Methylenetetrahydrofolate reductase mutation with delayed methotrexate excretion and liver damage caused by high-dose methotrexate:one case report
This report described the process of liver dam-age caused by a combined dosing of proton pump inhibitor(PPI)and penicillin in an ALL child with MTX metabolism and excretion gene mutations after receiving high-dose metho-trexate(HD-MTX)chemotherapy.It provided some refer-ence for patients with MTX metabolism and excretion gene mutations,as well as similar combination therapy patients.Therefore methylenetetrahydro folate reductase(MTHFR)C677T,MTHFR A1298C and ABCB1 C3435T genotyping are recommended to perform before HD-MTX chemo-therapy.Based upon the results of genotypic analyses,the dosage of HD-MTX should be appropriately adjusted in advance.Blood concentration of MTX should be closely monitored for avoiding a combined dosing of PPI and penicil-lin potentially affecting MTX excretion to prevent delayed MTX excretion or adverse drug reaction.
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