[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-405483-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-405483-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","delayed-excretion-of-high-dose-methotrexate-in-pediatric-acute-leukemia-correlates-with-laxative-and-constipation-management","Delayed excretion of high-dose methotrexate in pediatric acute leukemia correlates with laxative and constipation management","","Background: Delayed excretion of high-dose methotrexate (HD-MTX) in pediatric acute lymphoblastic leukemia (ALL) can cause significant morbidity. Methods: This multisite chart review (2010–2020) assessed pediatric ALL patients receiving HD-MTX (5 g/m2). Delayed excretion was defined as serum MTX >0.4 μM at Hour 48. Laxative use after each infusion was tracked, with two or more doses as a constipation proxy, using multilevel logistic regression. Results and conclusions: Receiving at least two laxative doses was independently associated with delayed MTX excretion; prospective studies are needed.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/delayed-excretion-of-high-dose-methotrexate-in-pediatric-acute-leukemia-correlates-with-laxative-and-constipation-management/405483/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/delayed-excretion-of-high-dose-methotrexate-in-pediatric-acute-leukemia-correlates-with-laxative-and-constipation-management/405483.png","ImageObject",300,407,{"name":42,"@type":43},"Patrick","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"How did the study define delayed excretion of HD-MTX?","Question",{"text":63,"@type":64},"Delayed excretion was defined as a serum methotrexate concentration greater than 0.4 μM at Hour 48.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What did the study use as a proxy for constipation?",{"text":68,"@type":64},"Use of laxative medications after each HD-MTX infusion was tracked, and receipt of two or more doses served as a proxy for constipation.",{"name":70,"@type":61,"acceptedAnswer":71},"What was the main association found in the results?",{"text":72,"@type":64},"Independent of other factors, patients who received two or more laxative doses were nearly 60% more likely to experience delayed HD-MTX excretion than those receiving fewer than two doses (odds ratio 1.58; p = .002).","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},405483,1790819684,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":140,"language":141,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":12,"update_tm":145,"read_time":146,"preview_page_count":4},549758146520,"https://ap-avatar.wpscdn.com/avatar/80002397d8c0411e94?_k=1775819394049821470","Author Manuscr ipt Author Manuscr ipt Author Manuscr ipt Author Manuscript  \n\n| | HHS Public Access\u003Cbr>Author manuscript\u003Cbr>Pediatr Blood Cancer. Author manuscript; available in PMC 2026 January 01. |\n| --- | --- |\n\nPublished in final edited form as:  \nPediatr Blood Cancer. 2025 January ; 72(1): e31377 . doi:10.1002/pbc.31377 .  \nDelayed excretion of high-dose methotrexate in pediatric acute leukemia correlates with laxative and constipation management Jennifer A. Belsky 1 , Ashley Chavana2 , Ankona Banerjee2 , Mark Zobeck2,3 , Eric S.  \nSchafer2,3 , Karen R. Rabin2,3 , Monica Gramatges2,3 , Alex Sim4 , Audrey Leisinger1 , Trisha Reddy 1 , Megan J. Parod 1 , Philip Lupo2,3 , Michael Scheurer2,3 , Austin L. Brown2,3 , M. Brooke Bernhardt5  \n1 Department of Pediatrics, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA  \n2 Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, Texas, USA  \n3Texas Children’s Cancer and Hematology Center, Texas Children’s Hospital, Houston, Texas, USA  \n4College of Pharmacy, University of Texas, Houston, Texas, USA  \n5 Department of Pharmacy and Pharmaceutical Science, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA  \nAbstract  \nBackground: Delayed excretion of high-dose methotrexate (HD-MTX) in pediatric acute lymphoblastic leukemia (ALL) can result in significant morbidity. While methotrexate is primarily renally excreted, HD-MTX may overwhelm renal excretion and increase reliance on fecal elimination. This study evaluated the association between laxative use for constipation and delayed excretion of HD-MTX.  \nMethods: This multisite chart review included pediatric patients with ALL (2010–2020) who received HD-MTX (5 g/m2) . Delayed excretion was defined as a serum MTX concentration greater than 0.4 μM at Hour 48. We identified use of laxative medications after each HD-MTXinfusion, with receipt of two or more doses considered a proxy for constipation. Multilevel logistic regression models evaluated associations between clinical factors and delayed HD-MTX excretion to account for multiple MTX cycles per individual.  \nThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Correspondence Jennifer A. Belsky, 705 Riley Dr, Indianapolis, IN 46074, USA., [jbelsky@iu.edu](jbelsky@iu.edu).  \nJennifer A. Belsky and Ashley Chavana contributed equally as first authors. Austin L. Brown and M. Brooke Bernhardt contributed equally as senior authors.  \nCONFLICT OF INTEREST STATEMENT The authors declare no conflicts of interest.  \nSUPPORTING INFORMATION  \nAdditional supporting information can be found online in the Supporting Information section at the end of this article.  \nAuthor Manuscr ipt Author Manuscr ipt Author Manuscr ipt Author Manuscript  \nBelsky et al. Page 2  \nResults: A total of 533 eligible patients received 1875 HD-MTX infusions. Patients were mostly male (59.8%), Hispanic (56.7%), with a median age of 9.5 years. Delayed excretion was observed following 42.7% of HD-MTX infusions, and patients received two or more laxative doses during 19.9% of infusions. Independent of other factors, individuals who received two or more laxative doses were nearly 60%(odds ratio 1.58; 95% confidence interval: 1.19–2.09; p = .002) more likely to experience delayed excretion compared to those receiving fewer than two laxative doses.  \nConclusion: Receipt of at least two laxative doses was independently associated with delayed methotrexate excretion in pediatric patients with ALL. Future prospective studies are needed to confirm the secondary effects of constipation and confirm the association with constipation and identify clinical benefits that optimize drug excretion.  \nKeywords  \nALL; Chemotherapy; Methotrexate  \n","cbCainzEUN2V5Tz2","https://ap.wps.com/l/cbCainzEUN2V5Tz2","pdf",246570,13,"English","# Abstract\n# Background\n# Methods\n# Results\n# Conclusion\n# Keywords\n# Introduction","[{\"question\":\"How did the study define delayed excretion of HD-MTX?\",\"answer\":\"Delayed excretion was defined as a serum methotrexate concentration greater than 0.4 μM at Hour 48.\"},{\"question\":\"What did the study use as a proxy for constipation?\",\"answer\":\"Use of laxative medications after each HD-MTX infusion was tracked, and receipt of two or more doses served as a proxy for constipation.\"},{\"question\":\"What was the main association found in the results?\",\"answer\":\"Independent of other factors, patients who received two or more laxative doses were nearly 60% more likely to experience delayed HD-MTX excretion than those receiving fewer than two doses (odds ratio 1.58; p = .002).\"}]","Delayed excretion of high-dose methotrexate in pediatric acute leukemia correlates with laxative and constipation management | PDF",1790560262,33]