Carboxypeptidase G2 rescue in delayed methotrexate elimination in renal failure.
We report here the case of a 68-year-old woman who presented severe renal failure following the first cycle of high dose methotrexate (HDMTX) for the treatment of a cerebral malignant lymphoma. Before HDMTX administration, serum creatinine value was normal and three days after HDMTX, it reached 457 micromol/L. Leucovorin rescue, hemodialysis and cholestyramine did not increase MTX clearance. Because of the persistence of renal failure, and the high risk of important hematological side-effects associated with high MTX plasma levels, the patient received carboxypeptidase G2 (CPDG2). This allowed MTX plasma levels to decrease by 80% in 15 minutes. No side effects were observed and renal function normalized rapidly. In some patients, when high-dose leucovorin associated with hemodialysis and cholestyramine are unable to restore normal MTX clearance, CPDG2 should be considered because it may represent a safe and efficient alternative for the management of MTX intoxication.
Mohty
M
M
Hematology and Medical Oncology Department, Hôpital Lapeyronie, Montpellier, France.
Peyriere
H
H
Guinet
C
C
Hillaire-Buys
D
D
Blayac
J P
JP
Rossi
J F
JF
D000368:Aged; D001932:Brain Neoplasms / Q000097:blood / Q000188:drug therapy / Q000652:urine; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008223:Lymphoma / Q000097:blood / Q000188:drug therapy / Q000652:urine; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood / Q000652:urine; D051437:Renal Insufficiency / Q000139:chemically induced*; D011623:gamma-Glutamyl Hydrolase / Q000627:therapeutic use*
D011623:gamma-Glutamyl Hydrolase; D008727:Methotrexate