The utility of online haemodiafiltration in methotrexate poisoning

BMJ Case Rep. 2014 May 23:2014:bcr2014203530. doi: 10.1136/bcr-2014-203530.

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.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / therapy*
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Antimetabolites, Antineoplastic / blood
  • Antimetabolites, Antineoplastic / poisoning*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cyclophosphamide / therapeutic use
  • Doxorubicin / therapeutic use
  • Female
  • Hemodiafiltration*
  • Humans
  • Lymphoma, Large B-Cell, Diffuse / drug therapy*
  • Methotrexate / blood
  • Methotrexate / poisoning*
  • Middle Aged
  • Poisoning / therapy*
  • Prednisone / therapeutic use
  • Rituximab
  • Treatment Outcome
  • Vincristine / therapeutic use

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Antimetabolites, Antineoplastic
  • R-CHOP protocol
  • Rituximab
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone
  • Methotrexate