A case report: capillary leak syndrome in a patient receiving high-dose methotrexate, Tislelizumab and zanubrutinib for CNS lymphoma.

IF 2.7 4区医学 Q3 ONCOLOGY

Cancer Chemotherapy and Pharmacology Pub Date : 2025-07-07 DOI:10.1007/s00280-025-04796-3

Wenpeng Li, Yuxi Hou

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Abstract

Purpose: The high-dose methotrexate (MTX) regimen is a first-line treatment for primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL). However, MTX-related kidney injury is a severe treatment complication. No cases of capillary leak syndrome (CLS) causing delayed MTX metabolism-associated renal failure have been reported.

Case presentation: A 48-year-old female presented to Zibo Central Hospital in April 2024 with headaches. Contrast-enhanced magnetic resonance imaging (MRI) of the brain revealed a space-occupying lesion in the right occipital lobe. A stereotactic biopsy was performed to determine the nature of the lesion. Postoperative pathology confirmed DLBCL. The patient underwent a TZM regimen, which included Tislelizumab, MTX, and Zanubrutinib. On the first day following MTX, the patient developed generalized edema, shortness of breath, and reduced urine output. Laboratory tests revealed hypoxemia, low albumin levels, and acute kidney injury. Based on these findings, the patient was diagnosed with CLS. To quickly lower the blood MTX concentration, pleural effusion drainage and continuous renal replacement therapy (CRRT) were performed. The treatment was successful, and the patient recovered and was discharged.

Conclusion: CLS is a serious complication for DLBCL patients receiving high-dose MTX therapy.

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一例报告：接受大剂量甲氨蝶呤、替利单抗和扎鲁替尼治疗中枢神经系统淋巴瘤患者的毛细血管渗漏综合征。

目的：大剂量甲氨蝶呤（MTX）方案是原发性中枢神经系统弥漫性大b细胞淋巴瘤（PCNS-DLBCL）的一线治疗方案。然而，mtx相关的肾损伤是一种严重的治疗并发症。没有病例毛细血管渗漏综合征（CLS）引起延迟MTX代谢相关肾功能衰竭的报道。病例介绍：一名48岁女性，于2024年4月因头痛入院淄博市中心医院。脑磁共振造影（MRI）显示右侧枕叶占位性病变。进行立体定向活检以确定病变的性质。术后病理证实为DLBCL。患者接受TZM方案，其中包括Tislelizumab， MTX和Zanubrutinib。在甲氨蝶呤治疗后的第一天，患者出现全身性水肿、呼吸急促和尿量减少。实验室检查显示低氧血症、低白蛋白水平和急性肾损伤。基于这些发现，患者被诊断为CLS。为迅速降低血MTX浓度，行胸腔积液引流及持续肾替代治疗（CRRT）。治疗成功，患者康复出院。结论：慢性淋巴细胞白血病是大剂量甲氨蝶呤治疗的严重并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Chemotherapy and Pharmacology 医学-药学

CiteScore

6.10

自引率

3.30%

发文量

116

审稿时长

2.5 months

期刊介绍： Addressing a wide range of pharmacologic and oncologic concerns on both experimental and clinical levels, Cancer Chemotherapy and Pharmacology is an eminent journal in the field. The primary focus in this rapid publication medium is on new anticancer agents, their experimental screening, preclinical toxicology and pharmacology, single and combined drug administration modalities, and clinical phase I, II and III trials. It is essential reading for pharmacologists and oncologists giving results recorded in the following areas: clinical toxicology, pharmacokinetics, pharmacodynamics, drug interactions, and indications for chemotherapy in cancer treatment strategy.