Scholarlink

<p>Primary vitreoretinal lymphoma (PVRL) is a rare, aggressive subtype of central nervous system lymphoma that initially presents in the eye. High-dose methotrexate (HD-MTX) is a key component of systemic therapy, but its use can be complicated by nephrotoxicity and delayed drug clearance, requiring urgent management to avoid toxicity. We report the case of a 29-year-old man with bilateral PVRL receiving treatment with the MATRIX regimen. During the fourth cycle, the patient developed acute kidney injury following intravenous HD-MTX (3.5 g/m²), despite prophylactic measures including hydration, urinary alkalinization, and folinic acid rescue. Plasma MTX concentrations remained elevated at 32 µmol/L at 23 hours and 20 µmol/L at 42 hours post-infusion. A reduced glucarpidase dose (25 U/kg), half the standard dose, was administered 50 hours post-infusion, lowering MTX plasma concentrations by 94.6% from the pre-glucarpidase MTX concentration. Intensified folinic acid rescue was maintained. This case demonstrates that MTX clearance may be impaired, highlighting the importance of early therapeutic drug monitoring. Although the standard glucarpidase dose is 50 U/kg, emerging evidence supports the effectiveness of lower doses, which may offer similar clinical benefit while reducing costs. This consideration is particularly relevant in adults, as weight-based dosing substantially increases drug requirements and treatment costs compared to paediatric patients. Low-dose glucarpidase (25 U/kg) proved effective and safe in treating HD-MTX-induced nephrotoxicity in this patient, offering a cost-effective alternative in settings with limited availability of rescue agents, emphasizing the need for timely intervention and multidisciplinary coordination.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Half-dose glucarpidase: an effective rescue for toxic methotrexate plasma concentrations in a patient with bilateral primary vitreoretinal lymphoma

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月9日

查看全文
  • Ángela González-Román,
  • Thais Lizondo,
  • Carla Bastida,
  • Inés Monge-Escartín,
  • Gisela Riu,
  • Esther Carcelero,
  • Eduardo Aguilar,
  • Anna Gaya,
  • Dolors Soy

摘要

Primary vitreoretinal lymphoma (PVRL) is a rare, aggressive subtype of central nervous system lymphoma that initially presents in the eye. High-dose methotrexate (HD-MTX) is a key component of systemic therapy, but its use can be complicated by nephrotoxicity and delayed drug clearance, requiring urgent management to avoid toxicity. We report the case of a 29-year-old man with bilateral PVRL receiving treatment with the MATRIX regimen. During the fourth cycle, the patient developed acute kidney injury following intravenous HD-MTX (3.5 g/m²), despite prophylactic measures including hydration, urinary alkalinization, and folinic acid rescue. Plasma MTX concentrations remained elevated at 32 µmol/L at 23 hours and 20 µmol/L at 42 hours post-infusion. A reduced glucarpidase dose (25 U/kg), half the standard dose, was administered 50 hours post-infusion, lowering MTX plasma concentrations by 94.6% from the pre-glucarpidase MTX concentration. Intensified folinic acid rescue was maintained. This case demonstrates that MTX clearance may be impaired, highlighting the importance of early therapeutic drug monitoring. Although the standard glucarpidase dose is 50 U/kg, emerging evidence supports the effectiveness of lower doses, which may offer similar clinical benefit while reducing costs. This consideration is particularly relevant in adults, as weight-based dosing substantially increases drug requirements and treatment costs compared to paediatric patients. Low-dose glucarpidase (25 U/kg) proved effective and safe in treating HD-MTX-induced nephrotoxicity in this patient, offering a cost-effective alternative in settings with limited availability of rescue agents, emphasizing the need for timely intervention and multidisciplinary coordination.