ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2364

Multi-center Analyses on 518 Cases with Rheumatoid Arthritis Developing Lymphoproliferative Disorders (RA-LPD): The Prognostic Factors and the Influence of Anti-rheumatic Drugs on LPD Development

Yoshihiko Hoshida1, Shiro Ohshima 2, Yukihiko Saeki 3, Masao Katayama 4, Tomoya Miyamura 5, Atsuahi Hashimoto 6, Shinji Higa 7, Hisaji Oshima 8, Masato Yagita 9, Yasushi Hiramatsu 10, Norie Yoshikawa 11, Akiko Mitsuo 12, Akira Okamoto 13, Noriyuki Chiba 14, Takao Sugiyama 15, Shouhei Nagaoka 16, Shoji Sugii 17, Keigo Setoguchi 18, Asami Abe 19, Toshiaki Sugaya 20, Masahiro Koseto 21, Yasuo Kunugiza 22, Ryousuke Yoshihara 23, Shinichiro Tsunoda 24, Tomoaki Fujisaki 25, Hiroshi Furukawa 26, Kazuyoshi Saito 27, Kiyoshi Matsui 28, Yasuhiko Tomita 29 and Shigeto Tohma 30, 1National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Osaka, Japan, 2NHO Osaka Minami Medical Canter, Kawachinagano, Osaka, Japan, 3NHO Osaka Minami Medical Center, Kawachinagano, Osaka, Japan, 4National Hospital Organization Nagoya Medical Center, Nagoya, Japan, 5NHO Kyusyu Medical Center, Fukuoka, Japan, 6NHO Sagamihara Hospital, Sagamihara, Japan, 7Osaka Second Police Hospital, Osaka, Japan, 8NHO Tokyo Medical Hospital, Tokyo, Japan, 9Kitano Hospital, Osaka, Japan, 10Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo, Japan, 11NHO Miyakonojo Medical Center, Miyakonojo, Miyazaki, Japan, 12NHO Disaster Medical Center, Tokyo, Tokyo, Japan, 13National Hospital Organization HImeji Medical Center, Himeji, Hyogo, Japan, 14National Hospital Organization Morioka Medical Center, Morioka, Iwate, Japan, 15NHO Shimoshizu Hospital, Chiba, Chiba, Japan, 16Yokohama Minami Kyousai Hospital, Yokohama, Kanagawa, Japan, 17Department of Rheumatic Diseases, Tokyo Metropoitan Tama Medica Center, Fuchu, Japan, 18Tokyo Metropolitan Cancer and Infectious Dease Center Komagome Hospital, Tokyo, Tokyo, Japan, 19Niigata Rheumatic Center, Shibata, Niigata, Japan, 20Fuchu Hospital, Izumi, Osaka, Japan, 21Nippon Life Hospital, Osaka, Osaka, Japan, 22JCHO Hoshigaoka Medical Center, Katano, Osaka, Japan, 23Hyogo Prefecture Kakogawa Hospital, Kakogawa, Hyogo, Japan, 24Sumitomo Hospital, osaka, Osaka, Japan, 25Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan, 26Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan, 27University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan, 28Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan, 29International University of health and welfare, Narita, Chiba, Japan, 30National Hospital Organization Tokyo National Hospital, Tokyo, Japan

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: , , ,

Session Information

Date: Tuesday, November 12, 2019

Title: RA – Treatments Poster III: Safety and Outcomes

Session Type: Poster Session (Tuesday)

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

Background/Purpose: Lymphoproliferative disorders (LPD) remains as a major problem to resolve among the patients with rheumatoid arthritis (RA). During few decades, rheumatic therapy has dramatically changed with the advent of new disease modifying anti-rheumatic drugs (DMARDs). However, it is unclear whether these drugs relate to LPD developing in the patients withRA.

Methods: The current study included 518 RA-LPD patients in a Japanese multi-center collaborative study in order to characterize the current clinicopathological feature of RA-LPD and influence of methotrexate (MTX), tacrolimus (TAC) and biologic agents.

Results: Patient age at RA-LPD diagnosis ranged from 16 to 90 (median 69) years (1:2.43, men:women). Diffuse large B cell lymphoma was most frequent (51.3%), with 225 cases (81.5%) regressing only upon immunosuppressive agent withdrawal. Among these, 63 (27.0%) exhibited regrowth. The 5-year survival rate was 86.9%. Multivariate analysis revealed that sex (male), advanced clinical stage, TAC medication, T cell phenotype, and > 70 years of age upon LPD development constituted unfavorable prognostic factors.Additionally, the current clinicopathological profiles indicated that RA-LPD could be categorized into four groups depending on the use of DMARDs. Naïve, MTX, TAC and Bio (anti-tumor necrosis factor (TNF)). Naïve group consisted of the patients (45 cases) who had not received had MTX, TAC and anti-TNF agents. The positivity of EBER-1 of this group was lower than those of other groups. But it was a poorer prognostic factor. MTX group (461 cases), in which MTX had been administered with or without other DMARDs, showed increase of Hodgkin lymphoma (HL) and pharynx origin and decrease of B cell phenotype, stomach and breast origin. TAC group (78 cases), in which TAC had been used with or without other DMARDs, had a feature of older age, prolonged duration from the time of MTX initial medication to LPD development, the increase of polymorphic-LPD, elevated CRP at the onset of LPD and poorer prognosis. Bio (anti-TNF) group (110 cases), in which biologic agents (anti-TNF) had been given with/without other GMARDs, had a feature of younger age at the onset of LPD, the elongated duration from the time of MTX initial medication to LPD development, increase the frequency of HL, HL-like lesion, EBER-1 positivity, and decrease of Follicular lymphoma.

Conclusion: In conclusion, the current analyses showed the prognostic factors of RA-LPD and the distinctive characteristics in relation to the use of anti-rheumatic drugs.

Disclosure: Y. Hoshida, None; S. Ohshima, None; Y. Saeki, None; M. Katayama, None; T. Miyamura, None; A. Hashimoto, None; S. Higa, None; H. Oshima, None; M. Yagita, None; Y. Hiramatsu, None; N. Yoshikawa, None; A. Mitsuo, None; A. Okamoto, None; N. Chiba, None; T. Sugiyama, None; S. Nagaoka, None; S. Sugii, None; K. Setoguchi, None; A. Abe, None; T. Sugaya, None; M. Koseto, None; Y. Kunugiza, None; R. Yoshihara, None; S. Tsunoda, None; T. Fujisaki, None; H. Furukawa, Ajinomoto Co., Inc., 8, Ayumi Pharmaceutical Corporation, 8, Bristol-Myers Squibb Co., 2, Daiichi Sankyo Co., Ltd., 8, Dainippon Sumitomo Pharma Co., Ltd., 8, Daiwa Securities Health Foundation, 2, Japan Research Foundation for Clinical Pharmacology, 2, Kato Memorial Trust for Nambyo Research, 2, Luminex Japan Corporation Ltd., 8, Mitsui Sumitomo Insurance Welfare Foundation, 2, Nakatomi Foundation, 2, Pfizer Japan Inc., 8, Takeda Pharmaceutical Company, 8, Takeda Science Foundation, 2, The Nakatomi Foundation, 2; K. Saito, None; K. Matsui, Bristol-Myers Squibb, 5, 8; Y. Tomita, None; S. Tohma, None.

To cite this abstract in AMA style:

Hoshida Y, Ohshima S, Saeki Y, Katayama M, Miyamura T, Hashimoto A, Higa S, Oshima H, Yagita M, Hiramatsu Y, Yoshikawa N, Mitsuo A, Okamoto A, Chiba N, Sugiyama T, Nagaoka S, Sugii S, Setoguchi K, Abe A, Sugaya T, Koseto M, Kunugiza Y, Yoshihara R, Tsunoda S, Fujisaki T, Furukawa H, Saito K, Matsui K, Tomita Y, Tohma S. Multi-center Analyses on 518 Cases with Rheumatoid Arthritis Developing Lymphoproliferative Disorders (RA-LPD): The Prognostic Factors and the Influence of Anti-rheumatic Drugs on LPD Development [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/multi-center-analyses-on-518-cases-with-rheumatoid-arthritis-developing-lymphoproliferative-disorders-ra-lpd-the-prognostic-factors-and-the-influence-of-anti-rheumatic-drugs-on-lpd-development/. Accessed .

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