Prospective evaluation of the toxicity profile, and predictors of toxicity of high dose methotrexate in patients of acute lymphoblastic leukemia/lymphoma

- Treatment with high dose methotrexate was feasible and safe in an Indian hospital catering to patients from low socio-economic group.
- Dose of MTX, pre-infusion serum creatinine and early elimination kinetics (levels at 42 h and 48 h) predict delayed clearance and toxicity.
- If the 42 h MTX is ≤0.5 μmol/L (seen in 25% infusions), a single repeat value at 54 h is enough for checking that clearance has occurred.
- Based on the early kinetics an early discharge strategy could also be planned thus sparing beds in hospitals where there is shortage of inpatient beds.
- On the contrary, MTX > 1.5 μmol/L at 42 h strongly predicts delayed clearance and a need for more aggressive monitoring, hydration and leucovorin support.