， creatinine clearance （CrCl）， albumin （ALB） and other indexes were also collected before and after administration. The blood concentrations （

c

6 h

，

c

24 h

，

c

48 h

） of HD-MTX were recorded， drug information of proton pump inhibitors （PPIs） was extracted and used， and ADR occurring within 48 h after administration were all evaluated. Single factor analysis， multiple linear regression and

χ

2

test were used to analyze the influential factors.

RESULTS

2

A total of 133 patients were included in this paper. The results of the single factor analysis of HD-MTX blood drug concentration showed that age， CrCl had an effect on

c

6 h

（

P

＜0.05）； age， CrCl and ALB had an effect on

c

24 h

（

P

＜0.05）； age， body mass index （BMI）， CrCl， combined use of PPIs and ALB had an effect on

c

48 h

（

P

＜0.05）. The results of multiple linear regression analysis showed that age and CrCl had no effect on

c

6 h

（

P

＞0.05）， age was the main influential factor of

c

24 h

（

P

＜0.05）， and CrCl and combined use of PPIs were the main influential factors of

c

48 h

（

P

＜0.05）； the coefficient of variance expansion was between 1 and 3.5， indicating that the analysis results were acceptable. The overall incidence of adverse reactions was 51.13%， of which the blood and lymphatic system reactions were the most common. The results of the influential factors of ADR showed that age， BMI， liver function and CrCl had effect on the incidence of ADR （

P

＜0.05）.

CONCLUSIONS

2

During the process of HD-MTX in the treatment of lymphoma， the patient’s age， CrCl and combined use of PPIs should be considered， and the patient’s blood concentration should be monitored； at the same time， the age of patients， BMI， liver function and CrCl have an impact on the incidence of ADR.