Strategies for Managing Toxicities With High-Dose Methotrexate in Haematological Malignancies: Lessons From Clinical...

Area of Science:

• Oncology
• Nephrology
• Pharmacology

Background:

• High-dose methotrexate (HDMTX) is vital for treating various cancers.
• HDMTX can cause severe adverse events, notably acute kidney injury (AKI).

Purpose of the Study:

• To report two cases of HDMTX use in hematological malignancies.
• To highlight the importance of supportive care and early intervention for HDMTX toxicity.

Main Methods:

• Case report of an 8-year-old girl with NHL receiving HDMTX.
• Case report of a 76-year-old man with primary CNS lymphoma undergoing HDMTX treatment.
• Review of supportive care measures and interventions for managing HDMTX-induced toxicities.

Main Results:

• Patient 1 developed AKI and mucositis after HDMTX, requiring hydration, glucarpidase, and parenteral nutrition for recovery.
• Patient 2 experienced delayed MTX clearance, fluid overload, and acute liver injury, necessitating prolonged supportive care.
• Both cases underscore the potential for severe toxicity despite standard protocols.

Conclusions:

• Preemptive supportive care, including hydration and leucovorin, is essential.
• Vigilant monitoring and timely administration of glucarpidase are critical for managing delayed MTX clearance and preventing severe complications.
• Individualized patient management is key to optimizing outcomes in HDMTX therapy.