Effective removal of methotrexate by high-flux hemodialysis.
The purpose of the present study was to examine the clearance of methotrexate (MTX) by high-flux hemodialysis (HD) in pediatric oncology patients. We present three patients who experienced nephrotoxicity and prolonged exposure to toxic MTX concentrations following high-dose infusions during treatment for osteogenic sarcomas. Each patient was successfully treated with high-flux HD, followed by carboxypeptidase G2 (CPDG2) in two cases. Minimal systemic toxicity occurred. We review the literature and discuss guidelines for early and aggressive treatment for this complication of high-dose MTX therapy. Clinically important removal of MTX depends upon prompt initiation of HD after detection of nephrotoxicity and delayed clearance of MTX. Therapy is indicated in cases where compassionate use of CPDG(2) may not be available, or while awaiting its delivery.
Saland
Jeffrey M
JM
Department of Pediatrics, The Mount Sinai School of Medicine, One Gustave L. Levy Place Box 1664, NY 10029-6574, USA.
Leavey
Patrick J
PJ
Bash
Robert O
RO
Hansch
Eleonora
E
Arbus
Gerald S
GS
Quigley
Raymond
R
D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000097:blood* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy; D005260:Female; D016231:Fluorescence Polarization Immunoassay; D006207:Half-Life; D006801:Humans; D007008:Hypokalemia / Q000209:etiology; D017674:Hypophosphatemia / Q000209:etiology; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000097:blood* / Q000627:therapeutic use; D012516:Osteosarcoma / Q000188:drug therapy; D006435:Renal Dialysis / Q000009:adverse effects; D012208:Rhabdomyosarcoma / Q000188:drug therapy; D011623:gamma-Glutamyl Hydrolase / Q000627:therapeutic use
D000964:Antimetabolites, Antineoplastic; D011623:gamma-Glutamyl Hydrolase; D008727:Methotrexate