Successful treatment with adapted high dose methotrexate in a hemodialysis patient with primary central nervous system lymphoma: 100 mg/m2 seems sufficient - Inria - Institut national de recherche en sciences et technologies du numérique Access content directly
Journal Articles Nefrología (English Edition) Year : 2022

Successful treatment with adapted high dose methotrexate in a hemodialysis patient with primary central nervous system lymphoma: 100 mg/m2 seems sufficient

Abstract

High dose methotrexate (HD-MTX) based chemoimmunotherapy is a central part of the standard approach to treatment of primary central nervous system lymphoma (PCNSL). Renal dysfunction leads to delayed MTX complete elimination and critical MTX concentration. Despite the recommendations, hemodialysis status should not exclude HD-MTX. We report the case of a 64 years old woman on chronic hemodialysis with PCNSL successfully treated with HD-MTX-based chemoimmunotherapy with an adjusted dose of 100 mg/m2, instead of the usual dose of 3500 mg/m2, and daily hemodialysis started 24 h later. The patient had no significant toxicity and was in complete remission at 1 year after the end of the treatment. We argue that ESRD is not an absolute pitfall to the use of HD-MTX for hematological malignancies. Experts should consider the use of adjusted dose at 100 mg/m2 as a viable therapeutic modality in ESRD patients.

Dates and versions

hal-03939695 , version 1 (15-01-2023)

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Justine Solignac, Laure Farnault, Thomas Robert, Raphaëlle Fanciullino, Sylvain Choquet, et al.. Successful treatment with adapted high dose methotrexate in a hemodialysis patient with primary central nervous system lymphoma: 100 mg/m2 seems sufficient. Nefrología (English Edition), 2022, 42 (2), pp.130-134. ⟨10.1016/j.nefroe.2022.02.007⟩. ⟨hal-03939695⟩
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