Carboxypeptidase-G2 rescue in a patient with MTX-induced renal failure

Background: Methotrexate (MTX) is a very effective chemotherapeutic drug, w idely used in various malignant diseases for systemic therapy. In some case s, MTX-induced renal failure occurs which may not be prevented by the stand ard agent folin acid as a specific antidot. This results in a MTX-accumulat ion ill the body tissue with subsequent massive toxic side effects. Case Report: We report on a 62-year-old woman with acute lymphoblastic leuk emia (first diagnosis November 1997) receiving chemotherapy with 2340 mg me thotrexate over 24. hours. After an increase of the MTX-plasma-level 36 hou rs following MTX-application, increased serum creatinine levels (maximum 5. 07 mg/dl) were found. The application of folinic acid was without any signi ficant effect. Fifty-six hours following MTX, 50 U/kg carboxypeptidase-G2 w as 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.