{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T17:26:03Z","timestamp":1780680363098,"version":"3.54.1"},"reference-count":17,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    High\u2010dose methotrexate (HDMTX) is a key component of induction therapy for a range of cancers, but can lead to serious adverse effects, including acute kidney injury (AKI). We report two cases of HDMTX use in haematological malignancies. Patient 1 was an 8\u2010year\u2010old girl with high\u2010grade NHL. She received 3 courses of HDMTX (3\u2009g\/m\n                    <jats:sup>2<\/jats:sup>\n                    ) without issue. For her 4th course, she developed AKI with creatinine peaking at 240\u2009\u03bcmol\/L after HDMTX administration. She required intensified hydration and antihypertensive therapy for fluid overload, received glucarpidase for delayed MTX clearance, required parenteral nutrition for mucositis and ultimately made a full recovery. Patient 2 was a 76\u2010year\u2010old man with primary central nervous system lymphoma. He underwent HDMTX treatment per the MARTA protocol with dose reductions due to renal impairment. He experienced delayed MTX clearance leading to fluid overload, acute liver injury, required prolonged diuretic and antibiotic therapy, and was hospitalised for 3\u2009weeks before recovery. These cases emphasise the need for preemptive supportive care, including prehydration and folinic acid (leucovorin), careful monitoring and early intervention with glucarpidase in the event of toxicities.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.71977","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T10:28:55Z","timestamp":1770719335000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Strategies for Managing Toxicities With High\u2010Dose Methotrexate in Haematological Malignancies: Lessons From Clinical Cases"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0539-0630","authenticated-orcid":false,"given":"Vanessa","family":"McLelland","sequence":"first","affiliation":[{"name":"Bristol Royal Hospital for Children  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7842-1559","authenticated-orcid":false,"given":"Martin","family":"Guscott","sequence":"additional","affiliation":[{"name":"Resonance Inc.  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5423-3270","authenticated-orcid":false,"given":"Matthew R.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Beatson West of Scotland Cancer Centre  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms21103483"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015\u20100164"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2022.10.029"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.70176"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.1957"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103026(23)00371\u2010X"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcped.2025.100225"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpt.13739"},{"key":"e_1_2_11_10_1","article-title":"Improving the Practice of Prescribing Folinic Acid Rescue Post High\u2010Dose Methotrexate Chemotherapy","volume":"100","author":"Fosbrook C.","year":"2015","journal-title":"BMJ Archives of Disease in Childhood"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010021\u201006395\u20103"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27241"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.htct.2023.10.005"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27347"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15506"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijmpo.ijmpo_113_18"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2017\u20100243"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102023\u2010189432"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71977","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.71977","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71977","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T17:24:46Z","timestamp":1772990686000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.71977"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":17,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/ccr3.71977"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.71977","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"2024-12-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71977"}}