Saland Jeffrey M, Leavey Patrick J, Bash Robert O, Hansch Eleonora, Arbus Gerald S, Quigley Raymond
Department of Pediatrics, The Mount Sinai School of Medicine, One Gustave L. Levy Place Box 1664, NY 10029-6574, USA.
Pediatr Nephrol. 2002 Oct;17(10):825-9. doi: 10.1007/s00467-002-0946-7. Epub 2002 Aug 9.
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.
本研究的目的是检测高通量血液透析（HD）对儿科肿瘤患者甲氨蝶呤（MTX）的清除情况。我们报告了3例骨肉瘤治疗期间大剂量输注MTX后出现肾毒性且MTX毒性浓度暴露时间延长的患者。每名患者均成功接受了高通量血液透析治疗，其中2例随后接受了羧肽酶G2（CPDG2）治疗。全身毒性最小。我们回顾了文献并讨论了针对大剂量MTX治疗这一并发症的早期积极治疗指南。MTX的临床重要清除取决于肾毒性检测后及时开始血液透析以及MTX的延迟清除。在无法获得CPDG2的同情用药或等待其送达期间，建议进行治疗。
