Subscribe to RSS
Download PDF
DOI: 10.4103/ijmpo.ijmpo_113_18
Methotrexate and mucositis: A merry-go-round for oncologists
Financial support and sponsorship Nil.
Abstract
High-dose methotrexate is the backbone of various regimens for treating lymphoid malignancies. Mucositis is a well-known, dose-related side effect of methotrexate. Prophylactic measures such as folinic acid rescue are useful but do not prevent mucositis in all the cases. Once severe mucositis (WHO Grade IV) sets in, mortality is very high. The index case highlights the natural course of methotrexate-induced mucositis and the need for swift and preemptive intervention.
Publication History
Article published online:
08 June 2021
© 2019. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Farber S, Diamond LK. Temporary remissions in acute leukemia in children produced by folic acid antagonist, 4-aminopteroyl-glutamic acid. N Engl J Med 1948; 238: 787-93
- 2 Howard SC, McCormick J, Pui CH, Buddington RK, Harvey RD. Preventing and managing toxicities of high-dose methotrexate. Oncologist 2016; 21: 1471-82
- 3 Rask C, Albertioni F, Schrøder H, Peterson C. ral mucositis in children with acute lymphoblastic leukemia after high-dose methotrexate treatment without delayed elimination of methotrexate: Relation to pharmacokinetic parameters of methotrexate. Pediatr Hematol Oncol 1996; 13: 359-67
- 4 Sonis ST, Elting LS, Keefe D, Peterson DE, Schubert M, Hauer-Jensen M. et al. Perspectives on cancer therapy-induced mucosal injury: Pathogenesis, measurement, epidemiology, and consequences for patients. Cancer 2004; 100: 1995-2025
- 5 Goldin A, Venditti JM, Kline I, Mantel N. Mantel N. Eradication of leukaemic cells (L1210) by methotrexate and methotrexate plus citrovorum factor. Nature 1966; 212: 1548-50
- 6 Schmidt S, Thoennissen NH, Rudat A, Bieker R, Schliemann C, Mesters RM. et al. Use of palifermin for the prevention of high-dose methotrexate-induced oral mucositis. Ann Oncol 2008; 19: 1644-9
- 7 Schwartz S, Borner K, Müller K, Martus P, Fischer L, Korfel A. et al. Glucarpidase (carboxypeptidase g2) intervention in adult and elderly cancer patients with renal dysfunction and delayed methotrexate elimination after high-dose methotrexate therapy. Oncologist 2007; 12: 1299-308
- 8 Ramsey LB, Balis FM, O'Brien MM, Schmiegelow K, Pauley JL, Bleyer A. et al. Consensus guideline for use of glucarpidase in patients with high-dose methotrexate induced acute kidney injury and delayed methotrexate clearance. Oncologist 2018; 23: 52-61
- 9 Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM. et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2014; 120: 1453-61