Managing reduced methotrexate clearance in a patient with a heterozygous methylenetetrahydrofolate reductase gene polymorphism

David C. Gammon, Mansi S. Bhatt, Bhavini Patel, Meghan Anderson, Alixis Van Horn, Michael Glantz

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

High dose methotrexate has become one of the treatments of choice for patients with primary CNS lymphomas due to its ability to penetrate the blood-brain barrier. A potentially serious complication of this therapy is methotrexate-related nephrotoxicity. We report the case of a patient with a common genetic polymorphism that may have predisposed this patient experience clinically significant toxicity from systemic folate depletion. After the first cycle of chemotherapy that included high dose methotrexate, the patient's serum creatinine rose and the patient's methotrexate level remained above the toxic range for six days. On cycle two, the patient was treated with a 25% dose reduction in methotrexate and more aggressive hydration and alkalization. With this alteration in the regimen, the patient was able to receive six more cycles and had a complete radiographic tumor response in the brain and a disappearance of tumor cells in the CSF without any further renal complications. This case report illustrates the feasibility of administering high dose methotrexate with modifications as a treatment of choice in individuals with methylenetetrahydrofolate reductase gene mutations.

Original languageEnglish (US)
Pages (from-to)153-156
Number of pages4
JournalJournal of Oncology Pharmacy Practice
Volume14
Issue number3
DOIs
StatePublished - Dec 1 2008

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Methylenetetrahydrofolate Reductase (NADPH2)
Methotrexate
Genes
Poisons
Genetic Polymorphisms
Blood-Brain Barrier
Folic Acid
Lymphoma
Creatinine
Neoplasms
Therapeutics
Kidney
Drug Therapy
Mutation
Brain
Serum

All Science Journal Classification (ASJC) codes

  • Oncology
  • Pharmacology (medical)

Cite this

Gammon, David C. ; Bhatt, Mansi S. ; Patel, Bhavini ; Anderson, Meghan ; Van Horn, Alixis ; Glantz, Michael. / Managing reduced methotrexate clearance in a patient with a heterozygous methylenetetrahydrofolate reductase gene polymorphism. In: Journal of Oncology Pharmacy Practice. 2008 ; Vol. 14, No. 3. pp. 153-156.
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Managing reduced methotrexate clearance in a patient with a heterozygous methylenetetrahydrofolate reductase gene polymorphism. / Gammon, David C.; Bhatt, Mansi S.; Patel, Bhavini; Anderson, Meghan; Van Horn, Alixis; Glantz, Michael.

In: Journal of Oncology Pharmacy Practice, Vol. 14, No. 3, 01.12.2008, p. 153-156.

Research output: Contribution to journalArticle

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