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Strategies for Managing Toxicities With High‐Dose Methotrexate in Haematological Malignancies: Lessons From Clinical Cases

Year: 2026

Type: article

Abstract: ABSTRACT High‐dose methotrexate (HDMTX) is a key component of induction therapy for a range of cancers, but can lead to serious adverse effects, including acute kidney injury (AKI). We report two cases of HDMTX use in haematological malignancies. Patient 1 was an 8‐year‐old girl with high‐grade NHL. She received 3 courses of HDMTX (3 g/m 2 ) without issue. For her 4th course, she developed AKI with creatinine peaking at 240 μmol/L after HDMTX administration. She required intensified hydration and antihypertensive therapy for fluid overload, received glucarpidase for delayed MTX clearance, required parenteral nutrition for mucositis and ultimately made a full recovery. Patient 2 was a 76‐year‐old man with primary central nervous system lymphoma. He underwent HDMTX treatment per the MARTA protocol with dose reductions due to renal impairment. He experienced delayed MTX clearance leading to fluid overload, acute liver injury, required prolonged diuretic and antibiotic therapy, and was hospitalised for 3 weeks before recovery. These cases emphasise the need for preemptive supportive care, including prehydration and folinic acid (leucovorin), careful monitoring and early intervention with glucarpidase in the event of toxicities.

Source: Clinical Case Reports

DOI: 10.1002/ccr3.71977

Authors: Vanessa McLelland, Martin Guscott, Matthew R. Wilson

Institutions: Bristol Royal Hospital for Children, Resonance (United States), Beatson West of Scotland Cancer Centre

Language: English

Topic: Chemotherapy-induced organ toxicity mitigation

Subfield: Pathology and Forensic Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,820