title: Carboxypeptidase G2 rescue in a 79 year-old patient with cranial lymphoma after high-dose methotrexate induced acute renal failure.
abstract: A 79 year-old female patient presented with immunoblastic B-cell lymphoma of the ethmoidal sinuses and destruction of the anterior cranial fossa. After 3 cycles of high-dose methorexate (HD-MTX) MTX serum level remained elevated and creatinine serum levels raised. The patient received Carboxypeptidase G2 (CPG2) intravenously. Within one hour the MTX serum level decreased to <1 micromol/l as determined by high pressure liquid chromatography (HPLC). The patient recovered without significant toxicity and attained a long lasting ongoing (>14 months) complete remission. In this case we were able to demonstrate that rescue from HD-MT nephrotoxicity by CPG2 is also safe and effective in patients with advanced age with impaired renal function. With the help of CPG2, sufficient and potentially curative therapy with HD-MTX may also be provided to patients with a high risk of renal failure.
authors.affiliation: Medizinische Klinik III, Hämatologie, Onkologie und Transfusionsmedizin, Freie Universität Berlin, Universitäsklinikum Benjamin Franklin, Germany. aljoscha@zedat.fu-berlin.de
authors.forename: A
authors.initials: A
authors.lastname: Krackhardt
authors.forename: S
authors.initials: S
authors.lastname: Schwartz
authors.forename: A
authors.initials: A
authors.lastname: Korfel
authors.forename: E
authors.initials: E
authors.lastname: Thiel
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000627:therapeutic use*; D002330:Carmustine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D004232:Diuretics / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage; D005005:Ethmoid Sinus; D005260:Female; D005440:Fluid Therapy; D005492:Folic Acid / Q000378:metabolism; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D016393:Lymphoma, B-Cell / Q000188:drug therapy*; D016400:Lymphoma, Large-Cell, Immunoblastic / Q000188:drug therapy* / Q000473:pathology; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects* / Q000037:antagonists & inhibitors / Q000378:metabolism; D010255:Paranasal Sinus Neoplasms / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D012074:Remission Induction; D014750:Vincristine / Q000008:administration & dosage; D011623:gamma-Glutamyl Hydrolase / Q000627:therapeutic use*
chemical_list: D000964:Antimetabolites, Antineoplastic; D001426:Bacterial Proteins; D004232:Diuretics; D011344:Procarbazine; D014750:Vincristine; D005665:Furosemide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D005492:Folic Acid; D011623:gamma-Glutamyl Hydrolase; D002955:Leucovorin; D002330:Carmustine; D011241:Prednisone; D008727:Methotrexate