Anaphylaxis during the first course of high-dose methotrexate: a case report and literature review

Pugi, Alessandra; Benemei, Silvia; Vietri, Michele; Tondo, Annalisa; Calvani, Anna Maria; Mugelli, Alessandro; Vannacci, Alfredo; Lapi, Francesco

doi:10.1111/j.1365-2710.2011.01275.x

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…The reference lists of the included studies were screened for additional potentially eligible articles. In total, 58 manuscripts with 336 cases were identified [6] , [7] , [8] , [9] , [11] , [12] , [13] , [14] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] . Follow-up information was available for 140 patients ( Fig.…”

Section: Methodsmentioning

confidence: 99%

Clarifying prognostic factors of small cell osteosarcoma: A pooled analysis of 20 cases and the literature

Zhong

et al. 2020

Journal of Bone Oncology

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Introduction Small cell osteosarcoma (SCOS) is a rare subtype of osteosarcoma, with limited studies mainly focusing on histological features. Our study aims to analyze our own patients and those reported in the literature to increase the recognition of this rare disease, to evaluate patient survival and to further determine potential prognostic factors. Material and methods Twenty patients with SCOS were treated in our hospital between 2010 and 2019. Their follow-up data were collected retrospectively. A total of 336 literature cases from 58 manuscripts were retrieved by means of a PubMed search with the key word “small cell osteosarcoma”. Data pertaining to treatment and follow-up were extracted. We performed a pooled analysis for the survival of patients and the risk factors for local recurrence (LR), as well as metastatic disease (MD), in a total of 160 patients using the Kaplan-Meier method and Cox regression method. Results We reported our experience in diagnosing and treating SCOS. In our cases, elevated alkaline phosphatase (P = 0.013) and lactate dehydrogenase (P = 0.001) significantly impaired overall survival. In the pooled analysis, SCOS was diagnosed at the median age of 17 years and affected both sexes almost equally. The median follow-up duration was 19.5 months. In the pooled analysis cases, the 5-year overall survival rate was 38.6%, and 36.4% of patients survived 10 years. However, an increasing trend was detected, indicating recent improvements in management. The surgical margin status (P = 0.024) and metastases (P = 0.008) significantly impaired overall survival, and the response to chemotherapy was related to disease-free survival (P = 0.012). LR and MD were significantly correlated (P = 0.002) and could be observed after 5 years of follow-up. LR was significantly dependent on response to chemotherapy (P = 0.020). The development of MD seemed to be affected by response to chemotherapy (P = 0.060). Correlations between imaging features and prognosis were not detected. Conclusions This study suggested that positive margins, poor response to chemotherapy and MD are negative prognostic factors for SCOS, implied the potential role of laboratory examinations in the survival prediction and supported the need for prolonged or more intensive surveillance in patients with MD or LR. More well-documented literatures are encouraged to allow further confirmations.

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Section: Methodsmentioning

confidence: 99%

Clarifying prognostic factors of small cell osteosarcoma: A pooled analysis of 20 cases and the literature

Zhong

et al. 2020

Journal of Bone Oncology

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“…Methotrexate is an antifolate drug which is nearly insoluble in water, is effective in the treatment of a range of malignant and autoimmune diseases, 28 and was selected as the drug model in this study. The drug was micronized by SEDS, suspended in a PLLA-PEG-PLLA solution containing dichloromethane, and microencapsulated by PLLA-PEG-PLLA via SpEDS.…”

Section: Introductionmentioning

confidence: 99%

Formation of methotrexate-PLLA-PEG-PLLA composite microspheres by microencapsulation through a process of suspension-enhanced dispersion by supercritical CO2

Chen¹,

Wang²,

Wang³

et al. 2012

IJN

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Background:The aim of this study was to improve the drug loading, encapsulation efficiency, and sustained-release properties of supercritical CO 2 -based drug-loaded polymer carriers via a process of suspension-enhanced dispersion by supercritical CO 2 (SpEDS), which is an advanced version of solution-enhanced dispersion by supercritical CO 2 (SEDS). Methods: Methotrexate nanoparticles were successfully microencapsulated into poly (L-lactide)-poly(ethylene glycol)-poly(L-lactide) (PLLA-PEG-PLLA) by SpEDS. Methotrexate nanoparticles were first prepared by SEDS, then suspended in PLLA-PEG-PLLA solution, and finally microencapsulated into PLLA-PEG-PLLA via SpEDS, where an "injector" was utilized in the suspension delivery system. Results: After microencapsulation, the composite methotrexate (MTX)-PLLA-PEG-PLLA microspheres obtained had a mean particle size of 545 nm, drug loading of 13.7%, and an encapsulation efficiency of 39.2%. After an initial burst release, with around 65% of the total methotrexate being released in the first 3 hours, the MTX-PLLA-PEG-PLLA microspheres released methotrexate in a sustained manner, with 85% of the total methotrexate dose released within 23 hours and nearly 100% within 144 hours. Conclusion: Compared with a parallel study of the coprecipitation process, microencapsulation using SpEDS offered greater potential to manufacture drug-loaded polymer microspheres for a drug delivery system.

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“…2 As reações surgem habitualmente após várias administrações, embora estejam descritas reações graves com a administração da primeira dose de metotrexato. 21,23,24 Os testes cutâneos são frequentemente negativos e não são indicados nem realizados por rotina. 2 A abordagem descrita nos relatos de casos de hipersensibilidade ao metotrexato inclui a exclusão deste fármaco do protocolo terapêutico, embora com potencial limitação do sucesso terapêutico, a readministração após pré-medicação (anti-histamínico, corticosteroide, antagonistas dos recetores dos leucotrienos) e o recurso a protocolos de dessensibilização.…”

Section: Metotrexatounclassified

Reações de Hipersensibilidade a Citostáticos em Idade Pediátrica

Castro

Morais‐Almeida

2018

Gaz Med

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As reações de hipersensibilidade a antineoplásicos podem variar entre reações ligeiras a reações anafiláticas fatais e podem ser desencadeadas virtualmente por qualquer citostático. Na ausência de uma alternativa viável, a dessen-sibilização pode ser a única forma de prosseguir a terapêutica. Pretendeu-se com este artigo rever a literatura inde-xada publicada sobre este tema, de modo a caracterizar as reações de hipersensibilidade associadas aos fármacos citostáticos mais frequentemente utilizados em idade pediátrica e a sua abordagem.

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Anaphylaxis during the first course of high-dose methotrexate: a case report and literature review

Abstract: Given that this reaction has rarely been reported, we discuss the present case with a review of other similar cases. Further studies are needed to substantiate this 'signal alarm' for serious MTX-related hypersensitivity reactions.

Cited by 8 publications

References 14 publications

Clarifying prognostic factors of small cell osteosarcoma: A pooled analysis of 20 cases and the literature

Clarifying prognostic factors of small cell osteosarcoma: A pooled analysis of 20 cases and the literature

Formation of methotrexate-PLLA-PEG-PLLA composite microspheres by microencapsulation through a process of suspension-enhanced dispersion by supercritical CO2

Reações de Hipersensibilidade a Citostáticos em Idade Pediátrica

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