Role of folinic acid in methotrexate-based prophylaxis of graft-versus-host disease following hematopoietic stem cell transplantation

Methotrexate (MTX) is one of the main therapeutic agents currently used for prophylaxis graft-versus-host disease (GvHD) following hematopoietic stem cell transplantation. However, it associated with significant toxicity and considerable side effects in many patients, which lead to either early withdrawal or dose reductions that may expose patients risk GvHD graft failure. Folinic acid (FA) can bypass inhibitory MTX on folate availability control toxicity. concerns FA might inhibit anti-GvHD effect limited reports its clinical usefulness have led reluctance inclusion standard regimens. Additionally, universal dosing timing guidelines are lacking. I discuss available literature evaluate evidence safety regarding development rejection both adult pediatric patients. Although administration appears be safe, efficacy routine use all types transplants unproven further research required confirm toxicity-lowering effect, identify individual parameters influence practice, potential when developing a personalized regimen.