BTG : NCCN issues first pediatric acute lymphoblastic leukemia guidelines, including use of Voraxaze
This is in addition to updated NCCN guidelines for central nervous system (CNS) cancer, which now reference new consensus guidelines for Voraxaze. Inclusion of Voraxaze is based on publication of consensus guidelines for use of Voraxaze in patients with high-dose methotrexate-induced acute kidney injury and delayed methotrexate clearance in The Oncologisti.
High-dose methotrexate, defined as a dose higher than 500 mg/m2, is used to treat a range of adult and childhood cancers, including, osteosarcoma, acute lymphoblastic leukemia, and primary central nervous system lymphoma. Acute kidney injury due to high-dose methotrexate is a serious, life-threatening toxicity that can occur in pediatric and adult patients. Voraxaze is indicated for the treatment of toxic plasma methotrexate concentrations (>1 mol/L) in patients with delayed methotrexate clearance due to impaired renal function.
'NCCN is continuing to ensure the medical community has access to current best practice on how to manage delayed methotrexate elimination due to acute kidney injury,' said
About Methotrexate Toxicity
Methotrexate is a potent anticancer agent used in high doses (>500 mg/m2) to treat osteosarcoma, non-Hodgkin lymphoma, CNS lymphoma, and adult and pediatric acute lymphoblastic leukemia. Because methotrexate is primarily cleared by the kidneys, high doses can induce kidney dysfunction and delayed methotrexate elimination. Exposure to elevated concentrations of methotrexate for minutes to hours may lead to acute renal toxicity and other serious systemic adverse reactions. Early treatment with Voraxaze is associated with significantly lower rates of toxicity and mortality.ii
Acute kidney injury due to high dose methotrexate (HDMTX) is a serious, life threatening toxicity that can occur in pediatric and adult patients. Voraxaze (glucarpidase) is a treatment approved by the
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Indication and Limitations of Use
Voraxaze (glucarpidase) is indicated for the treatment of toxic plasma methotrexate concentrations (>1 mol/L) in patients with delayed methotrexate clearance due to impaired renal function
Voraxaze is not indicated for use in patients who exhibit the expected clearance of methotrexate (plasma methotrexate concentrations within 2 standard deviations of the mean methotrexate excretion curve specific for the dose of methotrexate administered) or those with normal or mildly impaired renal function because of the potential risk of subtherapeutic exposure to methotrexate
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