Carboxypeptidase G2 rescue in a 79 year-old patient with cranial lymphoma after high-dose methotrexate induced acute renal failure

Leuk Lymphoma. 1999 Nov;35(5-6):631-5. doi: 10.1080/10428199909169631.

Abstract

A 79 year-old female patient presented with immunoblastic B-cell lymphoma of the ethmoidal sinuses and destruction of the anterior cranial fossa. After 3 cycles of high-dose methorexate (HD-MTX) MTX serum level remained elevated and creatinine serum levels raised. The patient received Carboxypeptidase G2 (CPG2) intravenously. Within one hour the MTX serum level decreased to <1 micromol/l as determined by high pressure liquid chromatography (HPLC). The patient recovered without significant toxicity and attained a long lasting ongoing (>14 months) complete remission. In this case we were able to demonstrate that rescue from HD-MT nephrotoxicity by CPG2 is also safe and effective in patients with advanced age with impaired renal function. With the help of CPG2, sufficient and potentially curative therapy with HD-MTX may also be provided to patients with a high risk of renal failure.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / drug therapy
  • Acute Kidney Injury / therapy
  • Aged
  • Antimetabolites, Antineoplastic / administration & dosage
  • Antimetabolites, Antineoplastic / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bacterial Proteins / therapeutic use*
  • Carmustine / administration & dosage
  • Combined Modality Therapy
  • Cyclophosphamide / administration & dosage
  • Dexamethasone / administration & dosage
  • Diuretics / therapeutic use
  • Doxorubicin / administration & dosage
  • Ethmoid Sinus*
  • Female
  • Fluid Therapy
  • Folic Acid / metabolism
  • Furosemide / therapeutic use
  • Humans
  • Leucovorin / administration & dosage
  • Lymphoma, B-Cell / drug therapy*
  • Lymphoma, Large-Cell, Immunoblastic / drug therapy*
  • Lymphoma, Large-Cell, Immunoblastic / pathology
  • Methotrexate / administration & dosage
  • Methotrexate / adverse effects*
  • Methotrexate / antagonists & inhibitors
  • Methotrexate / metabolism
  • Paranasal Sinus Neoplasms / drug therapy*
  • Prednisone / administration & dosage
  • Procarbazine / administration & dosage
  • Remission Induction
  • Vincristine / administration & dosage
  • gamma-Glutamyl Hydrolase / therapeutic use*

Substances

  • Antimetabolites, Antineoplastic
  • Bacterial Proteins
  • Diuretics
  • Procarbazine
  • Vincristine
  • Furosemide
  • Dexamethasone
  • Doxorubicin
  • Cyclophosphamide
  • Folic Acid
  • gamma-Glutamyl Hydrolase
  • Leucovorin
  • Carmustine
  • Prednisone
  • Methotrexate

Supplementary concepts

  • CHOP protocol