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[Carboxypeptidase-G2-rescue in a woman with methotrexate-induced renal failure]
A von Poblozki1, W Dempke, H J Schmoll
1Klinik für Innere Medizin IV, Martin-Luther-Universität Halle-Wittenberg.
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.
Case Report:
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.
Conclusion:
CPDG2 may be highly effective in patients after development of an MTX-induced renal failure and delayed MTX-excretion.