Supplementary Material for: New Therapeutic Approach to Reduce Methotrexate Toxicity after High-Dose Chemotherapy in a Child with Acute Lymphocytic Leukemia: Efficacy and Safety of Hemoadsorption with HA-230 Adsorber

Background: High-dose methotrexate (HDMTX) is likely to cause a number of side effects and manifest itself as hepatotoxicity, nephrotoxicity, mucositis, and neurotoxicity. A several studies demonstrated the efficacy of extracorporeal detoxification methods such as plasma exchange, hemodialysis (HD), HD filtration, and hemoperfusion for the treatment of MTX delayed clearance. However, none of the existing methods as effective as expected and limited for general implementation due to a procedure-related complication. Case Report: Here, we report a successful implementation of HA-230 hemoadsorption procedure to remove cumulated MTX from the body and reduce its toxicity in a child with ALL after high-dose chemotherapy. Results and Conclusion: Based on our results, single-hemoadsorption procedure with the HA-230 adsorber in case of delayed methotrexate clearance was safe and well-tolerated in a pediatric patient with ALL and would significantly improve the patient’s condition. Further studies need to demonstrate its safety and efficacy in a large number of pediatric patients.

背景：大剂量甲氨蝶呤（HDMTX）极易引发多种不良反应，表现为肝毒性、肾毒性、黏膜炎及神经毒性。既往多项研究证实，血浆置换、血液透析（HD）、血液滤过及血液灌流等体外解毒手段可用于治疗甲氨蝶呤清除延迟，但现有方法均未达预期疗效，且因存在操作相关并发症，难以广泛推广应用。病例报告：本文报告1例急性淋巴细胞白血病（Acute Lymphoblastic Leukemia, ALL）患儿在接受大剂量化疗后出现甲氨蝶呤清除延迟，成功实施HA-230血液吸附术以清除体内蓄积的甲氨蝶呤并降低其毒性反应的诊疗案例。结果与结论：基于本研究结果，对于急性淋巴细胞白血病儿科患者出现的甲氨蝶呤清除延迟情况，采用HA-230吸附器的单次血液吸附治疗安全性良好、耐受性佳，可显著改善患者病情。未来仍需开展大规模儿科患者研究，以验证其安全性与有效性。