We have a 27-year-old male patient with acute lymphoblastic leukemia B in complete remission. The patient received 3 g/m2 (for 2.16 m2) of methotrexate 67 hours ago. The patient developed an acute renal failure creatinine 3.8 mg/dl), possibly due to the previous administration of amphotericin-B and other nephrotoxic drugs, in spite of receiving hyperhydratation (3 l/m2/d¥a), including bicarbonate. At the present the creatinine has dropped to 3.1 mg/dl, but the methotrexate levels (67 hours after the beginning of the methotrexate infusion) are of 28 microMol/L (!!). The patient is receiving the same hyperhydratation, plasmapheresis (a session with poor results), charcoal hemoperfusion (two sessions) and a dose of citrovorum factor (folinic acid) of 1000 mg/m2/3h from the 36 hours (in that moment the patient had methotrexate level of 126 in his serum). We have tried to obtain the enzyme CARBOXYPEPTIDASE G2, but without results. Apparently a dose of 50 U/kg (for 85 kg) has spectacular effects and it can repeat at the six hours.
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