Charcoal Hemoperfusion for Methotrexate Toxicity : A Safe and Effective Life-Rescue Alternative When Glucarpidase Is Not Available
Rosales, Alejandra (Medical University Innsbruck)
Madrid, Alvaro (Hospital Sant Joan de Déu (Manresa))
Muñoz, Marina (Hospital Universitari Vall d'Hebron)
Dapena, José Luis (Hospital Sant Joan de Déu (Manresa))
Ariceta Iraola, Gema (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Date:	2021
Abstract:	Background: High dose methotrexate (HDMTX) is used for the treatment of pediatric hemato-oncological diseases. HDMTX can induce acute kidney injury in cases of delayed elimination. The use of leucovorin remains the most effective rescue action. Further treatment options are of difficult access in the rare cases where leucovorin fails to prevent renal failure from occurring. Glucarpidase is an effective treatment in cases of methotrexate (MTX) delayed elimination, but cost is high and availability is limited. Charcoal hemoperfusion (CHP) is a very efficient procedure to remove protein-bound drugs, promoting fast MTX elimination, but is rarely considered as a treatment option. Methods: We present three pediatric cases with prolonged exposure to MTX after HDMTX and delayed elimination in which hemoperfusion was performed as rescue treatment for methotrexate intoxication. Results: Charcoal hemoperfusion was performed with positive results and no complications as bridging until glucarpidase was available in two cases and in one case where two doses of glucarpidase led to insufficient reduction of MTX levels. Conclusions: CHP can be considered as a rescue treatment option in MTX intoxication, since it is an effective and safe extracorporeal method for removing MTX, in cases where rescue with leucovorin is insufficient and glucarpidase is not available or while waiting for delivery.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Charcoal ; Hemoperfusion ; Methotrexate ; High dose methotrexate ; Glucarpidase ; Methotrexate toxicity
Published in:	Frontiers in Pediatrics, Vol. 9 (august 2021) , ISSN 2296-2360

DOI: 10.3389/fped.2021.635152
PMID: 34490152

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