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Medline ® Abstract for Reference 217

of 'Infusion reactions to systemic chemotherapy'

Readministration of high-dose methotrexate in a patient with suspected immediate hypersensitivity and T-cell acute lymphoblastic lymphoma.
Kohli A, Ferencz TM, Calderon JG
Allergy Asthma Proc. 2004;25(4):249.
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.
Section of Allergy and Clinical Immunology, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut 06520-8013, USA.