Snyder Ronald L
Pediatric Oncology/Bone Marrow Transplantation Service, Pharmacy Department, Children's Hospital of Orange County, CA 92868, USA.
Am J Health Syst Pharm. 2007 Jun 1;64(11):1163-9. doi: 10.2146/ajhp060187.
The successful resumption of high-dose methotrexate in a 13-year-old boy with recurrent anaplastic large-cell lymphoma (ALCL) who suffered renal dysfunction after a 24-hour infusion of high-dose methotrexate and required treatment with carboxypeptidase G(2) (CPDG(2) ) is described.
A 13-year-old boy who had been diagnosed in 2001 with stage I ALCL was admitted to the hospital in February 2005 after he developed a smaller left axillary mass in the area of his original mass. Recurrent ALCL was diagnosed, and treatments were initiated based on branch K3 of the protocol published in the non-Hodgkin's lymphoma-Berlin-Frankfurt-Münster (NHL-BFM) trial 90. In the NHL-BFM 90 protocol, all AA and BB courses include high-dose methotrexate therapy, which consists of aggressive alkalinized hydration, methotrexate 5 g/m(2) given as an i.v. infusion over 24 hours, and leucovorin rescue. During course BB2, the boy's serum methotrexate values exceeded NHL-BFM goals at 36, 42, and 48 hours. Because the patient's elimination of methotrexate remained slow and his serum creatinine level remained above normal limits, CPDG(2) was obtained for the treatment of methotrexate toxicity. The patient tolerated the CPDG(2) without adverse effects, and the patient's serum methotrexate concentration decreased from 14.47 to 0.66 microM. The patient went on to complete six courses based on the protocol. High-dose methotrexate was resumed at 50% then 100% of the original dose. He is currently in remission on maintenance therapy.
A 13-year-old boy with recurrent ALCL had methotrexate-induced nephrotoxicity following high-dose methotrexate. The resultant delayed methotrexate clearance required the standard therapies as well as use of investigational CPDG(2). High-dose methotrexate was successfully resumed.
描述一名13岁复发性间变性大细胞淋巴瘤（ALCL）男孩在24小时大剂量甲氨蝶呤输注后出现肾功能不全，需要用羧肽酶G(2)（CPDG(2)）治疗，之后成功恢复大剂量甲氨蝶呤治疗的情况。
一名2001年被诊断为Ⅰ期ALCL的13岁男孩，于2005年2月因原肿块部位左腋窝出现较小肿块而入院。诊断为复发性ALCL，并根据非霍奇金淋巴瘤 - 柏林 - 法兰克福 - 明斯特（NHL - BFM）试验90公布的方案K3分支开始治疗。在NHL - BFM 90方案中，所有AA和BB疗程均包括大剂量甲氨蝶呤治疗，其包括积极的碱化水化、静脉输注5 g/m(2)甲氨蝶呤持续24小时以及亚叶酸钙解救。在BB2疗程期间，该男孩的血清甲氨蝶呤值在36、42和48小时超过了NHL - BFM目标值。由于患者甲氨蝶呤清除缓慢且血清肌酐水平仍高于正常范围，因此获取了CPDG(2)用于治疗甲氨蝶呤毒性。患者耐受CPDG(2)且无不良反应，其血清甲氨蝶呤浓度从14.47微摩尔/升降至0.66微摩尔/升。患者继续按照方案完成了六个疗程。大剂量甲氨蝶呤以原剂量的50%然后100%恢复使用。他目前在维持治疗下处于缓解状态。
一名患有复发性ALCL的13岁男孩在大剂量甲氨蝶呤治疗后出现甲氨蝶呤诱导的肾毒性。由此导致的甲氨蝶呤清除延迟需要标准治疗以及使用研究性药物CPDG(2)。大剂量甲氨蝶呤成功恢复使用。
