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CASE REPORT
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 39-41

High-dose methotrexate: Treatment experience in patient with B-cell philadelphia-positive acute lymphoblastic leukemia


Department of Pharmacology and Pharmacy Practice, Maliba Pharmacy College, Uka Tarsadia University, Surat, Gujarat, India

Correspondence Address:
Dr. Avinash Khadela
Maliba Pharmacy College, Uka Tarsadia University, Gopal Vidyanagar, Bardoli Mahuva Road, Surat - 394 350, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jihs.jihs_13_21

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High-dose methotrexate (HDMTX) is gaining importance in the management of acute lymphoblastic leukemia (ALL). Its efficacy and toxicity depends on dose strength, route of administration, and infusion time. HDMTX toxicities can be controlled by continuous monitoring of urine pH and adequate supportive care (hyper-hydration, alkalinizing agents, and leucovorin rescue). A patient suffering from B cell Ph + ALL was kept on Berlin-Frankfurt-Münster-90 protocol and administered methotrexate 8 g/cycle by intravenous infusion with normal saline over 6 h. He developed leucopenia and severe anemia after receiving the first cycle of chemotherapy, which was treated with subcutaneous filgrastim 300 mcg OD for 5 days and 1 pint red blood cell. After the third cycle, patient developed mucositis and treated with leucovorin and local anesthetics; and continued the chemotherapy. In conclusion, the patient was continuously monitored for urine pH and tolerated the HDMTX well when provided adequate supportive care.


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