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May 2, 1966

Methotrexate in Leukemia Intramuscularly

JAMA. 1966;196(5):460. doi:10.1001/jama.1966.03100180132055

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To the Editor:—  We wish to report our experience with intramuscular use of methotrexate in the treatment of acute leukemia as originally reported by the Acute Leukemia Group B (JAMA194:75, 1965). We have been struck by the high incidence of severe toxic symptoms in the patients we have treated with the recommended dosage of 30 mg/ sq m twice weekly. We have so treated seven cases, in all of which complete remission was obtained. In six of these, toxic manifestations serious enough to necessitate cessation of therapy or significant reduction of dosage have developed.The major symptom has been severe oral ulceration of a much more extensive and disabling variety than we have ever seen with conventional doses of methotrexate by mouth. These lesions are very large, with serpiginous borders and marked edema and erythema of adjacent tissues. We have also seen, in conjunction with oral ulcerations, distressing

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