New recommendations for reversal of high-dose methotrexate cytotoxicity with folinic acid.

ABSTRACT:

Purpose

Folinic acid (FA) rescue protocols to counter the adverse effects of high-dose methotrexate (HDMTX) vary widely, and the risk of over-rescue and potential adverse effects of excessive FA (e.g., hypercalcemia) are under-recognized issues when providing augmented rescue in cases of delayed methotrexate elimination (DME). This opinion summary defines over-rescue, describes its potential adverse impacts, highlights the risk of hypercalcemia associated with excessive FA dosing in patients with acute kidney injury (AKI) from HDMTX, and provides recommendations to improve safety and efficacy of FA rescue in patients receiving HDMTX.

Methods

A multidisciplinary panel of experts with clinical experience in HDMTX treatment convened in three roundtable meetings to coalesce expe

SUBMITTER: Heldrup J 

PROVIDER: S-EPMC11903593 | biostudies-literature | 2025 Mar

REPOSITORIES: biostudies-literature