Abstract
When high-dose methotrexate (HDMTX) is administered in the treatment of primary central nervous system lymphoma (PCNSL), leucovorin rescue must often be extended due to a delay in the degradation of the blood concentra-tion of methotrexate (MTX). We determined whether or not a delay in the degradation of the MTX blood concentration and renal dysfunction could be prevented by a Japanese traditional medicine, saireito.
Seventeen patients with PCNSL were treated with HDMTX. The first course of HDMTX was provided according to standard protocol, and a 3 g-dose of saireito was administered 3 times per day during the second course of HDMTX. Before the MTX blood concentration decreased to < 1 × 10-7 mol/l, the serum blood urea nitrogen (BUN) and creatinine (Cr) were measured and the creatinine clearance (CCr) was measured, with or without the administration of saireito.
There were no cases that required prolonged administration of leucovorin rescue therapy during the second course of HDMTX with administration of saireito, whereas during the first course of HDMTX, 6 cases had a delay in the degradation of the MTX blood concentration, thus requiring prolongation of leucovorin rescue therapy. Moreover, after HDMTX therapy with the administration of saireito, BUN and Cr levels in the serum were significantly decreased and the CCr was significantly increased.
It is suggested that saireito increases urine flow by inhibiting reabsorption of water in the distal tubule. Administration of saireito during HDMTX therapy is effective in preventing renal failure.
