Prediction of methotrexate elimination after high dose infusion in children with acute lymphoblastic leukaemia using a population pharmacokinetic approach

1999 ◽  
Vol 13 (5) ◽  
pp. 595-604 ◽  
Author(s):  
Franck Odoul ◽  
Chantal Le Guellec ◽  
Jean-Pierre Lamagnère ◽  
Dominique Breilh ◽  
Marie-Claude Saux ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Population Pharmacokinetic ◽  
High Dose ◽  
Dose Infusion ◽  
Pharmacokinetic Approach

Case report on hypersensitivity to methotrexate infusion in a pediatric acute lymphoblastic leukaemia patient

2019 ◽  
Vol 26 (2) ◽  
pp. 462-464 ◽  
Author(s):  
Manjusha Sajith ◽  
Atmaram Pawar ◽  
Vibha Bafna ◽  
Sandip Bartakke
Keyword(s):  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
High Dose ◽  
Hypersensitivity Reactions ◽  
Cranial Radiotherapy ◽  
Cns Prophylaxis ◽  
Dose Methotrexate ◽  
Dose Infusion ◽  
Autoimmune Conditions ◽  
Leukaemia Patient

Methotrexate is extensively used in the treatment of various malignancies and autoimmune conditions. Methotrexate is associated with several toxicities, while hypersensitivity reactions to methotrexate are unusual, but have been reported in adult cancer patients. Hereby, we detail the case of a child with acute lymphoblastic leukaemia who developed a hypersensitivity reaction to high-dose methotrexate infusion (HDMTX) during the fourth cycle of HDMTX. The child was rechallenged with another brand of methotrexate; she started complaining of itching on trunk within 5 min of infusion. Few studies have reported that desensitization has been helpful in children with hypersensitivity reactions allowing the continuation of HDMTX. However, it was decided to omit parenteral methotrexate for this child. Cranial radiotherapy was given for CNS prophylaxis. In conclusion, unexpected hypersensitivity with methotrexate should be kept in mind during the treatment especially with high-dose infusion.

Nelarabine-associated myelopathy in a patient with acute lymphoblastic leukaemia: Case report

2020 ◽  
pp. 107815522092974
Author(s):  
Neus Amer-Salas ◽  
Gonzalo González-Morcillo ◽  
Juan Manuel Rodríguez-Camacho ◽  
Antonia Cladera-Serra
Keyword(s):  
Case Report ◽  
T Cell ◽  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Intrathecal Therapy ◽  
High Dose ◽  
Naranjo Algorithm ◽  
Therapeutic Doses ◽  
Upper Limb Paresis ◽  
Dose Dependent

Introduction Nelarabine is a purine analogue approved for the treatment of patients with T-cell lymphoblastic lymphoma and T-cell acute lymphoblastic leukaemia (T-ALL) that have relapsed or are refractory to two previous chemotherapy regimens. Adverse reactions to nelarabine include neurological toxicity, the pathophysiological mechanisms of which are unknown, although the administration of intrathecal therapy at therapeutic doses given concomitantly with high-dose systemic chemotherapy that crosses the blood–brain barrier may potentiate neurotoxicity. Case report We report a case of a 29-year-old woman with a diagnosis of relapsed T-ALL who developed severe myelopathy and polyneuropathy of toxic origin that led to paraplegia, upper-limb paresis, and dysautonomia after the first cycle of nelarabine. Management and outcome Rehabilitation and pharmacological treatments were initiated early, but no evidence of a significant clinical change was obtained. Discussion Neurotoxicity is a dose-dependent side effect of nelarabine. It is therefore important to consider previously administered neurotoxic drugs before using nelarabine and to monitor patients closely so as to be able to act promptly in case of toxicity. In accordance with the data obtained and based on the Naranjo algorithm, the adverse reaction could be considered possible.

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