My leukemia treatment, and dosing issues (methotrexate)?

My leukemia treatment, and dosing issues (methotrexate)?
I was diagnosed with Acute Lymphoblastic Leukemia in the summer of 2007. I was 17 at the time and I knew I'd be getting countless "poisons" pumped into me for treatment, and obviously it's logical to assume there would be many side effects from it ( there was ); this brings me to say only recently have I began to research the drugs I was taking for the illness.

I started to research because I was having quite a hard time with hair loss, I know hair loss is pretty much guaranteed because when I was in the height of treatment I lost about 70% of it and the rest was left as a weird fuzz.

Take note that the height or "harshest" time of treatment was at the end of 2008, beginning of 2009 (when I lost most of my hair).

So anyways, almost a year later my hair pretty much filled back in except it has stayed pretty thin on the temple areas and top and resembles the classic male-pattern baldness, except all I have is the receding hair line and thinness on top (hair in the in shape of a V), there is no thinning or spots elsewhere on my head (vertex, crown) as I would expect with heredity-acquired baldness.

*Forgot to mention all the males on both sides of my family have full heads of hair

This made me look into the chemotherapy-agents I was taking at home, I thought they might be making me progressively thinner.

I am ordered to take as of now, once-a-week, x23 5mg pills of methotrexate. This drug, as I found, is very commonly used for patients with rheumatoid arthritis, and also used for cancer patients as an immunosuppressive agent; which as you could assume, would be the main part of treatment with an excessive amount of white blood cells with leukemia.

My problem is this, after reading many reports and submissions from various places around the net on methotrexate (askapatient, RA-forums, etc) it not only became clear that some of these people were experiencing the progressive thinning as I was,

but that they were taking a -considerably- lower dose than me.

I somewhat expected this, as anyone might see the correlation between an immune system suppression drug and its needed dose escalation.

After doing the math, I've found that I am currently taking orally, 57.5 mg of methotrexate per week. With FDA guidelines saying not to exceed 30mg a week, I just wonder.....I know "guidelines" aren't followed religiously with a lot of medications, but almost doubling the guideline recommended? Really?

So after all of this background information, my question(s):

Can anybody in the medical field tell me-

if there is a maximum life dose of methotrexate, and the effects if it is exceeded?

From http://www.drugs.com/dosage/methotrexate.html#Usual_Adult_Dose_for_Acute_Lymphoblastic_Leukemia :

"Usual Adult Dose for Acute Lymphoblastic Leukemia
Maintenance (during remission): 15 mg/m2 IM or orally twice a week."

What does this equate to (assuming the dose amount is correlated with weight) for a person weighing on average 180 lbs?


Sorry for the long read...

I know I should bring this up with the doctor, but I have a feeling he will shrug it off, it just makes me really wonder if they really know what they are doing, even by the FDA standards of MTX's maximum weekly dosage of 30mg's, taking 57.5mg is 191% over the norm.

More surprisingly, to find this out that with this particular medication folinic acid can be (and should be, as recommended in many clinical studies) given following methotrexate treatment to substantially reduce the side effects (while proven to not hinder the immunosuppressive function) why this was not given or even mentioned...
No, I have never had a bone marrow transplant at all.

But I am most definitely going to ask the doctor when my appointment comes around. Seems a little unnecessary to me, and I also forgot to mention the countless intrathecal injections of MTX I've had an are still having on a monthly basis.
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