Prevention of toxicity in chemotherapy with high doses of methotrexate in children

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Methotrexate (MTX) is a widely used anti-tumor drug, folic acid antagonists. The effectiveness of high doses (more than 1 g/m2) of MTX in a monotherapy or in a combination with other chemotherapeutic drugs has been proven in a treatment of a large spectrum of oncological diseases in children such as osteosarcoma, tumors of the central nervous system, lymphomas, acute lymphoblastic leukemia. The use of high doses of MTX is often fraughted with development of life-threatening complications such as MTX-induced acute kidney injury, neurotoxicity, myelosuppression. Currently developed recommendations for therapeutic monitoring and supportive care, including hyper-hydration, urine alkalization and leucovorin therapy, allow to reduce toxicity of MTX, but in some patients it is not always possible to prevent the development of complications. Cohort studies in order to identify risk factors for toxicity after high doses of MTX in children with different forms of cancer are limited, as well as comparing various types of supportive care regimens, including, infusion therapy. Studying of development mechanisms of MTX toxicity depending on background conditions will allow to improve existing recommendations and develop new and most effective standards of supportive therapy with respect to the individual specifics of patients.

作者简介

Ekaterina Evsiutina

Almazov National Medical Research Centre, Ministry of Healthcare of the Russian Federation

编辑信件的主要联系方式.
Email: olovar90@mail.ru

Anesthesiologist-resuscitator of the Department of Chemotherapy for Oncohematological Diseases and Bone Marrow Transplantation for Children

俄罗斯联邦, Saint Petersburg

Yuliya Dinikina

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation; Almazov National Medical Research Centre, Ministry of Healthcare of the Russian Federation

Email: dinikinayulia@mail.ru

MD, PhD, Associate Professor, Department of Oncology, Pediatric Oncology and Radiotherapy; Pediatric Oncologist, Head of the Department of Chemotherapy for Oncohematological Diseases and Bone Marrow Transplantation for Children

俄罗斯联邦, Saint Petersburg

Margarita Belogurova

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation; Almazov National Medical Research Centre, Ministry of Healthcare of the Russian Federation

Email: deton.hospital31@inbox.ru

MD, PhD, Dr Med Sci, Professor, Head, Department of Oncology, Pediatric Oncology and Radiotherapy; Leading Researcher of the Department of Chemotherapy for Oncohematological Diseases and Bone Marrow Transplantation for Children

俄罗斯联邦, Saint Petersburg

Yuriy Aleksandrovich

St. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: jalex1963@mail.ru

MD, PhD, Dr Med Sci, Professor, Head of the Department of Anesthesiology, Resuscitation and Emergency Pediatrics, Faculty of Postgraduate Education

俄罗斯联邦, Saint Petersburg

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