2026-04-17T01:28:00Zhttps://recercat.cat/oai/requestoai:recercat.cat:11351/73882025-10-24T10:24:22Zcom_2072_378070com_2072_378040col_2072_378092
RECERCAT
author
Rosales, Alejandra
author
Madrid Aris, Alvaro Domingo
author
Muñoz López, Marina
author
Dapena Diaz, Jose Luis
author
Ariceta Iraola, Gema
2025-10-24T10:24:22Z
2025-10-24T10:24:22Z
2022-04-22T15:42:21Z2022-04-22T15:42:21Z2021-08
http://hdl.handle.net/11351/7388
Carbó vegetal; Glucarpidasa; Toxicitat del metotrexatCarbón vegetal; Glucarpidasa; Toxicidad del metotrexatoCharcoal; Glucarpidase; Methotrexate toxicityBackground: 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.
Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess
Infants - Malalties - Tractament
Hematologia oncològica
Metotrexat - Depuració
DISEASES::Neoplasms::Neoplasms by Site::Hematologic Neoplasms
Other subheadings::Other subheadings::Other subheadings::/drug therapy
DISCIPLINES AND OCCUPATIONS::Health Occupations::Medicine::Pediatrics
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Sorption Detoxification::Hemoperfusion
DISCIPLINAS Y OCUPACIONES::profesiones sanitarias::medicina::pediatría
ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias hematológicas
Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::desintoxicación por adsorción::hemoperfusión
Charcoal Hemoperfusion for Methotrexate Toxicity: A Safe and Effective Life-Rescue Alternative When Glucarpidase Is Not Available
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion