(123) High Dose Methotrexate Management: Increasing Efficiencies to Decrease Length of Stay at a Community Hospital

Poster Abstract: Background/Rationale: High- dose methotrexate (HD-MTX) is defined as a methotrexate dose ≥ 500-1000 mg/m2. This regimen is administered in the inpatient setting due to potential toxicities and need for monitoring and continuous fluids. Supportive care measures are routinely implemented to facilitate methotrexate clearance and prevent toxicity; these include adequate hydration, urinary alkalinization, serum methotrexate level monitoring, and leucovorin rescue.

At Abbott Northwestern Hospital, it was identified that there are opportunities to optimize supportive care, which is in line with the literature and accepted practices at other institutions. Key proposed changes to our practices include starting oral sodium bicarbonate tablets the day prior to admission, calling patients to screen for drug-drug interactions, drawing pertinent labs and starting intravenous hydration prior to hospitalization, and early discharge with oral leucovorin for select patients.

Objective: Assess if planned changes to HD-MTX processes decrease length of hospital stay for planned HD-MTX admission. Secondary outcomes include incidence of nephrotoxicity, time to methotrexate administration, and time to urinary alkalinization.

Methods: Retrospective chart review including pre-implementation and post-implementation groups. Inclusion criteria include patients treated with HD-MTX (dose ≥500 mg/m2) for an active malignancy. Exclusion criteria include patients less than 18 years of age.

Results: Pending

Discussion/

Conclusion: Pending

References (must also be included in final poster): 1. Alsdorf WH, Karagiannis P, Langebrake C, Bokemeyer C, Frenzel C. Standardized Supportive Care Documentation Improves Safety of High-Dose Methotrexate Treatment. Oncologist. 2021;26(2):e327-e332.
2. Hamed KM, Dighriri IM, Baomar AF, et al. Overview of Methotrexate Toxicity: A Comprehensive Literature Review. Cureus. 2022;14(9):e29518.
3. Kowalski, A, Jaszczur, S, Nadeau-Ngyten M, Merl M. Assessment of High-Dose Methotrexate Management Guidelines in Adults with Cancer at an Academic Medical Center. J Hematol Oncol Pharm. 2021;11(2)e69-73,
4. Alsdorf WH, Karagiannis P, Langebrake C, Bokemeyer C, Frenzel C. Standardized Supportive Care Documentation Improves Safety of High-Dose Methotrexate Treatment. Oncologist. 2021;26(2):e327-e332
5. Toama W, Kolla B, Hoiness J, Hurley P, Dudek A, Gustafson S, Jahagirdar B. Safety of Novel Inpatient High Dose Methotrexate Protocol with Reduced Length of Hospital Stay [abstract]. In: Blood 140 (supplement 1). 2022.
6. Binder A, Burdette S, Galanis P, Birchmeier K, Handley N, Piddoubny M. Implementing an early discharge initiative for patients receiving high-dose methotrexate. In: ASCO Quality Care Symposium. 2019.