Continuous plasma resin perfusion for detoxification of methotrexate

Greil, Johann; Wyss, P.; Ludwig, Kerstin U.; Bonakdar, S.; Scharf, Joachim-Hermann; Beck, J. D.; Ruder, H.

doi:10.1007/s004310050656

Cited by 13 publications

(10 citation statements)

References 9 publications

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“…Modern protocols and institution of therapeutic drug monitoring have decreased the likelihood of these events, but in such cases, the management of delayed MTX clearance is of great importance. Previous reports have documented MTX clearance with various levels of success using HD [8,9,10,11], HD with charcoal hemoperfusion [12,13,14], HD with serum exchange [15], HD with plasma perfusion [16], and hemofiltration with plasma perfusion over an anion exchange resin [17]. In our experience, HD was superior to HD with charcoal hemoperfusion [18].…”

Section: Discussionmentioning

confidence: 39%

Effective removal of methotrexate by high-flux hemodialysis

Saland

Leavey

Bash

et al. 2002

Pediatric Nephrology

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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.

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Section: Discussionmentioning

confidence: 39%

Effective removal of methotrexate by high-flux hemodialysis

Saland

Leavey

Bash

et al. 2002

Pediatric Nephrology

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“…28,69,70 Increases in MTX plasma concentrations after the completion of dialysis-based methods were reported and quantified in seven reports. Rebound increases in postdialysis plasma MTX concentrations by 10 -221% of the postprocedure MTX levels 21,71,72 and to 90 -100% of the preprocedure MTX levels were reported. 23,24,26,73 Reported complications from the various dialysis methods included cardiac arrest in one patient after plasma exchange, 23 bleeding from the catheter exit site, 24 anemia, 24,25 thrombocytopenia, 24,74 and hypokalemia and severe hypophosphatemia, 70 but the incidence of these complications could not be estimated accurately.…”

Section: Use Of Dialysis-based Methods To Remove Mtxmentioning

confidence: 94%

High‐dose methotrexate‐induced nephrotoxicity in patients with osteosarcoma

Widemann

Balis

Kempf-Bielack

et al. 2004

Cancer

265

224

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BACKGROUNDHigh‐dose methotrexate (HDMTX)‐induced renal dysfunction can be life threatening, because it delays methotrexate (MTX) excretion, thereby exacerbating the other toxicities of MTX. HDMTX‐induced nephrotoxicity has been managed with high‐dose leucovorin, dialysis‐based methods of MTX removal, thymidine, and with the recombinant enzyme, carboxypeptidase‐G2 (CPDG2), which cleaves MTX to inactive metabolites. The objectives of the current study were to estimate the current incidence of HDMTX‐induced renal dysfunction in patients with osteosarcoma and to compare the efficacy and recovery of renal function for dialysis‐based methods of MTX removal with treatment using CPDG2.METHODSThe literature was reviewed for osteosarcoma trials, use of dialysis‐based methods for MTX removal, and reports of MTX‐induced nephrotoxicity, including information regarding recovery of renal function. Clinical trial databases of select osteosarcoma studies were reviewed. The efficacy of CPDG2 and renal recovery after CPDG2 rescue was obtained from the database of a compassionate‐release trial.RESULTSApproximately 1.8% of patients with osteosarcoma (68 of 3887 patients) who received HDMTX developed nephrotoxicity Grade ≥ 2. The mortality rate among those patients was 4.4% (3 of 68 patients). Dialysis‐based methods of MTX removal were used frequently but had limited effectiveness in removing MTX compared with the rapid reductions > 98% in plasma MTX concentrations achieved with CPDG2. CPDG2 did not appear to increase the time to recovery of renal function compared with supportive treatment that included dialysis‐based methods.CONCLUSIONSHDMTX‐induced renal dysfunction continues to occur in approximately 1.8% of patients with osteosarcoma who are treated on clinical protocols with optimal supportive care. For patients with delayed MTX excretion and high plasma MTX concentrations, CPDG2 should be considered over hemodialysis to lower plasma MTX concentrations rapidly and efficiently. Cancer 2004. © 2004 American Cancer Society.

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“…Most of the patients were suffering from either osteosarcoma or non-Hodgkin lymphoma. Only 6 of the 15 patients were aged less than 18 years [3,11,16,19]. A closer look at the 9 cases in which clinical details were available suggests that compromised renal function may be an important predisposing factor to HDMTX-associated nephropathy.…”

Section: Discussionmentioning

confidence: 95%

High-Dose Methotrexate-Associated Acute Renal Failure May Be an Avoidable Complication

Fong

Lee

2006

Pediatric Hematology and Oncology

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A 17-year-old boy with acute lymphoblastic leukemia developed acute renal failure within 48 h of an intravenous high-dose methotrexate (5 g/m2) infusion. His renal function returned to baseline 14 days later with supportive care, folinic acid rescue, and urinary alkalinization. A retrospective review revealed that the patient had been exposed to iopamidol, an intravenous contrast medium, on the day prior to the commencement of methotrexate treatment. Methotrexate-associated nephropathy is a rare complication in pediatric oncology, and a review of the literature suggests that exposure to nephrotoxic agents may be a significant but perhaps underrecognized risk factor for its development.

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Continuous plasma resin perfusion for detoxification of methotrexate

Abstract: The use of PRP alone or in combination with HDF is a new and effective treatment strategy for extracorporeal detoxification of MTX.

Cited by 13 publications

References 9 publications

Effective removal of methotrexate by high-flux hemodialysis

Effective removal of methotrexate by high-flux hemodialysis

High‐dose methotrexate‐induced nephrotoxicity in patients with osteosarcoma

High-Dose Methotrexate-Associated Acute Renal Failure May Be an Avoidable Complication

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