ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2460

Study of Sixteen Cases of Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders Developed in Rheumatoid Arthritis Patients

Yoshihiko Ikeno1, Youkou Kobayashi2, Ikuo Akutsu3, Hirokuni Hirata4, Masafumi Arima5 and Kazuhiro Kurasawa6, 1Rheumatology, Japanese Red Cross Nasu Hospital, Tochigi, Japan, 2Hematology, Japanese Red Cross Nasu Hospital, Tochigi, Japan, 3Respiratory and allergy, Japanese Red Cross Nasu Hospital, Tochigi, Japan, 4Respiratory and allergy, Dokkyo Medical University Saitama Medical center, Saitama, Japan, 5Rheumatology, Dokkyo Medical University, mibu-gun, Tochigi, Japan, 6Rheumatology, Dokkyo Medical University, Mibu, Tochigi, Japan

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Date: Tuesday, October 23, 2018

Session Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

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

Background/Purpose: Methotrexate-associated lymphoproliferative disorders (MTX-LPDs) was first reported in 1991. The symptom is known to spontaneously regress after suspending the use of MTX, suggesting its association with LPDs. In recent years, there have been also reports of the disorder’s association with biological drugs and immunosuppressive drugs, which are classified as a kind of other iatrogenic immunodeficiency-associated lympholiferative disorders (OIIA-LPDs). Regional differences in terms of their frequency, their risk factors, and many other aspects of the disorders still remain unknown.

Methods: The study assessed 16 patients who experienced the onset of OIIA-LPDs during the use of MTX, immunosuppressive drugs, or biological drugs between April 2011 and April 2018. The patients were assessed for their ages, pathological types, MTX dosages, LDH, CRP, lymphocyte counts, sIL-2R, MMP-3, EBER-ISH, EBV-DNA, and DAS28CRP. Also, the study used parameters to analyze the group of patients whose symptoms spontaneously regressed and the other group treated with chemotherapy.

Results: Among the 16 cases, six cases went through spontaneous regression, while two cases terminated in death. Among pathological types, DLBCL accounted for nine cases, followed by four cases with Hodgkin lymphoma. Among the three cases tested with EBER-ISH, two cases were found positive, while one out of four cases tested with EBV-DNA was identified positive. The DAS28CRP level at the onset of LPD was 1.80±0.3 in the spontaneous regression group and 3.8±1.1 in the chemotherapy group, demonstrating a significant decrease (p=0.01182) in the spontaneous regression group.

Conclusion: Among the patients with OIIA-LPDs originating in rheumatoid arthritis, the number of EBER-ISH-positive cases was significantly high. Furthermore, the possible association of the active status of rheumatoid arthritis at the onset of LPDs with the necessity of chemotherapy was suggested.

Disclosure: Y. Ikeno, None; Y. Kobayashi, None; I. Akutsu, None; H. Hirata, None; M. Arima, None; K. Kurasawa, None.

To cite this abstract in AMA style:

Ikeno Y, Kobayashi Y, Akutsu I, Hirata H, Arima M, Kurasawa K. Study of Sixteen Cases of Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders Developed in Rheumatoid Arthritis Patients [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/study-of-sixteen-cases-of-other-iatrogenic-immunodeficiency-associated-lymphoproliferative-disorders-developed-in-rheumatoid-arthritis-patients/. Accessed January 20, 2020.

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