Consensus on managing delayed methotrexate elimination in high-dose therapy: insights from the Middle East.

ABSTRACT:

Introduction

High-dose methotrexate (HDMTX) therapy is a cornerstone in treating pediatric and adult cancers, namely, acute lymphoblastic leukemia, non-Hodgkin lymphoma, and osteosarcoma, due to its capability to penetrate the blood-brain barrier. Despite its therapeutic benefits, HDMTX poses significant risks of delayed methotrexate elimination (DME) and associated toxicities such as acute kidney injury (AKI). These risks necessitate individualized dosing and preventive strategies, including hyperhydration, urine alkalinization, and leucovorin rescue.

Methods

To address these challenges, a modified Delphi method with two rounds was used to develop consensus statements to guide clinicians in mitigating HDMTX-associated toxicities and optimizing management strategies. A panel

SUBMITTER: Al Manasour M 

PROVIDER: S-EPMC12631234 | biostudies-literature | 2025

REPOSITORIES: biostudies-literature