Successful Use of High Dose Methotrexate in Treatment of Primary CNS Lymphoma Patients Without Access to Serum Methotrexate Levels Monitoring: Challenges and Outcome

Leucovorin (folinic acid) rescue for high‐dose methotrexate: A review

“…The leucovorin rescue protocol used in the studies without MTX level monitoring was similar to those with MTX-level monitoring (6-12 doses of 10-15 mg/m 2 leucovorin every 6 h at 24-42 h after 1-5 g/m 2 MTX infusion). 47,[49][50][51] At present, no article has been published on leucovorin dose adjustments based on indicators other than MTX plasma levels. Some studies have confirmed that serum creatinine, creatinine clearance rate, and serum cystatin C were useful to identify patients with a high risk of delayed MTX elimination if MTX monitoring was not available.…”

“…Via assiduous monitoring of urine pH and serum creatinine, extended hydration, and twice‐daily examination of mucosal membranes, 48 the administration of additional doses of leucovorin can allow for the safe administration of HDMTX for the most patients. The leucovorin rescue protocol used in the studies without MTX level monitoring was similar to those with MTX‐level monitoring (6–12 doses of 10–15 mg/m 2 leucovorin every 6 h at 24–42 h after 1–5 g/m 2 MTX infusion) 47,49–51 . At present, no article has been published on leucovorin dose adjustments based on indicators other than MTX plasma levels.…”