Among patients with hematologic malignancies treated with methotrexate, lactate dehydrogenase (LDH) and albumin levels at baseline of treatment may be factors associated with acute kidney injury (AKI), according to study results published in Hematological Oncology.

A team of researchers conducted a retrospective single cohort study to characterize factors and develop cut-offs that may facilitate the identification of patients with hematologic malignancies who are at risk for AKIs.

Patients who received more than 1 g of methotrexate were assessed for renal toxicity. Additionally, the investigators measured baseline variables associated with AKI and estimated overall survival in the cohort.

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A total of 160 patients (median age at diagnosis, 58 years; 55% men) completed at least 1 cycle of methotrexate. The primary indications for methotrexate were central nervous system (CNS) prophylaxis in patients with diffuse large B-cell lymphoma (51.2%), primary CNS lymphoma (13.8%), and acute lymphatic leukemia (15%). Doses of methotrexate varied from 743 mg/m2 to 5442 mg/m2.

In 9% of the 265 cycles of methotrexate, 13% of patients developed AKIs (21 patients); 18 patients developed AKI only once during their first cycle.

Results from a univariate analysis suggested that acute nephrotoxicity was significantly linked to age older than 40 years (odds ratio [OR], 7.6), LDH levels greater than 380 units/L (OR, 5.4), estimate glomerular filtration rate less than 112 mL/m (OR, 4.7), and albumin levels less than 3.6 g/dL (OR, 2.9) at the start of treatment. However, multivariate analysis results stayed significant only for LDH (OR, 4.1) and albumin levels (OR, 4.17). In addition, median drug elimination was longer in patients with AKIs compared with those who did not have AKIs (8 days vs 5 days).

Within 1 month, creatinine levels went back to normal in 80% of cases but median survival among patients with and without AKIs was 37 months vs 145 months.

“Whether these findings can be translated into reliable predictors in clinical practice, remains to be determined,” the investigators concluded.


Amitai I, Rozovski U, El-Saleh R, et al. Risk factors for high-dose methotrexate associated acute kidney injury in patients with hematological malignancies [published online June 7, 2020]. Hematol Oncol. doi: 10.1002/hon.2759

This article originally appeared on Hematology Advisor