The clinical impact of absolute lymphocyte count in peripheral blood                    among patients with methotrexate - associated lymphoproliferative                    disorders

Michihide Tokuhira; Yuka Tanaka; Yasuyuki Takahashi; Yuta Kimura; Tatsuki Tomikawa; Tomoe Anan; Junichi Watanabe; Morihiko Sagawa; Morihiro Higashi; Shuju Momose; Koichi Amano; Takayuki Tabayashi; Reiko Nakaseko; Jun-ichi Tamaru; Masahiro Kizaki

doi:10.3960/jslrt.19039

Original Article

The clinical impact of absolute lymphocyte count in peripheral blood among patients with methotrexate - associated lymphoproliferative disorders

Michihide Tokuhira , Yuka Tanaka, Yasuyuki Takahashi, Yuta Kimura, Tatsuki Tomikawa, Tomoe Anan, Junichi Watanabe, Morihiko Sagawa, Morihiro Higashi, Shuju Momose, Koichi Amano, Takayuki Tabayashi, Reiko Nakaseko, Jun-ichi Tamaru, Masahiro Kizaki

Author information

Michihide Tokuhira Corresponding author
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Yuka Tanaka
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Yasuyuki Takahashi
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Yuta Kimura
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Tatsuki Tomikawa
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Tomoe Anan
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Junichi Watanabe
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Morihiko Sagawa
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Morihiro Higashi
Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Shuju Momose
Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Koichi Amano
Department of Immunology and Rheumatology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
Takayuki Tabayashi
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Reiko Nakaseko
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Jun-ichi Tamaru
Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,
Masahiro Kizaki
Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan,

Keywords: methotrexate, lymphoproliferative disorders, rheumatoid arthritis, relapse/regrowth, absolute leukocyte count

JOURNAL OPEN ACCESS

2020 Volume 60 Issue 2 Pages 41-50

DOI https://doi.org/10.3960/jslrt.19039

Browse “Advance online publication” version

Details

Abstract

Regressive lymphoproliferative disorders (R-LPD) after methotrexate (MTX) withdrawal are one of the specific features of methotrexate - associated lymphoproliferative disorders (MTX-LPD). Although the impact of the absolute lymphocyte count (ALC) on the pathogenesis of R-LPD has been recently emphasized, understanding relapse/regrowth events (RRE) and differences among LPD subtypes is necessary. In this study, we confirmed ALC recovery in the regressive group (R-G; R-LPD without RRE) and relapse/regrowth group (R/R-G; R-LPD with RRE). The increase in ALC lasted at least 2 years in R-G, whereas it decreased within 3 years in R/R-G, supporting the better overall survival (OS) in R-G, as previously reported. In addition, our study suggested that an ALC of 1000/µL at the time of development of LPD is a significant predictor for treatment-free survival (TFS). Furthermore, an ALC of 1000/µL at 6 months after MTX withdrawal was found to be a significant indicator of TFS and OS for R-G and R/R-G. The ALC decreased gradually before LPD development in R/R-G, whereas it decreased 6 months before LPD development in R-G, confirming the important role of ALC in the pathogenesis of MTX-LPD such as regressive events and RRE. In addition to ALC, other predictive factors, such as serum C-reactive protein and soluble interleukin-2 receptors, may be helpful in the management of MTX-LPD, including the decision making for an additional chemotherapy for regressive LPD after MTX withdrawal.

Corresponding author

Register with J-STAGE for free!