Characteristics of Histopathology and Clinical Course of 19 Cases That Developed a Lymphoproliferative Disease (LPD) during Methotrexate (MTX) Treatment.

Noriyuki HAYASHI¹, Kae HAMAMOTO², Kouichiro YODA², Maki YODA², Shinsuke YAMADA³, Hitoshi GOTO² and Masaaki INABA², ¹Rheumatology, Osaka City University Graduate School of Medicine, Osaka, Japan, ²Second Department of Internal Medicine, Osaka City University Medical School, Osaka, Japan, ³Rheumatology, Osaka City University Graduate School of Midicine, Osaka, Japan

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Lymph node, methotrexate (MTX) and viruses

Session Information

Date: Tuesday, November 10, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster Session III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

We examined the clinical features of the cases after discontinuation or decrease of dosage of MTX in the MTX-LPD.

Methods:

We retrospectively examined a patient background, a clinical presentation, a histopathology, and clinical course in 19 patients of Osaka City University Hospital rheumatology clinic from 2006 through 2014.

Results:

These cases were average age 64.5 y.o. (37-81), 3 male/16 female , 8.1 mg/week of MTX average dosage, 1,510 mg (312-6110 mg) of MTX average total doses, and mean DAS28(CRP) of 3.65 (2.3-5.46) at the MTX-LPD onset.

Lymph node biopsy performed in 16 patients showed reactive lymphadenopathy syndrome 6, Diffuse large B-cell lymphoma (DLBCL) 5, Hodgkin’s lymphoma 3, primary effusion lymphoma (PEL) 1, and non-specific Peripheral T-cell lymphoma 1. Epstein-Barr virus (EBV) DNA in blood specimen was examined in 4 cases resulting 2 positive, 2 negative.

16 cases improved by discontinuation of MTX spontaneously, but 3 cases required chemotherapy. It is reported that MTX-LPD often showed EBV-positive in histopathology, and the pathological type of EBV-positive LPD could show both the B-cell and the T-cells. One of 16 patients which performed lymph node biopsy was diagnosed T-cell lymphoma, and EBV was proved even in this case histologically. This case also improved spontaneously after discontinuation of MTX. The mechanism is not revealed, but the EBV infects both B-cells and T-cells.

Conclusion:

There was no difference in the ratio of the histopathology compared with malignant lymphoma besides iatrogenic immunodeficiency-associated lymphproliferative disorders. Contribution of the EBV infection is suggested in MTX-LPD development. In this study, it is suggested that the mechanism is applicable in T-cell lymphoma, although all cases are not EBV-positive in histopathology. Further study is necessary on revealing the mechanism of pathogenesis of MTX-LPD, and EBV infection to T-cells.

Disclosure: N. HAYASHI, None; K. HAMAMOTO, None; K. YODA, None; M. YODA, None; S. YAMADA, None; H. GOTO, None; M. INABA, None.

To cite this abstract in AMA style:

HAYASHI N, HAMAMOTO K, YODA K, YODA M, YAMADA S, GOTO H, INABA M. Characteristics of Histopathology and Clinical Course of 19 Cases That Developed a Lymphoproliferative Disease (LPD) during Methotrexate (MTX) Treatment. [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/characteristics-of-histopathology-and-clinical-course-of-19-cases-that-developed-a-lymphoproliferative-disease-lpd-during-methotrexate-mtx-treatment/. Accessed .

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