title: The utility of online haemodiafiltration in methotrexate poisoning.
abstract: Summary We report a case of a 56-year-old woman with a high-grade diffuse large B-cell lymphoma who unexpectedly developed toxic plasma levels of methotrexate (MTX) following the first cycle of rituximab-cyclophosphamide, hydroxydanorubicin, oncovin, prednisolone (R-CHOP) with a high-dose MTX chemotherapy protocol. She also developed non-oliguric acute kidney injury secondary to MTX nephrotoxicity. We elected to treat her with online-haemodiafiltration (HDF) and this proved to be efficient with a dramatic response. Rapid clearance of MTX to therapeutic levels was possible within three sessions. Prompt therapy with high-volume online-HDF is an effective choice for rapid MTX clearance and swift reversal of MTX nephrotoxicity.
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center, Riyadh, Ar-Riyadh, Saudi Arabia Internal Medicine Department, Faculty of Medicine, Alexandria University, Egypt.
authors.forename: Mohamed Said
authors.initials: MS
authors.lastname: Abdelsalam
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center, Riyadh, Ar-Riyadh, Saudi Arabia.
authors.forename: Mohammed Mahdi
authors.identifier: http://orcid.org/0000-0002-3158-8316
authors.initials: MM
authors.lastname: Althaf
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center, Riyadh, Ar-Riyadh, Saudi Arabia.
authors.forename: Osman
authors.initials: O
authors.lastname: Alfurayh
authors.affiliation: Department of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Ar-Riyadh, Saudi Arabia.
authors.forename: Irfan
authors.initials: I
authors.lastname: Maghfoor
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000628:therapy*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000097:blood / Q000506:poisoning*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008727:Methotrexate / Q000097:blood / Q000506:poisoning*; D008875:Middle Aged; D011041:Poisoning / Q000628:therapy*; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000964:Antimetabolites, Antineoplastic; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone; D008727:Methotrexate