GRP-111 Management of Methotrexate-Induced Renal Failure Without Glucarpidase

Background Glucarpidase (Voraxaze) is effective in the treatment of methotrexate (MTX)-induced renal dysfunction but many cases this can be handled with standard treatment. Purpose To describe the progress of a patient with MTX-induced renal failure in whose management glucarpidase was not used. Materials and Methods A 13 year-old girl with acute lymphoblastic leukaemia treated with high-dose MTX. Baseline laboratory tests were normal, except for elevated transaminases and GGT. Results The patient received her first consolidation cycle with 500 mg/m2 of MTX in 30 minutes, followed by 4500 mg/m2 in 23.5 hours, oral mercaptopurine 30 mg/m²/day and triple intrathecal therapy. Simultaneously, she received hyperhydration/alkalinisation (3000 ml/m²/day).There was no pharmacological interaction to MTX. 24 hours after the MTX infusion stared, the serum creatinine level (Cr) had tripled (see the table below).The following measures were taken: hyperhydration/alkalinisation (4500 ml/m²/day), colestyramine (3 g/6 h) and folinic acid rescue at 500 mg/m²/6 h 31 hours after the start of the MTX infusion. Although the protocol provides for the possibility of administering glucarpidase, it was decided not to do this because the methotrexate level was Conclusions An early intervention with supportive treatment based on folinic acid, hyperhydration and urine alkalinisation was effective in the management of MTX-induced renal toxicity. No conflict of interest.