Frontiers in Medicine最新文献

{"title":"Study of predictive factors for response to ¹⁷⁷LU-PSMA in patients with metastatic castration-resistant prostate cancer.","authors":"Hugo Peslier, Valérie Seegers, Pierre-Alban Dufour","doi":"10.3389/fmed.2025.1538507","DOIUrl":"10.3389/fmed.2025.1538507","url":null,"abstract":"<p><strong>Introduction: </strong>Metastatic castration-resistant prostate cancer (mCRPC) is an aggressive disease with a poor prognosis and few therapeutic options. In recent years, ¹⁷⁷Lu-PSMA, a novel radioligand therapy, has shown promising results in patients who have failed conventional therapies. However, around 30% of patients do not respond adequately to this treatment. In this retrospective cohort study, we examined clinical, biological, and ⁶⁸Ga-PSMA PET/CT-derived factors associated with poor treatment response.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study including 63 patients treated at ICO Angers for progressive mCRPC following Novel Hormonal Agents and taxane-based chemotherapy. The primary endpoint was early treatment discontinuation, defined as stopping therapy at or before the 4th cycle. Secondary endpoints included PSA response and overall survival.</p><p><strong>Results: </strong>A total of 63 patients were included in the study. Factors associated with early treatment discontinuation included a BMI < 25 kg/m², PSA doubling time < 2 months, hemoglobin levels <10 g/dL, albumin levels <35 g/L, lactate dehydrogenase (LDH) levels >250 IU/L and alkaline phosphatase (ALP) levels >125 IU/L. On ⁶⁸Ga-PSMA PET/CT imaging, low SUL_max, high Total Tumor Volume, and a low PSG score were also linked to early treatment discontinuation.</p><p><strong>Conclusion: </strong>This study identified several clinical, biological, and ⁶⁸Ga-PSMA PET/CT-derived factors associated with early treatment discontinuation. Patients with poor overall health, aggressive or extensive disease, or low PSMA expression are at higher risk of treatment failure.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1538507"},"PeriodicalIF":3.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transvaginal ultrasound and magnetic resonance imaging in detecting rectosigmoid deep infiltrating endometriosis: a comparative meta-analysis.","authors":"Ziwei Xu, Yisheng Li, Yingying Wang, Yiting Wan, Jing Chen","doi":"10.3389/fmed.2025.1552185","DOIUrl":"10.3389/fmed.2025.1552185","url":null,"abstract":"<p><strong>Objective: </strong>This meta-analysis aimed to assess the diagnostic efficacy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) for the detection of rectosigmoid deep infiltrating endometriosis (DIE).</p><p><strong>Methods: </strong>A thorough systematic review was performed by searching the PubMed and Embase databases for studies evaluating the diagnostic performance of TVS and MRI in rectosigmoid DIE, up until August 12, 2024. The DerSimonian and Laird approach was utilized to calculate sensitivity and specificity, with the Freeman-Tukey double arcsine transformation employed for data analysis. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.</p><p><strong>Results: </strong>The meta-analysis encompassed 10 studies involving 1,604 patients. The findings revealed that TVS had an overall sensitivity of 0.85 (95% CI: 0.76-0.92) and specificity of 0.92 (95% CI: 0.85-0.98), while MRI demonstrated a sensitivity of 0.83 (95% CI: 0.73-0.92) and specificity of 0.95 (95% CI: 0.90-0.99). Statistical analysis indicated no significant differences in sensitivity (<i>p</i> = 0.86) or specificity (<i>p</i> = 0.50) between the two imaging techniques. Additionally, the funnel plot asymmetry test did not reveal significant publication bias for any outcomes (Egger's test: all <i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>The meta-analysis reveals nearly equivalent diagnostic performance of TVS and MRI in detecting rectosigmoid DIE, with no statistical differences in sensitivity and specificity. However, high heterogeneity among studies highlights the need for further prospective research.</p><p><strong>Systematic review registration: </strong>The protocol for this meta-analysis has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the ID: CRD42024559141, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024559141.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1552185"},"PeriodicalIF":3.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the NG-Test Carba 5 for the clinical detection of carbapenemase-producing gram-negative bacteria.","authors":"Hai-Feng Qin, Jin-Ke He, Xin Chen, Ke Jiang, Xiao-Yan Cai, Xiao-Ni Wu, Lei Ye, Hao-Kai Chen, Xu-Guang Guo, Yong Xia","doi":"10.3389/fmed.2025.1512345","DOIUrl":"10.3389/fmed.2025.1512345","url":null,"abstract":"<p><strong>Background: </strong>Currently, the spread and prevalence of carbapenem-resistant gram-negative bacteria cause a worldwide health problem, significantly affecting patients' prognosis. Therefore, reliable detection of carbapenemases is crucial for managing and controlling infections. Numerous investigations have shown that the innovative immunochromatographic assay NG-Test Carba 5 has great sensitivity and specificity for carbapenemase typing. This meta-analysis aimed to comprehensively assess the efficacy of the NG-Test Carba 5 in the clinical detection of carbapenemase-producing gram-negative bacteria.</p><p><strong>Methods: </strong>Previously published articles were systematically reviewed, relevant data were extracted, and the results were pooled and analyzed using Meta-DiSk 1.4 and Stata 12.0 software.</p><p><strong>Results: </strong>The sensitivity, specificity, positive LR value, and negative LR value for the identification of carbapenemase-type KPC, NDM, VIM, IMP, and OXA-48-like by immunochromatographic NG-Test Carba 5 using PCR as gold standard were 0.97 [95% CI (0.97, 0.98)], 0.99 [95% CI (0.99, 1.00)], 65.38 [95% CI (36.73, 116.39)], and 0.03 [95% CI (0.02, 0.05)], respectively, and the combined diagnostic odds ratio was 2,734.42 [95% CI (1,464.05, 5,107.12)]. The AUC of the SROC curve was 0.9976.</p><p><strong>Conclusion: </strong>In summary, the NG-Test Carba 5 is a clinical test that can identify and quickly detect five major carbapenemases, thus offering valuable insights for clinical decision-making and infection control.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1512345"},"PeriodicalIF":3.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation quality through time in therapeutic range in Sub-Saharan Africa: a systematic review and meta-analysis.","authors":"Desalegn Getnet Demsie, Zenaw Debasu Addisu, Chernet Tafere, Kebede Feyisa, Bereket Bahiru, Malede Berihun Yismaw, Getahun Mihret, Abere Tilahun, Desye Gebrie, Derbew Fikadu Berhe","doi":"10.3389/fmed.2025.1517162","DOIUrl":"10.3389/fmed.2025.1517162","url":null,"abstract":"<p><strong>Background: </strong>The quality of anticoagulation with warfarin is often assessed through the time in therapeutic range (TTR). However, achieving optimal TTR and maintaining therapeutic INR levels presents significant challenges in Sub-Saharan Africa. This review aims to summarize the existing evidence on the quality of warfarin anticoagulation among patients in Sub-Saharan Africa.</p><p><strong>Method: </strong>We searched MEDLINE via Ovid, PubMed, Embase via Ovid, and Scopus, and citation analysis from Google Scholar. The review's primary focus was therapeutic INR and TTR ≥ 65. Meta-analysis was conducted using R version 4.3.3. A mixed-effects meta-regression model was used to examine the influence of moderators, with heterogeneity estimated using <i>I</i> ² and prediction intervals (PI), and publication bias assessed through funnel plots and Egger's test, with <i>p</i> < 0.05 indicating potential bias. The robustness of pooled proportions was tested using a leave-one-out sensitivity analysis. The preparation of this review adhered to the guidelines outlined in the PRISMA.</p><p><strong>Results: </strong>We identified 15 observational studies for inclusion in this systematic review and meta-analysis. Egger's test confirmed an absence of publication bias across these studies. Sensitivity analyses showed consistency in individual therapeutic INR (pooled estimate: 0.37; range: 0.37-0.40) and TTR (pooled estimate: 0.16; range: 0.15-0.17), closely aligning with pooled proportions. Meta-analysis of high-quality TTR measurements yielded a pooled prevalence of 17% (<i>I</i> ² = 89%), with study-specific values ranging from 10 to 29% and predicted effect sizes between 0.05 and 0.34. The therapeutic INR was observed at a pooled prevalence of 40% (<i>I</i> ² = 86%; prediction interval: 0.16, 0.67).</p><p><strong>Conclusion: </strong>Warfarin therapy is associated with very low percentage of TTR suggests poor quality of anticoagulation management. Sensitivity analyses confirmed the robustness of these findings.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1517162"},"PeriodicalIF":3.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital tranexamic acid decreases early mortality in trauma patients: a systematic review and meta-analysis.","authors":"Yi Li, Mei Tian, Wen Zhong, Jiatong Zou, Xin Duan, Haibo Si","doi":"10.3389/fmed.2025.1552271","DOIUrl":"10.3389/fmed.2025.1552271","url":null,"abstract":"<p><strong>Background: </strong>As an anti-fibrinolytic agent, tranexamic acid (TXA) is widely recognized for its efficacy in managing hemorrhagic conditions. Prehospital application of TXA has been reported in recent years, but its benefits in trauma patients remain debated.</p><p><strong>Materials and methods: </strong>A literature search was conducted across databases including PubMed, Cochrane Library, Embase, Web of Science, SCOPUS, and the Cochrane Central Register for Clinical Trials from inception to October 2024, focusing on studies related to prehospital TXA and clinical outcomes in trauma patients. The Cochrane Risk of Bias 2 Tool was applied to assess the quality of randomized control trials (RCTs), while the Newcastle-Ottawa Scale was used for observational cohort studies. Data were pooled under a random- or fixed-effects model using RevMan 5.4 with odds ratio (OR) and 95% confidence interval (CI) as the effect measures.</p><p><strong>Results: </strong>A total of 286 publications were identified from the initial database search, and 12 studies, including five RCTs and seven observational cohort studies with a total of 12,682 patients, were included. Significant early survival benefits were observed in patients receiving prehospital TXA compared to those not receiving prehospital treatment. Compared to the control group, the prehospital TXA group exhibited a significant reduction in 24-h mortality with an OR of 0.72 and a 95% CI of 0.54-0.94 (<i>p</i> = 0.02), while no statistically significant difference in the incidence of venous thromboembolism (VTE; OR: 1.14, 95% CI: 0.98-1.33, <i>p</i> = 0.09). No significant differences were observed in other outcomes, such as 28-30-day mortality, overall mortality, length of hospital stay, and the incidence of multiple organ failure (all <i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>Prehospital TXA decreases early (24-h) mortality in trauma patients without a significant increase in the risk of VTE and other complications, and further studies are still needed to improve and optimize its management strategy.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/, Identifier: CRD 42019132189.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1552271"},"PeriodicalIF":3.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing European paediatric research - the contribution of the Innovative Health Initiative.","authors":"Nathalie Seigneuret","doi":"10.3389/fmed.2025.1553448","DOIUrl":"10.3389/fmed.2025.1553448","url":null,"abstract":"<p><p>Children deserve health solutions, including medicines, medical devices and diagnostics, that are adapted to their needs. They should not be left behind when it comes to benefitting from innovations. The introduction of paediatric legislation in the EU and US in the 2000s dramatically changed the regulatory environment by fostering the development of medicines for children. However, the development of paediatric medicines remains challenging, and many needs remain unmet. When it comes to medical devices and <i>in vitro</i> diagnostics (IVDs), very few are designed and intended specifically for use in children, leading doctors to use adult devices and adapt them to fit children. To address the scientific, technical, and operational challenges related to paediatric development, multi-stakeholder collaboration is key. The European public-private partnerships the Innovative Health Initiative (IHI), and its predecessor the Innovative Medicines Initiative (IMI), contribute to advancing paediatric research by bringing together the private health industry sectors and public partners including academia, healthcare providers, patients and carers, regulators, and health technology assessment bodies. Several of their large collaborative research projects have already produced significant results that are optimising the development of paediatric medicines. This article looks at these achievements and discusses opportunities for further public-private collaborative research to boost the development of innovative health solutions that address specifically all children's needs.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1553448"},"PeriodicalIF":3.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing pathogenic variants in mismatch repair genes: personalized prevention strategies for lynch syndrome in Chinese families.","authors":"Xiufang Wang, Haichun Ni, Lin Zhu, Hui Huang, Aiping Deng, Jifa Hu, Wei Cai, Juyi Li","doi":"10.3389/fmed.2025.1527249","DOIUrl":"10.3389/fmed.2025.1527249","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to analyze the pathogenic variants in one family with colorectal cancer and another with endometrial cancer and provide appropriate personalized prevention strategies for carriers of these genetic mutations.</p><p><strong>Methods: </strong>One proband with colorectal cancer and another with endometrial cancer and their family members were enrolled in this study. Whole-exome sequencing was used to identify pathogenic gene mutations in both families. We compared the structural difference between the wild-type and mutant MSH2 proteins using SWISS-MODEL and PyMOL visualization software.</p><p><strong>Results: </strong>We identified one novel mutation (NM_000251.2:c.1486delT:p.L496*) in the <i>MSH2</i> gene in Family I and a known mutation (NM_001258271.1:c.884 + 4A > G) in the <i>MLH1</i> gene in Family II. The novel mutation (NM_000251.2:c.1486delT:p.L496*) caused a stop gain mutation, resulting in the absence of amino acids 496-934 in the mutant MSH2 protein. This led to the loss of Domain 5 and alterations in the sequences of Domain 3 and Domain 4 regions, resulting in premature termination of MSH2 protein coding. The known mutation (NM_001258271.1:c.884 + 4A > G) in <i>MLH1</i> causes the skipping of exon 10, producing a truncated protein and undergoing nonsense-mediated decay based on literature reports. Thus, 5-fluorouracil-based adjuvant chemotherapy is not recommended for patients with lynch syndrome.</p><p><strong>Conclusion: </strong>The novel stop gain mutant (NM_000251.2:c.1486delT:p.L496*) in <i>MSH2</i> is deemed pathogenic for LS, and the mutant (NM_001258271.1:c.884 + 4A > G) in <i>MLH1</i> has been further confirmed to be pathogenic. These findings expand the spectrum of mismatch repair gene variations in the ethnic group Han of China and reaffirm the importance of genetic testing for LS.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1527249"},"PeriodicalIF":3.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy of transcatheter arterial chemoembolization for hepatocellular carcinoma: is the alteration of the inflammation index important?","authors":"Chao Luo, Hua Xiang, Jie Tan","doi":"10.3389/fmed.2025.1543903","DOIUrl":"10.3389/fmed.2025.1543903","url":null,"abstract":"<p><strong>Introduction: </strong>Transcatheter arterial chemoembolization (TACE) is widely applied for locoregional malignant lesions control in intermediate and selected advanced hepatocellular carcinoma (HCC). Various inflammation indices, such as neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammatory index (SII), and Lymphocyte-to-C Reactive Protein Ratio (LCR) have been explored as tools for predicting the efficacy of TACE. However, the role and predictive value for dynamic changes of peripheral inflammatory indicators pre- and post-TACE remains unclear.</p><p><strong>Objective: </strong>To explore the association between the alteration in inflammatory index and the efficacy and prognosis of TACE and to provide more evidence for early prediction of the efficacy of TACE.</p><p><strong>Methods: </strong>This was a retrospective single-center study. HCC patients who received TACE as initial treatment were enrolled. The relationship between the alteration of inflammation indices (calculated as post-TACE minus pre-TACE measurements) and TACE efficacy and prognosis was investigated. Progression-free survival (PFS) was the primary endpoint, and treatment efficacy was evaluated based on mRECIST criteria.</p><p><strong>Results: </strong>Before propensity score matching (PSM), the change in LMR was significantly associated with treatment effective rate, with the unelevated ΔLMR group achieving a 79.4% treatment effective rate compared to 36.4% in the elevated group (<i>p</i> < 0.001). The estimated median PFS was 9.7 months and 4.5 months in the unelevated and elevated group, with a significant difference (<i>p</i> = 0.016). After PSM, the treatment effective rate was 48.7 and 38.5% (<i>p</i> = 0.214), and the estimated median PFS was 8.9 and 5.5 months (<i>p</i> = 0.173) for the unelevated and elevated group, respectively.</p><p><strong>Conclusion: </strong>Our study demonstrated that alteration of indices of peripheral inflammation, including ΔNLR, ΔLMR, ΔSII, and ΔPLR, may not be valuable prognostic markers for HCC patients who received TACE.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1543903"},"PeriodicalIF":3.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding vitiligo through the eyes of a typical patient in the U.S.","authors":"Yan Valle, Torello Lotti, Julia Sigova","doi":"10.3389/fmed.2025.1511344","DOIUrl":"10.3389/fmed.2025.1511344","url":null,"abstract":"","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1511344"},"PeriodicalIF":3.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-flux hemodialysis as rescue therapy for high-dose methotrexate toxicity: case series and clinical insights.","authors":"Ana Carolina Nakamura Tome, Karise Fernades Santos, Emerson Quintino Lima, Rodrigo Jose Ramalho","doi":"10.3389/fmed.2025.1495705","DOIUrl":"10.3389/fmed.2025.1495705","url":null,"abstract":"<p><p>High-dose methotrexate (HD-MTX) toxicity represents a significant clinical challenge in oncology, commonly resulting in acute kidney injury (AKI), myelosuppression, and potentially life-threatening multiorgan failure. This case series describes three patients treated at Hospital de Base in São José do Rio Preto, Brazil, who developed HD-MTX-induced AKI following the administration of chemotherapy. Two patients had hematologic malignancies and one had osteosarcoma. All received conventional rescue therapies, including leucovorin and aggressive hydration, but demonstrated persistent elevation of serum methotrexate levels, necessitating the initiation of high-flux hemodialysis (HF-HD). The mean number of HF-HD sessions required was 5.3 ± 2.5, and the mean relative reduction in serum methotrexate concentration was 44.5 ± 19.1%. These findings suggest that HF-HD is an effective therapeutic option for HD-MTX toxicity management in settings where glucarpidase is not readily available, although repeated sessions may be required due to the observed rebound in serum methotrexate levels.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1495705"},"PeriodicalIF":3.1,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}