High-dose continuous venovenous hemofiltration combined with charcoal hemoperfusion for methotrexate removal

Methotrexate (MTX) is used to treat various disorders and can be safely administered at high doses if renal function is adequate, high urine output (UOP) is maintained, urine is alkalinized and leucovorin rescue is given. Despite those measures, toxicity (mucositis, diarrhea, renal dysfunction and myelosuppression) occurs with prolonged high serum drug concentrations [1]. Dialysis-based methods of removal are largely ineffective because MTX is highly protein bound [1]. Use of charcoal hemoperfusion has also been reported but is minimally effective. We report the first case of high-dose continuous venovenous hemofiltration (CVVH) after charcoal hemofiltration for MTX removal in a patient with toxicity following lymphoma treatment.