To this day, repeated intrathecal injections of high-dose methotrexate (HD-MTX) have been recognized as an option for the prevention of central nervous system damage and as an important option for the treatment of childhood acute lymphoblastic leukemia (ALL)[1]. However, especially in developing countries, the use of high-dose HD-MTX regimens in pediatric cancer patients has been controversial and represents a dilemma that is difficult to balance effectiveness and toxicity. Pediatric patients with cancer in Indonesia face the same dilemma. Due to frequent treatment interruptions and inadequate medical care, clinicians are often reluctant to use HD-MTX therapy, fearing that patients may develop comorbidities such as infections and malnutrition.
The protocol of HD-MTX has been in place for more than 15 years and the dose has been changed, from 500 mg/m2 in 2006, to 1000 mg/m2. However, most of the studies have focused on the injection regimen of HD-MTX and little attention has been paid to the toxicity and therapeutic efficacy aspects of this method. Therefore, it is necessary to conduct some studies to obtain basic data in order to improve the efficacy and safety of this therapeutic regimen.
Nur Melani Sari's research team evaluated the toxicity and efficacy of HD-MTX by using 24-hour and 48-hour blood levels of MTX[2].