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Pediatric Transplants

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.

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Acknowledgements

Supported in part by the Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina (P30 CA138313).

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Correspondence to M P Hudspeth.

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Hudspeth, M., Heath, T., Chiuzan, C. et al. Folinic acid administration after MTX GVHD prophylaxis in pediatric allo-SCT. Bone Marrow Transplant 48, 46–49 (2013). https://doi.org/10.1038/bmt.2012.82

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