methotrexate IV

Serum MTX concentration serves as an objective marker of MTX-related toxicity. Under adequate rescue therapy and concentration monitoring, a single MTHFR polymorphism appears insufficient to guide dose adjustment. A combined strategy is recommended, with concentration monitoring as the primary approach and genetic factors as an adjunct.

Flumatinib likewise lowered MTX clearance and raised ≥ grade 2 nephrotoxicity to 29.4%, yet neither effect reached statistical significance. Temporary withdrawal of olverembatinib before HD-MTX infusion may prevent MTX-related nephrotoxicity.

P2, N=50, Recruiting, Fred Hutchinson Cancer Center | Not yet recruiting --> Recruiting

He was started on levetiracetam for a first-time seizure and discharged...Two weeks later, high-dose methotrexate plus cytarabine was initiated, with neurological improvement...Computed tomography (CT) showed no new intracranial findings, but pancytopenia and cultures positive for carbapenem-resistant Citrobacter freundii were identified, and he died of septic shock. This case illustrates that CNS ALCL can radiographically mimic metastatic disease, underscores the necessity of tissue diagnosis, and highlights the competing imperatives of timely intensive chemotherapy and rigorous infection surveillance, particularly for multidrug-resistant organisms in older adults with PCNSL.

P=N/A, N=20, Completed, Ohio State University Comprehensive Cancer Center | Active, not recruiting --> Completed | Trial completion date: Nov 2026 --> Dec 2025

P1, N=14, Completed, Wake Forest University Health Sciences | Active, not recruiting --> Completed

Due to transaminitis, high-dose methotrexate therapy was deferred, and the patient was initiated on intrathecal (IT) chemotherapy with methotrexate and cytarabine. Following five cycles of IT chemotherapy, the patient's neurologic status significantly improved, and CSF analysis showed resolution of the atypical T-cell population. This case highlights the rare occurrence of CNS progression of FMF, even in the absence of lymphatic involvement and with well-controlled skin manifestations, and underscores the role of IT chemotherapy in managing this complication.

P2, N=42, Not yet recruiting, Minia University

P2, N=16, Recruiting, Wake Forest University Health Sciences | Trial primary completion date: Dec 2025 --> May 2026

Treatment with rituximab, high-dose methotrexate, and focal radiotherapy was initiated...Liquid biopsy of the CSF provides a promising alternative for diagnosing PISCL. However, further studies are needed to validate the clinical utility of this diagnostic approach.

While topical corticosteroids are the most common treatment adopted, other options include watchful waiting, phototherapy and systemic methotrexate...Clinicians should remain vigilant in diagnosing LyP. Although its course is often benign, the association with haematological malignancy requires both careful clinicopathological correlation for diagnosis and long-term follow-up.

P4, N=0, Withdrawn, Takeda | Trial completion date: Jul 2028 --> Aug 2025 | Recruiting --> Withdrawn | Trial primary completion date: Jul 2028 --> Aug 2025