High-dose methotrexate (HD-MTX) with rigorous supportive care is
essential to the treatment of pediatric non-Hodgkin lymphomas (NHL). We
describe the safety and tolerability of HD-MTX in patients with NHL
treated at our center. In our cohort of 46 patients, the majority had at
least one course of delayed clearance and/or creatinine elevation.
Additionally, more than one-third of patients experienced an episode of
grade ≥3 mucositis. Creatinine elevations and delayed clearance were
independently associated with subsequent grade ≥3 mucositis. We advocate
for greater availability of methotrexate monitoring to allow dose
escalation of this essential modality around the world.