Safety Analysis of High-Dose Methotrexate in Pediatric Non-Hodgkin Lymphomas

Authors

M Brooke Bernhardt
Austin L Brown
Austyn T Grim
Michael E Scheurer
Nader Kim El-Mallawany
Nmazuo W Ozuah

Publication Date

11-1-2022

Journal

Pediatric Blood & Cancer

DOI

10.1002/pbc.29940

PMID

36069680

PMCID

PMC10707448

PubMedCentral® Posted Date

12-8-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Child, Creatinine, Humans, Lymphoma, Non-Hodgkin, Methotrexate, Mucositis, childhood cancer, methotrexate, non-Hodgkin lymphoma

Abstract

High-dose methotrexate (HD-MTX) with rigorous supportive care is essential to the treatment of pediatric non-Hodgkin lymphomas (NHL). We describe the safety and tolerability of HD-MTX in patients with NHL treated at our center. In our cohort of 46 patients, the majority had at least one course of delayed clearance and/or creatinine elevation. Additionally, more than one-third of patients experienced an episode of grade ≥3 mucositis. Creatinine elevations and delayed clearance were independently associated with subsequent grade ≥3 mucositis. We advocate for greater availability of methotrexate monitoring to allow dose escalation of this essential modality around the world.