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indications and dosage of HD-MTX containing regimen
Doses between 50 and 500 mg/m2, as used for malignant gestational trophoblastic disease (GTD), are considered intermediate-dose MTX. In general, these patients do not require aggressive hydration or urinary alkalinization. Leucovorin rescue is rarely needed with doses ≤250 mg/m2 unless unexpected toxicity is encountered. (See “Initial management of low-risk gestational trophoblastic neoplasia”, section on ‘Methotrexate as the preferred option’.)
Low-dose MTX (<50 mg/m2) is used intravenously for the treatment of bladder and breast cancer and desmoid tumors, and orally for patients with T-cell large granular lymphocyte (LGL) leukemia, ALL, acute promyelocytic leukemia, mycosis fungoides, and various nonmalignant immune-mediated disorders (table 2).