Methotrexate-induced acute kidney injury in patients with hematological malignancies: Three case reports with literature review

Abstract

Background: High-dose methotrexate (HD-MTX) therapy has been used to treat a wide range of oncological malignancies. While the therapy can be tolerated with hydration, urine pH control, and leucovorin rescue therapy, HD-MTX is cytotoxic and can cause renal failure. There have been several case reports of HD-MTX toxicity in patients with solid tumors; however, few case series of hematological malignancies have been published. Patients with hematological malignancies tend to be administered many concomitant drugs, which can affect the elimination of MTX and result in acute kidney injury. Case presentation: Here, we present three cases of HD-MTX-induced acute kidney injury in patients with hematological malignancies. Several blood purification methods were used to attempt to eliminate MTX. Conclusions: Rapid elimination of MTX is needed for patients with higher serum MTX concentrations to avoid additional cytotoxic effects, especially in patients who have experienced many complications. Although the most effective method for MTX elimination remains unknown, the results of our retrospective survey suggest that combined modalities, such as hemodialysis and plasma exchange, may be suitable for treatment of patients with hematological malignancies.