International Journal of Science and Research
Toxicity of High-Dose Methotrexate and Its Correlation with Serum Levels in Adult Acute Lymphoblastic Leukaemia
By D Srujana, Kashinath Benakatti, Darshan R S and 5 others.
Abstract
Background
High-dose methotrexate (HDMTX) is central to consolidation in acute lymphoblastic leukaemia (ALL) but causes substantial toxicity, and data on adults are limited.
Methods
We retrospectively analysed 400 HDMTX cycles (5 g/m2) given to 106 adults with ALL on the BFM-95 protocol at Kidwai Memorial Institute of Oncology, Bengaluru (June 2023-November 2024). Toxicity was graded by CTCAE v5.0 and related to serum methotrexate levels at 48 and 72 hours (toxic: >1 and >0.1 ?mol/L).
Results
Toxicity occurred in 154 cycles (38.5%); the next dose was reduced by 15% in 94 (23.5%). Levels were toxic at 48 hours in 34 cycles and at 72 hours in 24. Toxic levels were associated with leucopenia, neutropenia, thrombocytopenia, raised SGOT and raised creatinine at both times, and with raised SGPT and bilirubin at 48 hours (p<0.05). Vomiting (18%), febrile neutropenia (5.5%) and mucositis (5.5%) were the commonest non-haematological events. No treatment-related deaths occurred. Toxicity prolonged admission (mean 11.48 days against about 5 days usually) and delayed the next cycle by 15-17 days on average.