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All Journal Indonesian Journal of Cancer
M Rahimi Bahar
Department of Child Health, Sam Ratulangi University Medical School/Prof. Dr. R.D. Kandou Hospital, Manado, Indonesia
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Public Health

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Adapting the Capizzi-Methotrexate Protocol for T-LBL in a Lower-Middle-Income Country: A Case Report: Adapted C-MTX for T-LBL in an LMIC Charity Cesilia Tololiu; Stefanus Gunawan; Max F J Mantik; M Rahimi Bahar; Anjo J P Veerman
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1572

Abstract

Introduction: Treating pediatric T-cell lymphoblastic lymphoma (T-LBL) in lower-middle-income countries (LMICs) is challenging, as the standard high-dose methotrexate (HD-MTX) regimen is unsafe without therapeutic drug monitoring. This case report aims to describe the clinical implementation, feasibility, and safety outcomes of an adapted Capizzi-style methotrexate (C-MTX) protocol as a practical alternative in a resource-limited setting Case Presentation: We report a case in Indonesia with T-LBL who was treated with an adapted C-MTX-based regimen. The protocol was chosen due to the inability to perform serum methotrexate measurements. He achieved initial complete remission and tolerated the therapy well. However, he experienced a relapse shortly after treatment completion Conclusions: Our experience demonstrates that a modified Capizzi-style Methotrexate protocol is a valuable and effective therapeutic strategy for pediatric T-LBL in settings with limited resources. This approach offers a practical way to circumvent the risks of unmonitored HD-MTX and can improve the standard of care.
Co-Authors Anjo J P Veerman Charity Cesilia Tololiu Max F J Mantik Stefanus Gunawan