Neoplasma Vol.52, p.456-463, 2005
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Title: High-dose methotrexate and/or leucovorin rescue for the treatment of children with lymphoblastic malignancies: do we really know why, when and how?
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Author: J., STERBA
; D., VALIK
; V., BAJCIOVA
; V., KADLECOVA
; V., GREGOROVA
; D., MENDELOVA
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Abstract: Methotrexate (MTX) remains a mainstay in the treatment of children
with hematological malignancies. The availability
of an antidote/rescue agent, leucovorin (LV) has allowed
escalation of MTX doses to achieve enormous plasma concentrations,
compared with plasma folate. However, a recent review of more than
40 trials for children with ALL concluded that
the addition of high dose MTX (HDMTX) in many different doses and
schedules did not improve CNS therapy and made
only minor improvements in systemic therapy for children with ALL
[11]. Some assessment suggested that by HDMTX
benefits only limited amount of children with ALL. Recent
treatment schedules vary markedly in terms of timing, dosing
and scheduling of MTX and/or leukovorin, which may leave us
uncertain with ideas such as "how should we best use
HDMTX and LV?" or "why are we still using such by industry
recomended doses of MTX?"
The answer of how best to incorporate HDMTX and/or LV into ALL
treatment plans is still not known and further clinical
and pharmacological studies dealing with still controversial
systemic MTX issue are actual even now, after more than
5 decades of clinical experiences with the MTX in pediatric
oncology.
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Keywords: child, acute lymphoblastic leukemia, methotrexate, toxicity,
effectiveness
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Year: 2005, Volume: 52, Issue: |
Page From: 456, Page To: 463 |
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