TY - JOUR
T1 - Methotrexate-associated lymphoproliferative disorders
T2 - Management by watchful waiting and observation of early lymphocyte recovery after methotrexate withdrawal
AU - Inui, Yumiko
AU - Matsuoka, Hiroshi
AU - Yakushijin, Kimikazu
AU - Okamura, Atsuo
AU - Shimada, Takaki
AU - Yano, Shingo
AU - Takeuchi, Mai
AU - Ito, Mitsuhiro
AU - Murayama, Tohru
AU - Yamamoto, Katsuya
AU - Itoh, Tomoo
AU - Aiba, Keisuke
AU - Minami, Hironobu
N1 - Publisher Copyright:
© 2015 Informa UK, Ltd.
PY - 2015/11/2
Y1 - 2015/11/2
N2 - No optimum treatment of iatrogenic immunodeficiency-associated lymphoproliferative disorders due to methotrexate in patients with rheumatoid arthritis (MTX-LPD) has yet been established, although MTX withdrawal is known to have a substantial effect on tumor regression. Here, we retrospectively analyzed 20 cases of MTX-LPD. Tumor shrinkage occurred in 18 of 20 cases, but only following MTX withdrawal. This tumor regression ratio was considerably better than in previous reports, and appeared due to longer "watchful waiting." Lymphocyte recovery at 2 weeks after MTX withdrawal was significantly higher in cases with tumor regression in 1 month than in those without tumor regression (p = 0.001). Median time to maximal efficacy after MTX cessation in cases without chemotherapy was 12 weeks (range 2-76). In conclusion, watchful waiting for a longer period after MTX cessation with observation of early lymphocyte recovery and uninterrupted continuation of other anti-rheumatoid drugs may be an acceptable management plan for MTX-LPD.
AB - No optimum treatment of iatrogenic immunodeficiency-associated lymphoproliferative disorders due to methotrexate in patients with rheumatoid arthritis (MTX-LPD) has yet been established, although MTX withdrawal is known to have a substantial effect on tumor regression. Here, we retrospectively analyzed 20 cases of MTX-LPD. Tumor shrinkage occurred in 18 of 20 cases, but only following MTX withdrawal. This tumor regression ratio was considerably better than in previous reports, and appeared due to longer "watchful waiting." Lymphocyte recovery at 2 weeks after MTX withdrawal was significantly higher in cases with tumor regression in 1 month than in those without tumor regression (p = 0.001). Median time to maximal efficacy after MTX cessation in cases without chemotherapy was 12 weeks (range 2-76). In conclusion, watchful waiting for a longer period after MTX cessation with observation of early lymphocyte recovery and uninterrupted continuation of other anti-rheumatoid drugs may be an acceptable management plan for MTX-LPD.
KW - ALC recovery
KW - MTX withdrawal
KW - MTX-LPD
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U2 - 10.3109/10428194.2015.1022769
DO - 10.3109/10428194.2015.1022769
M3 - Article
C2 - 25721751
AN - SCOPUS:84947797963
SN - 1042-8194
VL - 56
SP - 3045
EP - 3051
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 11
ER -
