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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
High-dose methotrexate (HD-MTX) is a cornerstone in the treatment of hematologic malignancies and certain solid tumors, including osteosarcoma and germ cell tumors. However, HD-MTX can cause acute kidney injury (AKI) and delayed MTX clearance, leading to severe systemic toxicity. Glucarpidase (carboxypeptidase G2) is an enzymatic rescue therapy that rapidly hydrolyzes MTX into inactive metabolites. This systematic review aimed to evaluate the impact of glucarpidase on renal recovery and clinical outcomes in patients with HD-MTX–induced AKI or delayed MTX elimination.
A comprehensive search of PubMed, PMC and Scopus up to October 2025 was conducted to identify clinical studies of adults receiving HD-MTX for lymphoma, leukemia, CNS malignancies, osteosarcoma or germ cell tumours who developed AKI or delayed MTX elimination. Eligible designs included cohort studies, clinical trials, and target trial emulations. AKI was predominantly defined using KDIGO or AKIN criteria, with renal recovery defined as improvement of serum creatinine to CTCAE grade 0–1 or near-baseline values. Data on MTX clearance, renal recovery, adverse events, and mortality were extracted and qualitatively synthesized due to heterogeneity across study designs and populations.
Nine studies (four cohorts, four clinical trials, and one target trial emulation) involving 3,179 patients were included. Glucarpidase doses (1,000–2,000 U or 50 U/kg) were typically administered within 24–72 hours after HD-MTX. Across studies, rapid MTX reduction (≥95%) occurred within 15–30 minutes, even with lower doses. Renal recovery (improvement of serum creatinine from CTCAE grade ≥2 to 0–1) was achieved in 64–93% of evaluable patients, with faster recovery in younger populations. Cohort data showed comparable recovery between glucarpidase and non-glucarpidase groups despite greater initial AKI severity in the treated cohort. Trials demonstrated sustained MTX reduction, minimal rebound, and favorable safety, while the target trial emulation suggested improved kidney recovery (OR 2.7, 95% CI 1.7–4.3) and reduced systemic toxicities. Most studies reported normalization or improvement of serum creatinine within 2–4 weeks after glucarpidase, with limited rebound in MTX levels. Adverse events were infrequent and mild, and no MTX-related deaths were reported.
Glucarpidase provides rapid enzymatic reduction of MTX levels and facilitates renal function recovery in patients with HD-MTX–induced AKI. Its early use supports renal recovery, minimizes systemic toxicity, and allows safe continuation of chemotherapy. Further prospective studies are warranted to optimize timing, patient selection, and integration with renal replacement therapy in MTX-associated nephrotoxicity.
