Methotrexate-induced acute kidney injury in patients with hematological malignancies: three case reports with literature review

Background High-dose methotrexate (HD-MTX) therapy has been used to treat a wide range of oncological malignancies. While the therapy can be tolerated with hydration, urine pH control, and leucovorin rescue therapy, HD-MTX is cytotoxic and can cause renal failure. There have been several case reports of HD-MTX toxicity in patients with solid tumors; however, few case series of hematological malignancies have been published. Patients with hematological malignancies tend to be administered many concomitant drugs, which can affect the elimination of MTX and result in acute kidney injury.