title: Readministration of high-dose methotrexate in a patient with suspected immediate hypersensitivity and T-cell acute lymphoblastic lymphoma.
abstract: There is a paucity of literature addressing the management of methotrexate (MTX) hypersensitivity. We developed a high-dose MTX readministration protocol based on a modified, prolonged carboplatin desensitization protocol. Over 1.5 hours, 1/1000 of the total intravenous dose was administered followed by 1/100 over 1.5 hours, 1/10 over 6 hours, and the rest of the full dose over 24 hours. MTX readministration was successfully tolerated on three occasions in a 17-year-old male patient with T-cell acute lymphoblastic lymphoma and a history of urticarial reactions to MTX. This high-dose MTX readministration protocol may be valuable for treating patients with T-cell acute lymphoblastic lymphoma and suspected immediate MTX hypersensitivity.
authors.affiliation: Section of Allergy and Clinical Immunology, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut 06520-8013, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Kohli
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Ferencz
authors.forename: Jose G
authors.initials: JG
authors.lastname: Calderon
mesh_terms: D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D003888:Desensitization, Immunologic / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004342:Drug Hypersensitivity / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D014581:Urticaria / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate