High-dose methotrexate for the treatment of acute lymphoblastic leukemia in children (a pharmacokinetic study)

One of the ways how to vanquish resistence of the tumour cells to MTX is using HD-MTX therapy, because active transport of MTX across the cell membrane is changed to the passive diffusion (with the condition of monitoring MTX levels in blood, urine, liquor etc.). 24 children with ALL, cured by BFM 90 protocol, with 48 applications of HD-MTX, was evaluated. We proved the usefulness of observing the AUC value, with reveals significant differences between a group of children in the first complete remission and the children who made their exit or live in the second remission, between a group with CNS meningosis and those without that meningosis, also between T ALL and nonT nonB ALL. In spite of a certain scepticism in literature, we can recommend the observation of pharmacokinetic parametres - not only from the point of view of observing relevant MTX levels and subsequent adequate "rescue", but also as a further possibility to classify, sort out and study a set of children with ALL. To achieve this, we also recommend the AUC value besides the classically quoted clearance and Vd.