title: Folinic acid administration after MTX GVHD prophylaxis in pediatric allo-SCT.
abstract: Cyclosporine (CsA) and MTX are commonly used for GVHD prophylaxis in pediatric allo-SCT. Mucositis and hepatic toxicity frequently restrict the delivery of the fourth dose of MTX. Folinic acid (FA) may ameliorate MTX toxicity. We conducted a retrospective chart review of all pediatric patients who received CsA and MTX for GVHD prophylaxis from January 2000 to July 2010. Patients treated before July 2007 (N=29) did not receive FA and those treated from July 2007 onward did receive FA (N=18). Patients who received FA were significantly more likely to receive day +11 MTX (odds ratio (OR) 10.42, 95% confidence interval (CI): 1.21-262.27) but there was no significant difference in Grade III-IV GVHD between the two groups (OR 1.15, 95% CI: 0.08-18.14). FA did not impact relapse-free survival (RFS) (P=0.82). Increased likelihood of receiving day +11 MTX suggests that FA ameliorates MTX toxicity, such as severe mucositis. FA administration for MTX GVHD prophylaxis should be studied in a prospective, randomized fashion.
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA. hudspeth@musc.edu
authors.forename: M P
authors.initials: MP
authors.lastname: Hudspeth
authors.forename: T S
authors.initials: TS
authors.lastname: Heath
authors.forename: C
authors.initials: C
authors.lastname: Chiuzan
authors.forename: E
authors.initials: E
authors.lastname: Garrett-Mayer
authors.forename: E
authors.initials: E
authors.lastname: Nista
authors.forename: L
authors.initials: L
authors.lastname: Burton
authors.forename: D
authors.initials: D
authors.lastname: Ragucci
mesh_terms: D000293:Adolescent; D056486:Chemical and Drug Induced Liver Injury / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D016903:Drug Monitoring; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D005493:Folic Acid Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007223:Infant; D002955:Leucovorin / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D052016:Mucositis / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D012189:Retrospective Studies; D012720:Severity of Illness Index; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D016019:Survival Analysis; D014184:Transplantation, Homologous; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D005493:Folic Acid Antagonists; D007166:Immunosuppressive Agents; D014803:Vitamin B Complex; D016572:Cyclosporine; D002955:Leucovorin; D008727:Methotrexate