[Carboxypeptidase-G2-rescue in a woman with methotrexate-induced renal failure].
BACKGROUND
Methotrexate (MTX) is a very effective chemotherapeutic drug, widely used in various malignant diseases for systemic therapy. In some cases, MTX-induced renal failure occurs which may not be prevented by the standard agent folin acid as a specific antidot. This results in a MTX-accumulation in the body tissue with subsequent massive toxic side effects.


METHODS
We report on a 62-year-old woman with acute lymphoblastic leukemia (first diagnosis November 1997) receiving chemotherapy with 2,340 mg methotrexate over 24 hours. After an increase of the MTX-plasma-level 36 hours following MTX-application, increased serum creatinine levels (maximum 5.07 mg/dl) were found. The application of folinic acid was without any significant effect. Fifty-six hours following MTX, 50 U/kg carboxypeptidase-G2 was infused. The MTX-plasma-level decreased rapidly and a recovery of renal function was monitored.


CONCLUSIONS
CPDG2 may be highly effective in patients after development of an MTX-induced renal failure and delayed MTX-excretion.
von Poblozki
A
A
Klinik für Innere Medizin IV, Martin-Luther-Universität Halle-Wittenberg.
Dempke
W
W
Schmoll
H J
HJ
D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy*; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008727:Methotrexate / Q000009:adverse effects* / Q000097:blood; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome; D011623:gamma-Glutamyl Hydrolase / Q000008:administration & dosage / Q000627:therapeutic use*
D000964:Antimetabolites, Antineoplastic; D003404:Creatinine; D011623:gamma-Glutamyl Hydrolase; D008727:Methotrexate