Abstract
High-dose methotrexate (HDMTX) is defined as methotrexate dose of ≥500 mg/m2. It is used in the treatment of acute lymphoblastic leukemia, osteosarcoma, and primary
central nervous system lymphoma. Administration mandates adequate hydration; urine
alkalinization; leucovorin rescue, monitoring of urine output, serum creatinine, and
methotrexate levels. Delayed methotrexate clearance is managed by increasing hydration
and leucovorin dose. Glucarpidase is the antidote for patients with renal toxicity.
Studies from India have shown that HDMTX can be administered without monitoring of
methotrexate levels with strict monitoring of urine pH, urine output, and serum creatinine
and extended hydration and leucovorin doses.
Keywords
High-dose methotrexate - methotrexate levels - toxicity
