A Systematic Review of Neuropsychological Studies Confirms that Adequate
Folinic Acid Rescue Prevents Post Methotrexate Neurotoxicity
Abstract
A comprehensive literature search was performed of all databases of the
Web of Science Citation Index, during 1990-2020, for the terms:
neuropsychological, neurocognitive, cognitive, acute lymphoblastic (and
lymphocytic) leukemia, and osteogenic sarcoma, to see if there was
evidence of a correlation between folinic acid (FA) rescue inadequacy
and long-term cognitive damage. All English language, peer-reviewed
articles of neuropsychological assessments of children who had been
treated with high-dose methotrexate without irradiation, and which
included details of methotrexate and FA schedules, were selected. Four
groups of studies were found and analyzed, Those with no evidence of
cognitive deterioration, Those with evidence of cognitive deterioration,
studies with more than one protocol grouped together, preventing
separate analysis of any protocols, and those with significant serious
methodical problems. In all studies, protocols without evidence of
cognitive deterioration reported adequate FA rescue, and those with
evidence of cognitive deterioration reported inadequate FA rescue.