BURKİTT LENFOMALI HASTADA METOTREXAT’A BAĞLI HİPERSENSİTİVİTE REAKSİYONUNDA BAŞARILI DESENSİTİZASYON
Giriş: Methotrexate, otoimmün hastalıklarda ve kanser tedavisinde sıklıkla kullanılan anti- neoplastik bir ilaçtır. Yüksek doz Methotrexate’a bağlı yan etkiler sık görülmesine karşın hipersensitivite reaksiyonları nadirdir. Olgu: 46 yaşındaki erkek hasta kliniğimize deride kaşıntı, kızarıklık nedeniyle başvurdu. Burkitt Lenfoma tanısı mevcut olan hastanın Methotrexate uygulandıktan sonra bu şikayetlerinin ortaya çıktığı tespit edildi. Hastalığın tedavisi için bu ilaca devam edilmesi gerektiği bildirildi. Hipersensitivite reaksiyonları geliştikten sonra aynı ilacın kullanımı riskli olduğu için Methotrexate desensitizasyon yapılarak verildi. Hızlı desensitizasyon protokolü uygulanarak Methotrexate’in tolere edilmesi sağlandı. Sonuç: Uyguladığımız desensitizasyon protokolü ile hasta kemoterapisini sorunsuz bir şekilde tamamladı. Bu protokol Methotrexate’a bağlı anaflaktik/anaflaktoid reaksiyonlarda etkili ve güvenlidir.
SUCCESSFUL DESENSITIZATION IN HYPERSENSITIVITY REACTION DUE TO METHOTREXATE IN A PATIENT WITH BURKITT LYMPHOMA
ntroduction: Methotrexate is an anti-neoplastic drug that is frequently used in autoimmune diseases and cancer treatment. Although side effects due to high dose Mtx are common, hypersensitivity reactions are rare. Case: A 46-year-old male patient was admitted to our clinic because of itching and rash. It was found that the patient with the diagnosis of Burkitt Lymphoma had these complaints after Methotrexate application. It was reported that this drug should be continued for the treatment of the disease. Since the use of the same drug is hazardous after the development of hypersensitivity reactions, Methotrexate was given by desensitization. Methotrexate was tolerated by applying rapid desensitization protocol. Conclusion: The patient completed the chemotherapy without any problem with the desensitization protocol we applied. This protocol is effective and safe in anaphylactic / anaphylactoid reactions due to Methotrexate.
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- 1. al-Lamki Z, Thomas E, el-Banna N, Jaffe N. Acute urticaria and hepatitis complicating high-dose methotrexate therapy. Med Pediatr Oncol 1995; 24(2): 137-40.
- 2. Haykin ME, Gorman M, van Hoff J, Fulbright RK, Baehring JM. Diffusion-weighted MRI correlates of subacute methotrexaterelated neurotoxicity. J Neurooncol 2006; 76 (2): 153–7.
- 3. Elkiran ET, Altundag K, Aksoy S, Onal IK, Tekuzman G. Systemic anaphylactic reaction following intrathecal administration of methotrexate in adult patient with primary central nervous system lymphoma. Am J Hematol 2004; 75 (4): 265.
- 4. Davis KA, Williams P, Walker JC. Successful desensitization to high-dose methotrexate after systemic anaphylaxis. Annals of Allergy, Asthma & Immunology 2003; 90 (1): 87–9.
- 5. Ozguven AA, Uysal K, Gunes D, Koroglu T, Gurcu O, Olgun N. Delayed renal excretion of methotrexate after a severe anaphylactic reaction to methotrexate in a child with osteosarcoma. Journal of Pediatric Hematology/oncology 2009; 31(4):289–91.
- 6. Mac Ginnitie AJ, Walensky LD, Turvey SE, Orange JS, Bonilla FA, Silverman LB et al. Management of an anaphylactoid reaction to methotrexate with a stepwise graded challenge. Pediatr Allergy Immunol 2003; 14 (5): 409–11.
- 7. Alkins SA, Byrd JC, Morgan SK, Ward FT, Weiss RB. Anaphylactoid reactions to methotrexate. Cancer 1996; 77 (10): 2123–6.
- 8. Recker DP, Minor JR, Miller FW. Successful prevention of an anaphylactoid reaction to high-dose methotrexate. DICP 1989; 23 (12): 1032.
- 9. Caldeira T, Costa V, Silva I, Oliva T, et al. Anaphylactoid reaction to highdose methotrexate and re-administration after a successful desensitization. Pediatr Hematol Oncol 2008; 25(2): 131–4.
- 10. Von Stackelberg A, Hartmann R, Bührer C, Fengler R, Janka-Schaub G, Reiter A et al. High-dose compared with intermediate-dose methoterxate in children with a first relapse of acute lymphoblastic leukemia. Blood 2008; 111(5): 2573– 80.