Abstract
Summary We report a case of a 56-year-old woman with a high-grade diffuse large B-cell lymphoma who unexpectedly developed toxic plasma levels of methotrexate (MTX) following the first cycle of rituximab-cyclophosphamide, hydroxydanorubicin, oncovin, prednisolone (R-CHOP) with a high-dose MTX chemotherapy protocol. She also developed non-oliguric acute kidney injury secondary to MTX nephrotoxicity. We elected to treat her with online-haemodiafiltration (HDF) and this proved to be efficient with a dramatic response. Rapid clearance of MTX to therapeutic levels was possible within three sessions. Prompt therapy with high-volume online-HDF is an effective choice for rapid MTX clearance and swift reversal of MTX nephrotoxicity.
2014 BMJ Publishing Group Ltd.
MeSH terms
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Acute Kidney Injury / chemically induced
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Acute Kidney Injury / therapy*
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Antibodies, Monoclonal, Murine-Derived / therapeutic use
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Antimetabolites, Antineoplastic / blood
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Antimetabolites, Antineoplastic / poisoning*
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
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Cyclophosphamide / therapeutic use
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Doxorubicin / therapeutic use
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Female
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Hemodiafiltration*
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Humans
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Lymphoma, Large B-Cell, Diffuse / drug therapy*
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Methotrexate / blood
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Methotrexate / poisoning*
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Middle Aged
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Poisoning / therapy*
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Prednisone / therapeutic use
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Rituximab
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Treatment Outcome
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Vincristine / therapeutic use
Substances
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Antibodies, Monoclonal, Murine-Derived
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Antimetabolites, Antineoplastic
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R-CHOP protocol
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Rituximab
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Vincristine
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Doxorubicin
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Cyclophosphamide
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Prednisone
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Methotrexate