Congress Abstracts 2003

53

TREATMENT OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA WITH HIGH-DOSE METHOTREXATE: NURSING’S UNIQUE CONTRIBUTION. Jessica Cloud, RN, AA, Jennifer Hauck, RN, BSN, and MiKaela Olsen, RN, MS, OCN^®, Johns Hopkins Hospital, Baltimore, MD.

Primary central nervous system (CNS) lymphoma is a malignancy limited to the cranial and spinal axis without systemic metastasis. Untreated, the prognosis for primary CNS lymphoma is poor, with a median survival of approximately three months.

Methotrexate has been a key drug in the therapy provided to these patients. Clearance of high dose methotrexate is largely dependent upon renal function and urine Ph. Single agent high dose methotrexate used with leukovorin rescue is becoming a standard therapy for primary CNS lymphoma. High dose methotrexate administration is potentially lethal, with severe acute toxicities. Potential adverse reactions include renal failure, hepatic dysfunction, myelosuppression, and a host of other less serious adverse effects. Meticulous nursing care plans are essential for the successful treatment of these patients.

This presentation will showcase nursing’s significant contribution in preventing the potential adverse effects of high dose methotrexate. The pathophysiology of CNS lymphoma and mechanism of action of methotrexate used in conjunction with leukovorin rescue will be reviewed. A nursing care plan will identify risk factors to consider prior to administration; preparation for administration; and close clinical monitoring required such as blood pressure, intake and output, frequent weights, urine pH, serum renal and liver function, electrolytes, and serum methotrexate levels. Specific strategies to manage patients during the clearance period and for those patients who are slow to clear methotrexate or who have toxic methotrexate levels will be reviewed.

Two case studies will present toxic versus non-toxic outcomes of high dose methotrexate utilizing a serum methotrexate level graphing tool. The tool assists with the early identification of potentially toxic patients ensuring early intervention. Nursing assessment and early interventions provided during high dose methotrexate treatments have made a significant difference in the prevention of potential serious adverse effects in this patient population.