Reduced IV Fluids to Improve Clearance of HDMTX in Children w/Lymphoma or Acute Lymphoblastic Leukemia

Virginia Commonwealth University10 enrolled

Overview

To determine whether a reduced volume hydration regimen will lead to a shorter time to methotrexate clearance when compared to a standard intravenous (IV) hydration regimen.

This study uses a prospective randomized controlled crossover study design. Neither patients nor clinicians are blinded to the standard versus reduced intravenous fluids (IVF) regimen. Patients are randomized to begin with standard volume or reduced volume IVF. Over the course of 4 cycles of High Dose Methotrexate (HDMTX), patients alternate between standard and reduced volume post hydration fluids protocols.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

Conditions

Lymphoma Acute Lymphoblastic Leukemia Pediatric Cancer Pediatric ALL Pediatric Lymphoma

Interventions

Intravenous fluidsDRUG

Administration of post HDMTX intravenous fluids (IVF)

Eligibility

Sex: ALLMin age: 1 YearMax age: 17 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Diagnosis of lymphoma or acute lymphoblastic leukemia * Candidate for a minimum of 2 cycles HDMTX (5 g/m2) in the inpatient setting * Creatinine clearance ≥ 65 mL/min by modified Schwartz equation * Patients of childbearing potential must have a negative pregnancy test (serum or urine) * Lactating female patients must agree not to nurse a child while on this trial * All patients and/or their parents or legal guardians must provide written informed consent, with assent provided if applicable Exclusion Criteria: * Trisomy 21 * History of dialysis within 30 days prior to study registration or currently on dialysis * Polyuric renal dysfunction * Pregnancy * Known or suspected pleural effusion * Medical, psychological, or social condition that, in the opinion of the investigator, may increase the patient's risk or limit the patient's adherence with study requirements

Locations (1)

Virginia Commonwealth University/ Massey Cancer Center/ Children's Hospital of Richmond

Richmond, Virginia, United States

Outcomes

Primary Outcomes

Time elapsed (in hours) from end of HDMTX to a serum methotrexate level <0.1 micromol/L

To determine whether a reduced volume hydration regimen will lead to a shorter time to methotrexate clearance when compared to a standard IV hydration regimen by measuring serum methotrexate levels twenty-four hours following the end of the high dose methotrexate ( HDMTX) infusion, and continuing every twelve hours until the methotrexate level is less than 0.1 micromol/L.

Time frame: 63 Days

Secondary Outcomes

Markers of kidney toxicity

To determine the effect of a reduced volume hydration regimen on markers of kidney toxicity (nephrotoxicity) by evaluating serum creatinine levels from baseline levels as well as the maximum decrease in estimated glomerular filtration rate (GFR) utilizing the modified Schwartz equation, following each HDMTX cycle.

Time frame: 84 Days

Markers of fluid overload

To determine the effect of a reduced volume hydration regimen on markers of fluid overload by evaluating maximum weight gain during each hospitalization, and by evaluating the incidence of NCI Common Terminology Criteria for Adverse Events (CTCAE) version v5.0 ≥ grade 1 clinical sequelae of hydration such as facial edema, pulmonary edema, abdominal distension, extremity edema, and weight gain.

Time frame: 84 Days

Effects on therapy delays

To examine the effects of a reduced volume hydration regimen on treatment schedule by measuring the number of days subsequent therapy is delayed for reasons other than scheduling issues or preferences.

Time frame: 84 Days

Effects on development of severe mucositis

To examine the effects of a reduced volume hydration regimen on development of severe mucositis by measuring the incidence of grade ≥ 3 (CTCAE v5.0) mucositis.

Data from ClinicalTrials.gov

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