4/11/96

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.

Would somebody send us this product ASAP? Anybody has another idea? Please, reply us as soon as possible.

Sincerely