Neurotoxicity after high-dose methotrexate (MTX) is adequately explained by insufficient folinic acid rescue

2017 ◽  
Vol 79 (6) ◽  
pp. 1057-1065 ◽  
Author(s):  
Ian Joseph Cohen
Keyword(s):  
Folinic Acid ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Folinic Acid Rescue

scholarly journals Reduced dose folinic acid rescue after rapid high-dose methotrexate clearance is not associated with increased toxicity in a pediatric cohort

2021 ◽  
Author(s):  
Riitta Niinimäki ◽  
Henri Aarnivala ◽  
Joanna Banerjee ◽  
Tytti Pokka ◽  
Kaisa Vepsäläinen ◽  
...  
Keyword(s):  
Folinic Acid ◽  
Lymphoblastic Leukemia ◽  
High Dose ◽  
Optimal Dosage ◽  
High Dose Methotrexate ◽  
Reduced Dose ◽  
Dose Methotrexate ◽  
Antileukemic Effect ◽  
Folinic Acid Rescue ◽  
High Doses

Abstract Purpose Low doses of folinic acid (FA) rescue after high-dose methotrexate (HD-MTX) have been associated with increased toxicity, whereas high doses may be related to a decreased antileukemic effect. The optimal dosage and duration of FA rescue remain controversial. This study was designed to investigate, whether a shorter duration of FA rescue in the setting of rapid HD-MTX clearance is associated with increased toxicity. Methods We reviewed the files of 44 children receiving a total of 350 HD-MTX courses during treatment for acute lymphoblastic leukemia according to the NOPHO ALL-2000 protocol. Following a 5 g/m2 HD-MTX infusion, pharmacokinetically guided FA rescue commenced at hour 42. As per local guidelines, the patients received only one or two 15 mg/m2 doses of FA in the case of rapid MTX clearance (serum MTX ≤ 0.2 μmol/L at hour 42 or hour 48, respectively). Data on MTX clearance, FA dosing, inpatient time, and toxicities were collected. Results Rapid MTX clearance was observed in 181 courses (51.7%). There was no difference in the steady-state MTX concentration, nephrotoxicity, hepatotoxicity, neutropenic fever, or neurotoxicity between courses followed by rapid MTX clearance and those without. One or two doses of FA after rapid MTX clearance resulted in a 7.8-h shorter inpatient time than if a minimum of three doses of FA would have been given. Conclusion A pharmacokinetically guided FA rescue of one or two 15 mg/m2 doses of FA following HD-MTX courses with rapid MTX clearance results in a shorter hospitalization without an increase in toxic effects.

Treatment of advanced malignant melanoma with high dose methotrexate and folinic acid rescue

1982 ◽  
Vol 10 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Michael F. Leahy ◽  
Hulbert K. B. Silver ◽  
Paul Klimo ◽  
Thomas C. Hall
Keyword(s):  
Malignant Melanoma ◽  
Folinic Acid ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Advanced Malignant Melanoma ◽  
Folinic Acid Rescue

High-dose methotrexate with folinic acid rescue

1977 ◽  
Vol 34 (9) ◽  
pp. 961-965
Author(s):  
John F. Bender ◽  
William R. Grove ◽  
Clarence L. Fortner
Keyword(s):  
Folinic Acid ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Folinic Acid Rescue
Sign in / Sign up

Export Citation Format

Share Document