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.
Publication types
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Research Support, N.I.H., Extramural
MeSH terms
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Adolescent
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Chemical and Drug Induced Liver Injury / prevention & control
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Child
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Child, Preschool
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Cyclosporine / adverse effects
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Cyclosporine / therapeutic use
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Drug Monitoring
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Drug Therapy, Combination / adverse effects
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Female
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Folic Acid Antagonists / administration & dosage
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Folic Acid Antagonists / adverse effects*
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Folic Acid Antagonists / therapeutic use
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Graft vs Host Disease / etiology
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Graft vs Host Disease / physiopathology
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Graft vs Host Disease / prevention & control*
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Humans
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Immunosuppressive Agents / administration & dosage
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Immunosuppressive Agents / adverse effects*
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Immunosuppressive Agents / therapeutic use
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Infant
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Leucovorin / therapeutic use*
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Male
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Methotrexate / administration & dosage
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Methotrexate / adverse effects*
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Methotrexate / therapeutic use
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Mucositis / chemically induced
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Mucositis / physiopathology
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Mucositis / prevention & control
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Retrospective Studies
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Severity of Illness Index
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Stem Cell Transplantation / adverse effects*
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Survival Analysis
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Transplantation, Homologous
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Vitamin B Complex / therapeutic use*
Substances
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Folic Acid Antagonists
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Immunosuppressive Agents
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Vitamin B Complex
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Cyclosporine
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Leucovorin
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Methotrexate