Protocole de désensibilisation dans le cas d’une allergie au méthotrexate utilisé à hautes doses
Bibliographic record
Abstract
Resume Objectif : Illustrer le cas d’un patient ayant presente une reaction allergique importante au methotrexate utilise a hautes doses et detailler la prise en charge medicale effectuee pour poursuivre ce traitement de premier recours en vue de soigner son osteosarcome. Resume du cas : Le cas presente est celui d’un patient âge de 14 ans atteint d’un osteosarcome du femur distal droit avec des metastases pulmonaires. Le traitement qu’il recoit est un protocole du Children Oncology Group, le AOST0331, qui inclut l’administration de methotrexate a une dose de 12 g/m2. Lors de la perfusion de la premiere dose de methotrexate, il a presente une reaction allergique importante. Une reaction similaire s’est produite lors de la deuxieme dose malgre l’administration de premedication. Une allergie au methotrexate a donc ete constatee, et un protocole de desensibilisation a du etre elabore pour pouvoir poursuivre le traitement. Discussion : Peu de rapports de cas d’allergie au methotrexate sont disponibles dans la litterature medicale. Les strategies employees dans ces cas sont variees : administration de premedication, administration de doses croissantes ou augmentation du temps de perfusion du methotrexate. Ces donnees limitees n’ont pas permis l’elaboration d’un consensus sur la conduite a adopter dans ces situations. Conclusion : La strategie de desensibilisation qui a ete adoptee pour ce patient semble avoir ete efficace et lui a permis de recevoir le traitement de methotrexate au complet. Abstract Objective: To discuss a patient presenting with an important allergic reaction to high-dose methotrexate and to outline medical management to continue first-line treatment for osteosarcoma. Case summary: A 14-year old patient with osteosarcoma of the right distal femur with lung metastases was admitted to the hospital. The treatment received was AOST0331 protocol from the Children’s Oncology Group which included the administration of methotrexate at a dose of 12 g/m2. The patient had a significant allergic reaction during the infusion of the first dose of methotrexate. A similar reaction occurred during the second dose despite the use of premedication. An allergy to methotrexate was confirmed and a desensitization protocol was developed. Discussion: Few case reports of allergic reactions to methotrexate have been reported in the literature. In these cases, different approaches have been used, including the administration of pre-medications, administering increasing doses, or increasing the length of the infusion of methotrexate. Conclusion: Desensitization strategy used for this patient was effective, thus allowing the patient to receive his complete course of methotrexate. Key words: Allergy, anaphylaxis, desensitization, methotrexate, osteosarcoma
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.034 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.025 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".