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.
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 April 13, 2021.
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ACR Meeting Abstracts - 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/