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How to rescue high-dose methotrexate induced nephrotoxicity and literature review about hemodiafiltration?
Yang, YY, Gao, L, Ding, N, Wang, XB, Zhang, LP, Gao, LH, Wang, Z
Pakistan journal of pharmaceutical sciences. 2020;(3):1163-1167
Abstract
Methotrexate (MTX) is a highly renal and liver toxicity drug used in hematological malignancy treatment in children and adults. High-dose methotrexate (HD-MTX) therapy may cause impairment of kidney and decrease the elimination of MTX, at the same time, the serum concentration of MTX increased. Today the treatment for preventing MTX toxicity after renal shutdown is Carboxypeptidase. We report a patient who experienced nephrotoxicity after the HD-MTX infusions during the treatment for non-Hodgkin lymphoma (NHL) and received hemodiafiltration (HDF) with large dose of leucovorin (LV) to treat MTX intoxication. LV is very potent in the prevention of neurotoxicity and administration of LV could protect the normal cells, but the dosage and duration of LV should be according to the MTX concentration. Although a large dose of LV was applied, the patient's condition did not improve. It was found that the HDF with large dose of LV to save the patient and steadily improved the patient's clinical condition.
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2.
Fetal methotrexate syndrome: A systematic review of case reports.
Verberne, EA, de Haan, E, van Tintelen, JP, Lindhout, D, van Haelst, MM
Reproductive toxicology (Elmsford, N.Y.). 2019;:125-139
Abstract
Methotrexate is a folic acid antagonist known to be teratogenic in humans. Several cases of congenital malformations after fetal exposure to methotrexate have been published, resulting in the establishment of the 'fetal methotrexate syndrome'. However, it is unclear which congenital anomalies can truly be attributed to methotrexate exposure. The objective of this review is to delineate a consistent phenotype of the fetal methotrexate syndrome. We performed a systematic review that yielded 29 cases of (congenital) anomalies after in utero exposure to methotrexate and compared their malformation pattern to that of children and fetuses with congenital anomalies in general. Statistically significant higher proportions of microcephaly, craniosynostosis, tetralogy of Fallot, pulmonary valve atresia, limb reduction defects and syndactyly were found in the methotrexate group, indicating that these congenital anomalies are truly part of the fetal methotrexate syndrome. These results aid clinicians with diagnosing fetal methotrexate syndrome.
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3.
Prolonged response of meningeal carcinomatosis from non-small cell lung cancer to salvage intrathecal etoposide subsequent to failure of first-line methotrexate: a case report and literature review.
Park, MJ
The American journal of case reports. 2015;:224-7
Abstract
BACKGROUND As the incidence of meningeal carcinomatosis (MC) in non-small cell lung cancer (NSCLC) patients has been increasing, MC has recently become an important clinical problem in the management of NSCLC. However, development of new treatments is lacking and a standard treatment guideline is not yet available. Research on salvage intrathecal chemotherapy after failure of first-line treatment for NSCLC patients with MC has rarely been reported in the literature. Here, we report the case of an NSCLC patient with MC who showed durable response to salvage intrathecal etoposide subsequent to failure of first-line methotrexate. CASE REPORT A 58-year-old Asian man with lung adenocarcinoma with bone metastasis presented gait disturbance, diplopia, and progressively increasing headache. The diagnosis of MC was made by brain magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) cytology. After MC progression was suspected during the first-line treatment of intrathecal MTx, intrathecal etoposide was used as a salvage treatment. Brain MRI performed after 2 months of the treatment demonstrated disappearance of enhancing lesions along the ependymal lining of the lateral ventricles. His clinical status markedly improved from Eastern Cooperative Oncology Group performance status of 4 to 2. Stable neurologic status was maintained and CSF cytology remained negative while weekly injection of etoposide was continued for 19 weeks. However, hepatic metastatic lesions persistently progressed despite systemic palliative chemotherapy and the patient died of the disease. CONCLUSIONS To our knowledge, this is the first case report in which intrathecal etoposide was successfully used to treat MC from NSCLC after failure of MTx. This case report might provide preliminary evidence of the feasibility of intrathecal etoposide as salvage intrathecal chemotherapy (ITC). Further clinical trials including larger numbers of patients are necessary to evaluate the role of this ITC regimen for NSCLC patients with MC.
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4.
Aggressive fibromatosis of the neck treated with a combination of chemotherapy and indomethacin.
Longhi, A, Errani, C, Battaglia, M, Alberghini, M, Ferrari, S, Mercuri, M, Molinari, M
Ear, nose, & throat journal. 2011;(6):E11-5
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Abstract
Aggressive fibromatosis (desmoid tumor) of the neck is rare. When feasible, surgery is the best treatment option. However, complete excision with negative margins is not possible in most cases because of the involvement of vascular and nervous structures. Also, surgery results in poor functional and aesthetic outcomes. Sometimes debulking surgery with positive margins is performed, but the anatomy of the neck is a challenge for oncologic surgeons, and recurrences are not uncommon. Radiotherapy is seldom employed for the same reasons. On the other hand, systemic treatment with chemotherapy, hormone therapy, and noncytotoxic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) has been used with good results. We report a case of inoperable aggressive fibromatosis of the neck that was successfully treated for about 21 months with a combination of chemotherapy and the NSAID indomethacin. As far as we know, this is the first reported use of a combination of chemotherapy and an anti-inflammatory drug in the treatment of aggressive fibromatosis of the neck. We also review the literature on cases of aggressive fibromatosis of the neck that have been reported over the past 12 years.
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A case of acute sarcoid myositis treated with weekly low-dose methotrexate.
Fujita, H, Ishimatsu, Y, Motomura, M, Kakugawa, T, Sakamoto, N, Hayashi, T, Kohno, S
Muscle & nerve. 2011;(6):994-9
Abstract
A 25-year-old man was referred to our hospital with a 2-month history of progressive proximal extremity weakness. His serum creatine kinase (CK) level was extremely elevated, and chest X-ray revealed bilateral hilar lymphadenopathy and small nodules in bilateral lung fields. Biopsy specimens obtained from muscle and lung revealed non-caseating epithelioid cell granulomas. On the basis of these findings, the patient was diagnosed with sarcoidosis and acute sarcoid myositis. Although steroid pulse therapy was administered repeatedly, the muscle symptoms did not improve, and the serum CK level remained high. We added 7.5 mg oral methotrexate once per week to oral prednisolone, and this improved both the muscle weakness and the CK level. Concurrent administration of methotrexate could be a therapeutic option for cases with acute sarcoid myositis refractory to steroid therapy.
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Pulmonary toxicity in a patient with psoriasis receiving methotrexate therapy.
McKenna, KE, Burrows, D
Clinical and experimental dermatology. 2000;(1):24-7
Abstract
We report a 34-year-old woman with psoriasis who developed shortness of breath during methotrexate therapy. Methotrexate had been started 4 months earlier and the patient had ingested a cumulative dose of 232 mg. Pulmonary function tests showed a reduction in transfer factor to 76% of predicted. Methotrexate was stopped and her symptoms rapidly resolved. Pulmonary function tests deteriorated further despite stopping methotrexate but with no recurrence of symptoms with a transfer factor of 66% of predicted 2 months later. At 5 months after stopping methotrexate the patient remained well and pulmonary function had improved with a transfer factor of 79% of predicted. Pulmonary toxicity is a rare but important adverse effect of methotrexate therapy in patients with psoriasis.