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. 2023 Sep;30(5):e28.
doi: 10.1136/ejhpharm-2022-003453. Epub 2023 Feb 2.

Acute kidney injury and delayed methotrexate clearance in an adult patient with Philadelphia chromosome-positive acute lymphoblastic leukaemia treated with imatinib

Chen Chen  1 , Jian Qi  2 , Xia Li  3 , Wang Yongjing  4
Affiliations

Acute kidney injury and delayed methotrexate clearance in an adult patient with Philadelphia chromosome-positive acute lymphoblastic leukaemia treated with imatinib

Chen Chen et al. Eur J Hosp Pharm. 2023 Sep.

Abstract

A female patient in her early 30s was treated with imatinib and high-dose methotrexate (HD-MTX) for Philadelphia chromosome-positive acute lymphoblastic leukaemia. The patient developed delayed MTX clearance and grade 3 acute kidney injury characterised by elevated creatinine (114% increase from baseline). After intensified calcium folinate rescue therapy and hydration, the MTX serum level was appropriately decreased 72 hours after the start of MTX infusion, and renal function returned to normal. Medication analysis by a clinical pharmacist suggested that the concomitant treatment with imatinib likely contributed to the delayed MTX clearance and caused the acute kidney injury.

Keywords: Acute Kidney Injury; DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS; Drug Monitoring; Leukemia; PHARMACY SERVICE, HOSPITAL; Safety.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Changes in laboratory indices of the patient. BUN, blood urea nitrogen; MTX, methotrexate; SCr, serum creatinine.
See this image and copyright information in PMC

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References

    1. Howard SC, McCormick J, Pui C-H, et al. . Preventing and managing toxicities of high-dose methotrexate. Oncologist 2016;21:1471–82. 10.1634/theoncologist.2015-0164 - DOI - PMC - PubMed
    1. Kawaguchi S, Fujiwara S-ichiro, Murahashi R, et al. . Risk factors for high-dose methotrexate-induced nephrotoxicity. Int J Hematol 2021;114:79–84. 10.1007/s12185-021-03132-8 - DOI - PubMed
    1. Wiczer T, Dotson E, Tuten A, et al. . Evaluation of incidence and risk factors for high-dose methotrexate-induced nephrotoxicity. J Oncol Pharm Pract 2016;22:430–6. 10.1177/1078155215594417 - DOI - PubMed
    1. Wang X, Song Y, Wang J, et al. . Effect of proton pump inhibitors on high-dose methotrexate elimination: a systematic review and meta-analysis. Int J Clin Pharm 2020;42:23–30. 10.1007/s11096-019-00958-5 - DOI - PubMed
    1. Krämer I, Rosentreter J, Fried M, et al. . Significant interaction between high-dose methotrexate and high-dose piperacillin-tazobactam causing reversible neurotoxicity and renal failure in an osteosarcoma patient. J Oncol Pharm Pract 2021;27:1000–4. 10.1177/1078155220953878 - DOI - PubMed

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