Background/Purpose: Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is important complication in the rheumatoid arthritis (RA) treatment. There were few reports about clinical features of MTX-LPD and RA treatment after MTX-LPD.

Methods: We retrospectively extracted RA patients diagnosed as MTX-LPD in 3 rheumatology centers between March 2019 and January 2008 from medical record.

Results: 39 patients were included. We classified MTX-LPD disease course after withdrawal of MTX in three; not improved group (group A; 8 patients) , completely improved group (group B; 19 patients) , improved once but relapse after few years group (group C; 12 patients).There was significant difference in EBER-ISH positivity between improved after withdrawal of MTX group (group B + group C) and group A (11/17 vs 1/7 p=0.00247). Significant difference was seen in morbidity rate of Sjogren’s syndrome (SS) between group B and C (0/19 vs 4/12 p=0.00701). Histopathological examples were obtained 32 patients; 12 of 32 were diagnosed as diffuse large B-cell lymphoma (DLBCL), 8 as Hodgkin’s lymphoma(HL), 7 as hyperplasia, 2 as Follicular lymphoma (FL), 1 as peripheral T-cell lymphoma (PTCL), 1 as Angioimmunoblastic T-cell lymphoma (AITL), 1 as Lymphomatoid granulomatosis (LYG). All patients discontinued MTX after diagnosed as MTX-LPD. In improved after withdrawal of MTX group (group B + group C), 25 of 31 patients showed relapse of RA in average 9.61 months after discontinuation of MTX. In group A, all patients received chemotherapy and RA flare was not seen during chemotherapy but three of 8 showed relapse of RA in average 26.5 months. After RA flare following drugs were administered including overlap; Iguratimod(IGU) in 10 cases, Salazosulfapyridine(SSZ) , Abatacept(ABT), and Tacrolimus(TAC) in 8, Bucillamine(BUC) in 6, Mizoribine(MZB) in 5, Tocilizmab(TCZ) in 2, Auranofin(AUR), D penicillamine and Etanercept(ETN) in 1. Recurrence of LPD was seen in 4 cases after additional administration of DMARDs; IGU in 2cases, SSZ and TAC in one.

Conclusion:

EBER-ISH positivity was associated with spontaneous improvement of MTX-LPD and absence of SS was associated with completely improvement of MTX-LPD. Relapse of RA after withdrawal of MTX is common and LPD might recur after additional treatment of RA flare, but there was no specific drug to recur LPD.

« Back to 2019 ACR/ARP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-for-rheumatoid-arthritis-after-methotrexate-associated-lymphoproliferative-disorder-developed/