A prospective, crossover randomized trial of the optimal timing for leucovorin rescue after high-dose methotrexate management in adult non-Hodgkin’s lymphoma patients

Abstract

This study aimed to investigate the optimal time of leucovorin rescue for HDMTX in non-Hodgkin’s lymphoma (NHL) patients. Ninety-eight patients treated with HDMTX were randomly assigned to receive leucovorin at either 18 or 24 h after initiation of HDMTX infusion during the first cycle and switched to the other mode in the second cycle. All courses achieved an efficacious MTX concentration. Compared to the 18th hour group, the 24th hour group exhibited an increase in incidence of thrombocytopenia (48% versus 34.7%, p = .036) and grade III/IV neutropenia (34.7% versus 21.4%, p = .039). No bleeding occurred and the incidence of fever with grade III/IV neutropenia was low with no difference observed between the two groups. We recommend that with the HDMTX generally used most adult patients with NHL may have greater therapeutic benefit and acceptable toxicity with their LV rescue started at 24 h instead of 18 h.

Keywords:

• High-dose methotrexate
• leucovorin
• MTX concentration
• non-Hodgkin’s lymphoma

Acknowledgments

We thank all of our colleagues for their assistance. We are also grateful to all of the patients who took part in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

CP conducted the experiments, created the figures and wrote the manuscript; XL and HH performed the research and analyzed and interpreted the data; CG and XF performed the data analyses and reviewed the manuscript; HH, ZW, QR, FL, SL, YT and YL supervised and designed the research, analyzed and interpreted the data and co-wrote the manuscript. All authors reviewed the results and approved the final version of the manuscript.