Abstract
OBJECTIVES: Patients with methotrexate-associated lymphoproliferative disorders (MTX-LPD) treated in our rheumatology department were studied to investigate unresolved problems.
METHODS: The medical records of 27 patients with MTX-LPD diagnosed from 2005 to 2015 were investigated..
RESULTS: The occurrence of LPD increased since 2011, when the maximum dose of MTX was approved, increasing from 8 to 16 mg/week. The detected lesions were lymph node (n = 8), extranodal organ (n = 5), and both (n = 14). In the histopathological examination (total 25 cases), 13 cases of diffuse large B-cell lymphoma and 6 cases of Hodgkin’s lymphoma were identified. EBER-ISH test was positive in 9 out of 11 patients tested. sIL-2R value at LPD onset was 8047 ± 10496 U/ml (n=24), which was higher as the clinical stage advanced. Patients with good prognosis, who achieved remission only by discontinuation of MTX and whose LPD did not recur, had a significantly lower sIL-2R value than the patients with other clinical courses. Fourteen out of 27 patients achieved remission with just cessation of MTX, but 5 of them had relapsed. Exacerbation of RA was observed in 18 out of 26 patients. Five patients received biological agents, and one of them showed recurrence of LPD. There were 7 cases of LPD relapse from 18 patients with RA exacerbation, whereas only a case from 8 patients without RA exacerbation..
CONCLUSIONS:The development of MTX-LPD is related to MTX dose and EB virus. Furthermore, sIL-2R value at LPD onset is useful for the prognostic prediction of MTX-LPD and recurrence of LPD is often seen after RA exacerbation.
