Methotrexate-associated lymphoproliferative disorders: Management by watchful waiting and observation of early lymphocyte recovery after methotrexate withdrawal

Yumiko Inui, Hiroshi Matsuoka, Kimikazu Yakushijin, Atsuo Okamura, Takaki Shimada, Shingo Yano, Mai Takeuchi, Mitsuhiro Ito, Tohru Murayama, Katsuya Yamamoto, Tomoo Itoh, Keisuke Aiba, Hironobu Minami

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)3045-3051
Number of pages7
JournalLeukemia and Lymphoma
Volume56
Issue number11
DOIs
Publication statusPublished - Nov 2 2015
Externally publishedYes

Fingerprint

Watchful Waiting
Lymphoproliferative Disorders
Methotrexate
Observation
Lymphocytes
Neoplasms
Rheumatoid Arthritis
Drug Therapy
Pharmaceutical Preparations

Keywords

  • ALC recovery
  • MTX withdrawal
  • MTX-LPD

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Methotrexate-associated lymphoproliferative disorders : Management by watchful waiting and observation of early lymphocyte recovery after methotrexate withdrawal. / Inui, Yumiko; Matsuoka, Hiroshi; Yakushijin, Kimikazu; Okamura, Atsuo; Shimada, Takaki; Yano, Shingo; Takeuchi, Mai; Ito, Mitsuhiro; Murayama, Tohru; Yamamoto, Katsuya; Itoh, Tomoo; Aiba, Keisuke; Minami, Hironobu.

In: Leukemia and Lymphoma, Vol. 56, No. 11, 02.11.2015, p. 3045-3051.

Research output: Contribution to journalArticle

Inui, Y, Matsuoka, H, Yakushijin, K, Okamura, A, Shimada, T, Yano, S, Takeuchi, M, Ito, M, Murayama, T, Yamamoto, K, Itoh, T, Aiba, K & Minami, H 2015, 'Methotrexate-associated lymphoproliferative disorders: Management by watchful waiting and observation of early lymphocyte recovery after methotrexate withdrawal', Leukemia and Lymphoma, vol. 56, no. 11, pp. 3045-3051. https://doi.org/10.3109/10428194.2015.1022769
Inui, Yumiko ; Matsuoka, Hiroshi ; Yakushijin, Kimikazu ; Okamura, Atsuo ; Shimada, Takaki ; Yano, Shingo ; Takeuchi, Mai ; Ito, Mitsuhiro ; Murayama, Tohru ; Yamamoto, Katsuya ; Itoh, Tomoo ; Aiba, Keisuke ; Minami, Hironobu. / Methotrexate-associated lymphoproliferative disorders : Management by watchful waiting and observation of early lymphocyte recovery after methotrexate withdrawal. In: Leukemia and Lymphoma. 2015 ; Vol. 56, No. 11. pp. 3045-3051.
@article{b287aedbc2404df9b5363c3e387952da,
title = "Methotrexate-associated lymphoproliferative disorders: Management by watchful waiting and observation of early lymphocyte recovery after methotrexate withdrawal",
abstract = "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.",
keywords = "ALC recovery, MTX withdrawal, MTX-LPD",
author = "Yumiko Inui and Hiroshi Matsuoka and Kimikazu Yakushijin and Atsuo Okamura and Takaki Shimada and Shingo Yano and Mai Takeuchi and Mitsuhiro Ito and Tohru Murayama and Katsuya Yamamoto and Tomoo Itoh and Keisuke Aiba and Hironobu Minami",
year = "2015",
month = "11",
day = "2",
doi = "10.3109/10428194.2015.1022769",
language = "English",
volume = "56",
pages = "3045--3051",
journal = "Leukemia and Lymphoma",
issn = "1042-8194",
publisher = "Informa Healthcare",
number = "11",

}

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

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

UR - http://www.scopus.com/inward/record.url?scp=84947797963&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84947797963&partnerID=8YFLogxK

U2 - 10.3109/10428194.2015.1022769

DO - 10.3109/10428194.2015.1022769

M3 - Article

C2 - 25721751

AN - SCOPUS:84947797963

VL - 56

SP - 3045

EP - 3051

JO - Leukemia and Lymphoma

JF - Leukemia and Lymphoma

SN - 1042-8194

IS - 11

ER -