A case of 24-hour direct hemoperfusion for methotrexate toxicity

Abstract

High-dose methotrexate (MTX) therapy is an effective treatment for leukemia and malignant lymphoma but can result in severe adverse effects, including MTX toxicity. Management of MTX toxicity typically involves the use of glucarpidase as an antidote, along with extracorporeal blood purification techniques such as plasma exchange, hemodialysis, and direct hemoperfusion (DHP). We present a case of MTX toxicity successfully treated with 24-hour DHP combined with continuous renal replacement therapy (CRRT). At the start of DHP, the MTX clearance rate was 84.5 mL/min, which decreased to 32.1 mL/min after 24 hours. For CRRT, the clearance rates were 35.7 mL/min at initiation and 30.7 mL/min at 12 hours. Importantly, DHP sustained significant clearance even after 24 hours, demonstrating its effectiveness as a therapeutic option for MTX toxicity. This case underscores the potential of prolonged DHP in managing MTX toxicity, particularly its capacity to maintain substantial MTX clearance over extended periods.