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Acute kidney injury and delayed methotrexate clearance in an adult patient with Philadelphia chromosome-positive acute lymphoblastic leukaemia treated with imatinib
  1. Chen Chen1,
  2. Jian Qi2,
  3. Xia Li3,
  4. Wang Yongjing4
  1. 1Department of Clinical Pharmacy, The Second Hospital of Shandong University, Jinan, Shandong, China
  2. 2Department of Orthopedics, PLA 960th Hospital, Jinan, Shandong, China
  3. 3Shandong Center for Adverse Drug Reaction Monitoring, Jinan, Shandong, China
  4. 4Department of Hematology, The Second Hospital of Shandong University, Jinan, Shandong, China
  1. Correspondence to Dr Wang Yongjing, Department of Hematology, The Second Hospital of Shandong University, Jinan 250012, Shandong, China; wangyongjing2015{at}


A female patient in her early 30s was treated with imatinib and high-dose methotrexate (HD-MTX) for Philadelphia chromosome-positive acute lymphoblastic leukaemia. The patient developed delayed MTX clearance and grade 3 acute kidney injury characterised by elevated creatinine (114% increase from baseline). After intensified calcium folinate rescue therapy and hydration, the MTX serum level was appropriately decreased 72 hours after the start of MTX infusion, and renal function returned to normal. Medication analysis by a clinical pharmacist suggested that the concomitant treatment with imatinib likely contributed to the delayed MTX clearance and caused the acute kidney injury.

  • Acute Kidney Injury
  • Drug Monitoring
  • Leukemia
  • Safety

Data availability statement

All data relevant to the study are included in the article.

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