Figure 5.

Treatment with glucarpidase may be indicated in the case of excessively high MTX concentrations and rising creatinine. Time points indicated are after the start of the infusion and are not required measurement times. Guidance is provided for time points that are routinely measured in clinical practice. Renal toxicity grade 3+ is according to the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 4. Concentrations in µM can be converted to µg/mL by dividing by 2.2005. 120 µM = 54.5 µg/mL, 50 µM = 22.7 µg/mL, 30 µM = 13.6 µg/mL, 10 µM = 4.54 µg/mL, and 5 µM = 2.27 µg/mL.

*Urine pH >7, urine output >2.5L/m² per day, emesis control.

^†Hours are indicated after infusion start.

Abbreviations: Cr, serum creatinine; GFR, glomerular filtration rate; HDMTX, high‐dose methotrexate; LV, leucovorin (folinic acid, citrovorum factor, 5‐methyltetrahydrofolate); MTX, methotrexate; [MTX], plasma methotrexate concentration.