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<p>This study analyzed the correlation among serum cystatin C (CysC) levels, hypermethotrexemia, and kidney damage following high-dose methotrexate (HD-MTX) chemotherapy in children with acute lymphoblastic leukemia (ALL) to aid early prediction, diagnosis, and treatment.&#xa0;Clinical data from 103 children diagnosed with ALL were collected, totaling 412 HD-MTX chemotherapy sessions. The association between 20-h serum CysC levels, 44-h MTX blood concentrations, and 44-h serum creatinine levels was analyzed. Forty-four patients in the low-risk group received 3&#xa0;g/m<sup>2</sup> of HD-MTX, while 59 patients in the intermediate-risk group received 5&#xa0;g/m<sup>2</sup> of HD-MTX. Some patients experienced a 20% dose reduction due to high 44-h MTX concentrations in previous cycles; however, no dose increases were observed.&#xa0;In the high MTX concentration group, 31.4% (27/86) of patients had elevated 20-h serum CysC levels, significantly higher than the 2.8% (9/324) in the low-concentration group (<i>P</i> &lt; 0.001). However, baseline serum CysC levels did not differ significantly (<i>P</i> = 0.377). Among the 36 cycles with elevated 20-h serum CysC levels, 19.4% (7/36) of patients progressed to elevated serum creatinine levels at 44&#xa0;h. In contrast, only one patient in the normal serum CysC group showed such progression (<i>P</i> &lt; 0.001). Furthermore, the 20-h serum CysC levels positively correlated with 44-h MTX concentrations and serum creatinine levels.&#xa0;Our findings indicate that 20-h serum CysC levels can predict hyperammonemia and kidney injury.</p>

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Role of cystatin C in predicting the risk of hypermethotrexemia and kidney injury after high-dose methotrexate chemotherapy in childhood acute lymphoblastic leukemia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月13日

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  • Wenting Pei,
  • Xiao Zhang,
  • Li-an Du,
  • Zhijuan Liu,
  • Li Song,
  • Muyuan Ji,
  • Xiao Mou,
  • Luping Ding,
  • Fu Li,
  • Xiaoling Li,
  • Xiaomei Yang

摘要

This study analyzed the correlation among serum cystatin C (CysC) levels, hypermethotrexemia, and kidney damage following high-dose methotrexate (HD-MTX) chemotherapy in children with acute lymphoblastic leukemia (ALL) to aid early prediction, diagnosis, and treatment. Clinical data from 103 children diagnosed with ALL were collected, totaling 412 HD-MTX chemotherapy sessions. The association between 20-h serum CysC levels, 44-h MTX blood concentrations, and 44-h serum creatinine levels was analyzed. Forty-four patients in the low-risk group received 3 g/m2 of HD-MTX, while 59 patients in the intermediate-risk group received 5 g/m2 of HD-MTX. Some patients experienced a 20% dose reduction due to high 44-h MTX concentrations in previous cycles; however, no dose increases were observed. In the high MTX concentration group, 31.4% (27/86) of patients had elevated 20-h serum CysC levels, significantly higher than the 2.8% (9/324) in the low-concentration group (P < 0.001). However, baseline serum CysC levels did not differ significantly (P = 0.377). Among the 36 cycles with elevated 20-h serum CysC levels, 19.4% (7/36) of patients progressed to elevated serum creatinine levels at 44 h. In contrast, only one patient in the normal serum CysC group showed such progression (P < 0.001). Furthermore, the 20-h serum CysC levels positively correlated with 44-h MTX concentrations and serum creatinine levels. Our findings indicate that 20-h serum CysC levels can predict hyperammonemia and kidney injury.