Carboxypeptidase-G 2 Rescue in Cancer Patients with Delayed Methotrexate Elimination after High-dose Methotrexate Therapy

Anke S. Krause Department for Internal Medicine I, University of Cologne, Cologne, Germany

Martin R. Weihrauch Department for Internal Medicine I, University of Cologne, Cologne, Germany

Udo Bode Department of Pediatrics, University of Bonn, Bonn, Germany

Gudrun Fleischhack Department of Pediatrics, University of Bonn, Bonn, Germany

Thomas Elter Department for Internal Medicine I, University of Cologne, Cologne, Germany

Theodor Heuer St. Franziskus Hospital Mönchengladbach, Mönchengladbach, Germany

Andreas Engert Department for Internal Medicine I, University of Cologne, Cologne, Germany

Volker Diehl Department for Internal Medicine I, University of Cologne, Cologne, Germany

Andreas Josting Department for Internal Medicine I, University of Cologne, Cologne, Germany

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Abstract

High-dose methotrexate (HDMTX) is a component of many cancer treatment regimens. Despite careful management, delayed renal clearance, followed by extremely high serum levels with potentially life-threatening toxicity can occur. In the present study, we report our results of carboxypeptidase-G 2 (CPDG 2 ) rescue in 8 patients with delayed methotrexate elimination and renal impairment after HDMTX therapy for lymphoma or osteosarcoma. A dose of 50 U/kg CPDG 2 was administered. MTX plasma levels decreased rapidly and recovery of renal function was observed in all patients. No patient developed severe WHO grade 4 MTX toxicity. CPDG 2 provides an alternative route of MTX elimination by converting it to inactive and non-toxic metabolites. CPDG 2 rescue was well tolerated, safe and very effective in preventing severe or life-threatening MTX toxicity.

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Carboxypeptidase-G 2 Rescue in Cancer Patients with Delayed Methotrexate Elimination after High-dose Methotrexate Therapy

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Carboxypeptidase-G 2 Rescue in Cancer Patients with Delayed Methotrexate Elimination after High-dose Methotrexate Therapy

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