Predictive Factor of Spontaneous Regression in Methotorexate-associated Lymphoproliferative Disorders with RA Patients

Tomohiro Kameda¹, shusaku nakashima², Masayuki Inoo³, Ikuko Onishi³, Noriyuki Kurata³, Hiromi Shimada¹, Risa Wakiya¹, Mikiya Kato¹, taichi miyagi⁴, Yusuke Ushio⁵, Rina Mino⁶, Kanako Chujo⁷, norimitsu Kadowaki⁸ and Hiroaki Dobashi⁹, ¹Kagawa University, Kagawa, Japan, ²Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa, Japan, ³Utazu Hospital, Yayauta-gun, Japan, ⁴Kagawa University, Kidagun, Japan, ⁵Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Miki, Kita District, Kagawa, Japan, ⁶Kagawa University, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Miki-cho, Kita-gun, Japan, ⁷Kagawa University, Miki, Kita District, Kagawa, Japan, ⁸Kagawa University, Kita-Gun, Japan, ⁹Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa, Kagawa, Japan

Meeting: ACR Convergence 2022

Keywords: rheumatoid arthritis

Session Information

Date: Monday, November 14, 2022

Title: RA – Diagnosis, Manifestations, and Outcomes Poster IV

Session Type: Poster Session D

Session Time: 1:00PM-3:00PM

Background/Purpose: Lymphoproliferative disorders (LPDs), including malignant lymphoma, are known to occur in RA patients treated with disease modified antirheumatic drugs (DMARDs). In particular, LPD associated with methotrexate (MTX)-treated RA is often referred to as MTX-associated LPD (MTX-LPD). Some MTX-LPDs spontaneously regress after discontinuation of MTX, even though they have been diagnosed with malignant lymphoma. However it is difficult to predict spontaneous regression (SR) of MTX-LPD. We clarified the predictive factors of spontaneous regression in accumulated MTX-LPD patients.

Methods: We enrolled 100 RA patients who diagnosed MTX-LPD from 2005 to 2021. We collected as follow data based on clinical reports retrospectively; 1) age, 2) gender, 3) duration from RA onset to LPD onset, 4) total dose of MTX, 5) duration of MTX administration, 6) presence of extranodal lesion 7) histological findings, 8) treatment for LPD. In addition, We divided these cases into spontaneous regression cases (SR group) and cases that treated with chemotherapy after MTX discontinuation (CTx group), and compared the difference of biomarker as follow subjects between two groups; serum LDH and sIL-2R at LPD onset, change in absolute number of peripheral lymphocytes (ΔALC) over follow-up.

Results: The mean age of 100 MTX-RA-LPD patients (M:F=30:70) were 66.7 ± 10.7 years old, and the duration from RA onset to LPD onset were 25.2 ± 11.0 years. The total dose of MTX and duration of MTX administration were over 2,600mg and over 5 years, respectively. The extranodal lesions were found in 51%, and diffuse large B cell lymphoma was the most common histological findings. Spontaneous regression was observed in 68%. In regards to the comparison between two groups, SR group and CTx group were 68 and 31cases respectively. The one case was unknown because of transfer to another hospital after LPD diagnosis. The level of sIL-2R and LDH was significantly lower in SR group. On the other hand, ΔALC was higher in the SR group.

Conclusion: We suggested that low level of serum sIL-2R and LDH at LPD onset was useful for predict of SR in MTX-LPD with RA patients.

Disclosures: T. Kameda, None; s. nakashima, None; M. Inoo, None; I. Onishi, None; N. Kurata, None; H. Shimada, None; R. Wakiya, None; M. Kato, None; t. miyagi, None; Y. Ushio, None; R. Mino, None; K. Chujo, None; n. Kadowaki, None; H. Dobashi, Bristol-Myers Squibb (BMS), Chugai, Eli Lilly, GlaxoSmithKlein (GSK), MSD, Novartis, Pfizer, UCB Pharma.

To cite this abstract in AMA style:

Kameda T, nakashima s, Inoo M, Onishi I, Kurata N, Shimada H, Wakiya R, Kato M, miyagi t, Ushio Y, Mino R, Chujo K, Kadowaki n, Dobashi H. Predictive Factor of Spontaneous Regression in Methotorexate-associated Lymphoproliferative Disorders with RA Patients [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/predictive-factor-of-spontaneous-regression-in-methotorexate-associated-lymphoproliferative-disorders-with-ra-patients/. Accessed .

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