TY - JOUR
T1 - Therapeutic drug monitoring of methotrexate in plasma using ultra high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry
T2 - Necessary after administration of glucarpidase in methotrexate intoxications
AU - Mulder, Midas B.
AU - Huisman, Ruud
AU - Engels, Frederike K.
AU - Van Der Sluis, Inge M.
AU - Koch, Birgit C.P.
N1 - Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018
Y1 - 2018
N2 - High-dose methotrexate (HD-MTX) is used to treat a variety of cancers. In all patients receiving HD-MTX, plasma MTX levels are monitored mainly to anticipate rescue therapy to prevent adverse events. We present 2 children treated with HD-MTX and afterward treated with glucarpidase at different time-points after their HD-MTX infusions. After the administration of glucarpidase, a nontoxic metabolite of MTX cross-reacts with MTX in the standard immunoassay (Abbott Diagnostics, Hoofddorp, the Netherlands) resulting in an artificially elevated MTX level. An artificially elevated MTX level results in unnecessarily long folinic acid administration, which decreases the effectivity of MTX. This grand round highlights the importance of measuring plasma MTX levels after the administration of glucarpidase with an ultra high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry method instead of with an immunoassay.
AB - High-dose methotrexate (HD-MTX) is used to treat a variety of cancers. In all patients receiving HD-MTX, plasma MTX levels are monitored mainly to anticipate rescue therapy to prevent adverse events. We present 2 children treated with HD-MTX and afterward treated with glucarpidase at different time-points after their HD-MTX infusions. After the administration of glucarpidase, a nontoxic metabolite of MTX cross-reacts with MTX in the standard immunoassay (Abbott Diagnostics, Hoofddorp, the Netherlands) resulting in an artificially elevated MTX level. An artificially elevated MTX level results in unnecessarily long folinic acid administration, which decreases the effectivity of MTX. This grand round highlights the importance of measuring plasma MTX levels after the administration of glucarpidase with an ultra high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry method instead of with an immunoassay.
KW - Glucarpidase
KW - Methotrexate
KW - Therapeutic drug monitoring
KW - U-HPLC-MS/MS
UR - http://www.scopus.com/inward/record.url?scp=85056518806&partnerID=8YFLogxK
U2 - 10.1097/FTD.0000000000000515
DO - 10.1097/FTD.0000000000000515
M3 - Article
C2 - 29994985
AN - SCOPUS:85056518806
SN - 0163-4356
VL - 40
SP - 383
EP - 385
JO - Therapeutic Drug Monitoring
JF - Therapeutic Drug Monitoring
IS - 4
ER -