title: [Carboxypeptidase-G2 administration after high-dose methotrexate. Treatment and drug interactions].
abstract: Methotrexate (MTX) is widely used as anticancer agent in various malignancies, including acute lymphoblastic leukaemia, lymphoma and osteosarcoma. High doses of MTX may cause acute renal dysfunction. Nephrotoxicity is prevented by the use of alkalinization and hydration. More recently Carboxypeptidase-G2, a recombinant bacterial enzyme that rapidly hydrolyzes MTX to inactive metabolites, has become available for the treatment of acute nephrotoxicity. On the other hand, glutamine is usually administered in oncology treatments to avoid other side effects. We report a case of an adolescent who was diagnosed with T lymphoblastic lymphoma. He was receiving treatment with glutamine when the third course of methotrexate was administered (5 g/m(2)) and he suffered a deterioration in his renal function. Carboxypeptidase was used but the methotrexate serum concentration reduction was not satisfactory. The technique to assess the amount of enzyme-inactivated methotrexate by quantification of MTX metabolites is not available in our country, therefore, the concentrations of MTX may be overestimated. The literature was reviewed to study the influence of glutamine on delayed methotrexate elimination which may lead to acute toxicity.
authors.affiliation: Unidad Gestión Clínica de Pediatría, Unidad Oncohematología, Complejo Hospitalario de Jaén, Jaén, España. jcozarolmo@hotmail.com
authors.forename: J A
authors.initials: JA
authors.lastname: Cózar Olmo
authors.forename: C
authors.initials: C
authors.lastname: Martínez Colmenero
authors.forename: I
authors.initials: I
authors.lastname: Peláez Pleguezuelos
authors.forename: I
authors.initials: I
authors.lastname: Leiva Gea
authors.forename: A B
authors.initials: AB
authors.lastname: López García
authors.forename: J
authors.initials: J
authors.lastname: de la Cruz Moreno
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000188:drug therapy*; D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D004347:Drug Interactions; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D011623:gamma-Glutamyl Hydrolase / Q000627:therapeutic use*
chemical_list: D000964:Antimetabolites, Antineoplastic; D011623:gamma-Glutamyl Hydrolase; D008727:Methotrexate