From the Guidelines
The time difference between administration of cytarabine and methotrexate in Hyperfractionated Cyclophosphamide, Vincristine (Oncovin), Doxorubicin (Adriamycin), and Dexamethasone (HyperCVAD) is approximately 24 hours, with methotrexate administered first on day 1, followed by cytarabine on days 2 and 3. According to the study published in Nature Reviews Clinical Oncology in 2019 1, methotrexate is given at a dose of 1 g/m2 on day 1, and cytarabine is administered at a dose of 1 g/m2 every 12 hours on days 2 and 3. This sequential administration is crucial to prevent overlapping toxicities and ensure the efficacy of both drugs. Key points to consider in the administration of these drugs include:
- Methotrexate is cleared first before cytarabine administration begins to prevent overlapping toxicities
- Adequate hydration and urine alkalinization are necessary during methotrexate administration
- Leucovorin rescue typically begins 24 hours after methotrexate completion to protect normal cells. The specific timing and dosing of these drugs are critical in the treatment of acute lymphoblastic leukemia and certain aggressive lymphomas, and should be carefully followed to maximize efficacy and minimize toxicity.
From the Research
Time Difference Between Administration of Cytarabine and Methotrexate
- The time difference between administration of cytarabine and methotrexate in Hyperfractionated Cyclophosphamide, Vincristine (Oncovin), Doxorubicin (Adriamycin), and Dexamethasone (HyperCVAD) is not explicitly stated in the provided studies.
- However, according to the study 2, the hyper-CVAD regimen alternates every 21 days with rituximab plus high-dose methotrexate-cytarabine, suggesting that cytarabine and methotrexate are administered together in the same cycle, but the exact timing is not specified.
- Another study 3 mentions that liposomal cytarabine was given intrathecally on days 2 and 15 of hyper-CVAD and day 10 of high-dose MTX and cytarabine courses, indicating that methotrexate and cytarabine are administered on different days, but the exact time difference is not provided.
- The study 4 also does not provide information on the time difference between administration of cytarabine and methotrexate in the HyperCVAD regimen.
Administration Schedule
- The administration schedule of cytarabine and methotrexate in HyperCVAD varies across different studies, with some studies suggesting that they are administered together in the same cycle 2, while others indicate that they are administered on different days 3.
- However, the exact time difference between their administration is not consistently reported across the studies.