Introduction: This study aimed to determine the efficacy of different Leucovorin regimens to reduce oral mucositis in children with acute lymphoblastic leukemia after high-dose Methotrexate (HD-MTX). Methods: Twelve articles were included in a systematic literature review. Articles were categorized into low/medium/high risk of bias. Results: As no randomized controlled trial assessing the effect of Leucovorin has been performed, the efficacy of Leucovorin to reduce oral mucositis remains unknown. Leucovorin was initiated at 24, 36 or 42 h after HD-MTX at a dose of 15 or 30 mg/m2. No meta-analysis could be performed as treatment regimens differed. When comparing studies with similar HD-MTX doses, we observed lower oral mucositis rates in regimens with higher cumulative doses of Leucovorin and early initiation of Leucovorin after MTX. Conclusion: Even though future studies are necessary, higher cumulative Leucovorin doses and early initiation of Leucovorin after start of MTX seem to reduce oral mucositis.

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Keywords Acute lymphoblastic leukemia, Leucovorin, Methotrexate, Oral mucositis
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Series VSNU Open Access deal
Journal Critical Reviews in Oncology / Hematology
Van der Beek, J.N. (J. N.), Oosterom, N, Pieters, R, de Jonge, R, van den Heuvel-Eibrink, M.M, & Heil, S.G. (2019). The effect of leucovorin rescue therapy on methotrexate-induced oral mucositis in the treatment of paediatric ALL: A systematic review. Critical Reviews in Oncology / Hematology (Vol. 142, pp. 1–8). doi:10.1016/j.critrevonc.2019.07.003