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New research · Ophthalmology
Annals of hematology · 1d
Case reportAnnals of hematology · 2026

Half-dose glucarpidase: an effective rescue for toxic methotrexate plasma concentrations in a patient with bilateral primary vitreoretinal lymphoma.

Ángela González-Román, Thais Lizondo, Carla Bastida … Dolors Soy
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OphthalmologyCase report

Half-dose glucarpidase sharply lowered toxic methotrexate levels after high-dose therapy.

Half-dose glucarpidase: an effective rescue for toxic methotrexate plasma concentrations in a patient with bilateral primary vitreoretinal lymphoma.

Ángela González-Román … Dolors Soy
Annals of hematology · 2026
Background

Primary vitreoretinal lymphoma (primary vitreoretinal lymphoma) is a rare, aggressive subtype of central nervous system lymphoma that initially presents in the eye.

Results
94.6%
MTX blood levels dropped sharply after the reduced dose was given
More results

We report the case of a 29-year-old man with bilateral primary vitreoretinal lymphoma receiving treatment with the MATRIX regimen.

During the fourth cycle, the patient developed acute kidney injury following intravenous high-dose methotrexate (3.5 g/m²), despite prophylactic measures including hydration, urinary alkalinization, and folinic acid rescue.

More results

Plasma MTX concentrations remained elevated at 32 µmol/L at 23 hours and 20 µmol/L at 42 hours post-infusion.

Although the standard glucarpidase dose is 50 U/kg, emerging evidence supports the effectiveness of lower doses, which may offer similar clinical benefit while reducing costs.

“
Conclusion

Low-dose glucarpidase (25 U/kg) proved effective and safe in treating high-dose methotrexate-induced nephrotoxicity in this patient, offering a cost-effective alternative in settings with limited availability of rescue agents, emphasizing the need for timely intervention and multidisciplinary coordination.

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