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Kaga M, Amano H, Kon T, Harada S, Ogura K. Other iatrogenic immunodeficiency-associated lymphoproliferative disorder presenting with multiple facial tumors. JAAD Case Rep 2024; 49:8-10. [PMID: 38873250 PMCID: PMC11170344 DOI: 10.1016/j.jdcr.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Affiliation(s)
- Maya Kaga
- Department of Dermatology and Allergy, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hirofumi Amano
- Department of Rheumatology and Internal Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takayuki Kon
- Department of Rheumatology and Internal Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Sakiko Harada
- Department of Hematology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kanako Ogura
- Department of Pathology, Juntendo University Nerima Hospital, Tokyo, Japan
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2
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Hoshida Y, Tsujii A, Ohshima S, Saeki Y, Yagita M, Miyamura T, Katayama M, Kawasaki T, Hiramatsu Y, Oshima H, Murayama T, Higa S, Kuraoka K, Hirano F, Ichikawa K, Kurosawa M, Suzuki H, Chiba N, Sugiyama T, Minami Y, Niino H, Ihata A, Saito I, Mitsuo A, Maejima T, Kawashima A, Tsutani H, Takahi K, Kasai T, Shinno Y, Tachiyama Y, Teramoto N, Taguchi K, Naito S, Yoshizawa S, Ito M, Suenaga Y, Mori S, Nagakura S, Yoshikawa N, Nomoto M, Ueda A, Nagaoka S, Tsuura Y, Setoguchi K, Sugii S, Abe A, Sugaya T, Sugahara H, Fujita S, Kunugiza Y, Iizuka N, Yoshihara R, Yabe H, Fujisaki T, Morii E, Takeshita M, Sato M, Saito K, Matsui K, Tomita Y, Furukawa H, Tohma S. Effect of Recent Antirheumatic Drug on Features of Rheumatoid Arthritis-Associated Lymphoproliferative Disorders. Arthritis Rheumatol 2024; 76:869-881. [PMID: 38272827 DOI: 10.1002/art.42809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/06/2024] [Accepted: 01/22/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE In this study, we examine how advancements in novel antirheumatic drugs affect the clinicopathologic features of lymphoproliferative disorder (LPD) in patients with rheumatoid arthritis (RA). METHODS In this multicenter study across 53 hospitals in Japan, we characterized patients with RA who developed LPDs and visited the hospitals between January 1999 and March 2021. The statistical tools used included Fisher's exact test, the Mann-Whitney U-test, the log-rank test, logistic regression analysis, and Cox proportional hazards models. RESULTS Overall, 752 patients with RA-associated LPD (RA-LPD) and 770 with sporadic LPD were included in the study. We observed significant differences in the clinicopathologic features between patients with RA-LPD and those with sporadic LPD. Histopathological analysis revealed a high frequency of LPD-associated immunosuppressive conditions. Furthermore, patients with RA-LPD were evaluated based on the antirheumatic drugs administered. The methotrexate (MTX) plus tacrolimus and MTX plus tumor necrosis factor inhibitor (TNFi) groups had different affected site frequencies and histologic subtypes than the MTX-only group. Moreover, MTX and TNFi may synergistically affect susceptibility to Epstein-Barr virus infection. In case of antirheumatic drugs administered after LPD onset, tocilizumab (TCZ)-only therapy was associated with lower frequency of regrowth after spontaneous regression than other regimens. CONCLUSION Antirheumatic drugs administered before LPD onset may influence the clinicopathologic features of RA-LPD, with patterns changing over time. Furthermore, TCZ-only regimens are recommended after LPD onset.
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Affiliation(s)
- Yoshihiko Hoshida
- National Health Organization (NHO) Osaka Minami Medical Center, Osaka, Japan
| | - Atsuko Tsujii
- National Health Organization (NHO) Osaka Minami Medical Center, Osaka, Japan
| | - Shiro Ohshima
- National Health Organization (NHO) Osaka Minami Medical Center, Osaka, Japan
| | - Yukihiko Saeki
- National Health Organization (NHO) Osaka Minami Medical Center, Osaka, Japan
| | - Masato Yagita
- Tazuke-Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
| | | | | | | | | | | | | | | | - Kazuya Kuraoka
- NHO Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | | | | | | | | | | | | | - Yuko Minami
- NHO Ibarakihigashi National Hospital, Tokai, Japan
| | | | | | - Ikuo Saito
- NHO Sagamihara National Hospital, Sagamihara, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Keigo Setoguchi
- Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Shoji Sugii
- Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Asami Abe
- Niigata Rheumatic Center, Shibata, Japan
| | | | | | | | - Yasuo Kunugiza
- Japan Community Health Care Organization Hoshigaoka Medical Center, Hirakata, Japan
| | | | | | | | | | | | | | - Masakazu Sato
- Kurashiki University of Science and the Arts, Kurashiki, Japan
| | - Kazuyoshi Saito
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Yasuhiko Tomita
- International University of Health and Welfare, Narita, Japan
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3
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Tanaka K, Ichikawa A, Umezawa N, Yamamoto K, Yoshifuji K, Okada K, Nogami A, Umezawa Y, Nagao T, Sakashita C, Mori T, Tohda S, Koike R, Yasuda S, Yamamoto M. Lymphoproliferative disorder risk after methotrexate treatment for rheumatoid arthritis. Cancer Sci 2023; 114:3719-3727. [PMID: 37365854 PMCID: PMC10475769 DOI: 10.1111/cas.15894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
Methotrexate (MTX)-associated lymphoproliferative disorder (MTX-LPD) is a troublesome problem in patients receiving MTX for rheumatoid arthritis (RA). However, its incidence, prognosis, and risk factors remain unclear. In this retrospective study, we evaluated the actual incidence, prognostic impact, and risk factors of MTX-LPD. Of the 986 patients with RA treated with MTX, 90 patients experienced 95 new malignancies (NMs), with LPD as the most frequent in 26 patients. The cumulative LPD incidences were 1.3% and 4.7% at 5 and 10 years after MTX initiation, respectively. Among the 24 patients who discontinued MTX after developing LPD, 15 showed sustained regression, without difference in overall survival between patients with LPD and without NM. Inflammatory markers and absolute lymphocyte counts were not useful for early LPD development detection, but most of the patients with LPD had persistently elevated erythrocyte sedimentation ratios. Regarding concomitant drugs, tacrolimus increased the risk only if patients were not receiving biological disease-modifying antirheumatic drugs (bDMARDs). bDMARDs did not increase the risk for any of the drugs or the number of classes used. The number of LPD cases was lower in patients with IL-6A even after a long period after MTX, although with no statistically significant difference. Thus, approximately 1 in 20 patients with RA developed MTX-LPD over the 10 years of MTX treatment, but it did not affect the survival of patients with RA. Tacrolimus increased the risk of developing LPD for certain patients and should be used with caution.
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Affiliation(s)
- Keisuke Tanaka
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
| | - Ayako Ichikawa
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
| | - Natsuka Umezawa
- Department of RheumatologyTokyo Medical and Dental UniversityTokyoJapan
| | - Kouhei Yamamoto
- Department of PathologyTokyo Medical and Dental UniversityTokyoJapan
| | - Kota Yoshifuji
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
| | - Keigo Okada
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
| | - Ayako Nogami
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
- Department of Laboratory MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Yoshihiro Umezawa
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
| | - Toshikage Nagao
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
| | - Chizuko Sakashita
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
| | - Takehiko Mori
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
| | - Shuji Tohda
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
- Department of Laboratory MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Ryuji Koike
- Department of RheumatologyTokyo Medical and Dental UniversityTokyoJapan
| | - Shinsuke Yasuda
- Department of RheumatologyTokyo Medical and Dental UniversityTokyoJapan
| | - Masahide Yamamoto
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
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Hatayama Y, Sugiyama H, Murakami D, Oura H, Shima Y, Shirato M, Nishino T, Nakazawa T, Suehiro K, Arai M. Primary Hepatic Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders After Methotrexate Therapy. J Med Cases 2023; 14:282-288. [PMID: 37692367 PMCID: PMC10482596 DOI: 10.14740/jmc4135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Prior reports described cases of lymphoproliferative diseases occurring after methotrexate (MTX) administration, which are called methotrexate-associated lymphoproliferative disorders (MTX-LPDs). It has become clear that these lymphoproliferative diseases also occur following treatment with other immunosuppressive drugs, and they have been termed as other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPDs). In most of these cases, the duration of immunosuppressive drugs is very long, on the order of years. In the present study, we evaluated the development of lymphoproliferative disease despite the short duration of immunosuppressive treatment and determined the tumor doubling time. A 71-year-old woman was diagnosed with adult-onset Still's disease. The patient was administered prednisone 30 mg per day starting on February 25, 2022 and MTX 6 mg per week starting 2 weeks later. Because she was a hepatitis B virus (HBV) carrier, nucleic acid analog therapy was also started to prevent HBV activation. Eight weeks later, biweekly tocilizumab was started. After 5 months of MTX administration, a solitary liver tumor measuring 37 × 32 mm2 was detected. Three months later, repeat computed tomography revealed that the liver tumor had grown rapidly to 7 cm in diameter. We considered the possibility of OIIA-LPDs and stopped MTX therapy. Biopsy specimens of the liver tumor exhibited lymphocyte proliferation, which was consistent with OIIA-LPDs. The doubling time for tumor growth was 33 days. Despite withdrawing MTX for 6 weeks, the tumor continued to grow, and thus, the patient was referred to the hematology unit. In previously reported cases of MTX-LPDs of hepatic origin, the average duration of MTX administration was 7.3 (2 - 13) years. This report describes a primary hepatic OIIA-LPDs-associated tumor that rapidly increased in size after an extremely short period of MTX administration.
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Affiliation(s)
- Yasuki Hatayama
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Harutoshi Sugiyama
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Daisuke Murakami
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Hirotaka Oura
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Yukiko Shima
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Miho Shirato
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Takayoshi Nishino
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Tadao Nakazawa
- Department of Pathology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
| | - Kenichi Suehiro
- Center for Rheumatic Diseases, Chibaken Saiseikai Narashino Hospital, Chiba 275-8580, Japan
| | - Makoto Arai
- Department of Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba 276-8523, Japan
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5
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Chow TK. Hepatic Superscan in Methotrexate-Associated Lymphoproliferative Disorder. Clin Nucl Med 2023; 48:534-535. [PMID: 37083567 DOI: 10.1097/rlu.0000000000004647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
ABSTRACT A 60-year-old man on methotrexate for treatment of adult-onset Still disease presented with acute onset of fever, pancytopenia, and deranged liver function. Besides FDG-avid lesions in spleen and skeleton, his 18 F-FDG PET/CT study showed diffuse and intense uptake in the liver with significantly suppressed heart and brain activity (reminiscent of a hepatic superscan). Subsequent biopsy confirmed the diagnosis of methotrexate-associated lymphoproliferative disorder.
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Affiliation(s)
- Tsz-Kit Chow
- From the Nuclear Medicine Unit, Department of Radiology, Queen Mary Hospital, Hong Kong
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Kitamura N, Kobayashi H, Nagasawa Y, Sugiyama K, Tsuzuki H, Tanikawa Y, Ikumi N, Okada Y, Takahashi Y, Asai S, Tamura N, Ogasawara M, Kawamoto T, Kuwatsuru R, Tamaki H, Kidoguchi G, Tateishi M, Kimura M, Mochida Y, Harigane K, Shimazaki T, Koike T, Tanimura K, Kataoka H, Amano K, Yasuoka H, Takei M. Risk factors associated with relapse after methotrexate dose reduction in patients with rheumatoid arthritis receiving golimumab and methotrexate combination therapy. Int J Rheum Dis 2023. [PMID: 37058849 DOI: 10.1111/1756-185x.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/06/2023] [Accepted: 03/25/2023] [Indexed: 04/16/2023]
Abstract
AIM To identify risk factors for relapse after methotrexate (MTX) dose reduction in rheumatoid arthritis (RA) patients receiving golimumab (GLM)/MTX combination therapy. METHOD Data on RA patients ≥20 years old receiving GLM (50 mg) + MTX for ≥6 months were retrospectively collected. MTX dose reduction was defined as a reduction of ≥12 mg from the total dose within 12 weeks of the maximum dose (≥1 mg/wk average). Relapse was defined as Disease Activity Score in 28 joints using C-reactive protein level (DAS28-CRP) score ≥3.2 or sustained (≥ twice) increase of ≥0.6 from baseline. RESULTS A total of 304 eligible patients were included. Among the MTX-reduction group (n = 125), 16.8% of patients relapsed. Age, duration from diagnosis to the initiation of GLM, baseline MTX dose, and DAS28-CRP were comparable between relapse and no-relapse groups. The adjusted odds ratio (aOR) of relapse after MTX reduction was 4.37 (95% CI 1.16-16.38, P = 0.03) for prior use of non-steroidal anti-inflammatory drugs (NSAIDs), and the aORs for cardiovascular disease (CVD), gastrointestinal disease and liver disease were 2.36, 2.28, and 3.03, respectively. Compared to the non-reduction group, the MTX-reduction group had a higher proportion of patients with CVD (17.6% vs 7.3%, P = 0.02) and a lower proportion of prior use of biologic disease-modifying antirheumatic drugs (11.2% vs. 24.0%, P = 0.0076). CONCLUSION Attention should be given to RA patients with history of CVD, gastrointestinal disease, liver disease, or prior NSAIDs-use when considering MTX dose reduction to ensure benefits outweigh the risks of relapse.
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Affiliation(s)
- Noboru Kitamura
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hitomi Kobayashi
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yosuke Nagasawa
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Kaita Sugiyama
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Tsuzuki
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yutaka Tanikawa
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Natsumi Ikumi
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yuito Okada
- Clinical Trials Research Center, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Takahashi
- Clinical Trials Research Center, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Asai
- Department of Pharmacology and Biofunction Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Naoto Tamura
- Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Michihiro Ogasawara
- Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshio Kawamoto
- Internal Medicine and Rheumatology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology & Center for Promotion of Data Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromichi Tamaki
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Genki Kidoguchi
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Mutsuto Tateishi
- Department of Rheumatology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Makiko Kimura
- Department of Rheumatology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Yuichi Mochida
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan
| | - Kengo Harigane
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan
| | - Takayuki Shimazaki
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan
| | - Takao Koike
- Hokkaido Medical Center for Rheumatic Diseases, Sapporo, Japan
| | | | - Hiroshi Kataoka
- Department of Rheumatology and Clinical Immunology, Sapporo City General Hospital, Sapporo, Japan
| | - Koichi Amano
- Department of Rheumatology and Clinical Immunology, Saitama Medical Center Saitama Medical University, Saitama, Japan
| | - Hidekata Yasuoka
- Department of Internal Medicine, Division of Rheumatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masami Takei
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
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Hori Y, Yamamoto H, Kawatoko S, Nozaki Y, Torisu T, Kato K, Koga Y, Miyoshi H, Ohshima K, Tateishi Y, Nakamura S, Kitazono T, Oda Y. Lymphoid and myeloid proliferative disorders associated with inflammatory bowel disease: A clinicopathological study of 15 cases. Hum Pathol 2022; 120:88-98. [PMID: 34990621 DOI: 10.1016/j.humpath.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022]
Abstract
Lymphoproliferative disorder (LPD) can occur in patients with inflammatory bowel disease (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD). On rare occasion, patients with IBD develop myeloid neoplasms; however, the frequency and clinicopathological features of IBD-associated lymphoid and myeloid proliferative disorder (LMPD) in Japanese patients is still unclear. In this study, we reviewed 2474 Japanese patients with IBD, and found that LMPD occurred in 12 (0.5%) patients with UC (n=7) or CD (n=5). Together with an additional 3 cases, we analyzed a total of 15 cases of LMPD for clinicopathological and histological features. Based on the status of using immunosuppressants such as biologics and immunomodulators, Epstein-Barr virus (EBV) infection, and histopathology, the 15 cases were classified into the Group I (high-grade LPD; n=7), Group II (low-grade LPD; n=5), and Group III (myeloid neoplasms; n=3). Most patients in Group I were undergoing strong immunosuppressive therapy, and the LPD lesions corresponded to high-grade B-cell or T/NK-cell lymphoma often with EBV infection. Discontinuation of immunosuppressive drugs alone did not resolve these LPDs; Group I patients required chemotherapy, and eventually 4 of them (57%) died of the tumor. Most cases in Group II were low-grade B-cell lymphoma without EBV infection and had an indolent clinical course with excellent prognosis. All patients in Group III developed acute myeloid leukemia (AML) during the course of CD. Two (67%) of these patients died of AML. Our study suggests that IBD-associated LMPD is very rare, but can follow an aggressive clinical course.
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Affiliation(s)
- Yoshifumi Hori
- Department of Anatomic Pathology, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan.
| | - Shinichiro Kawatoko
- Department of Anatomic Pathology, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Yui Nozaki
- Department of Anatomic Pathology, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Koji Kato
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Yuhki Koga
- Department of Pediatrics, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, Kurume University School of Medicine, 830-0011, Kurume, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, 830-0011, Kurume, Japan
| | - Yuki Tateishi
- Department of Pathology, Japan Community Health Care Organization (JCHO), Kyushu Hospital, 806-8501, Kitakyushu, Japan
| | - Shotaro Nakamura
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 028-3695, Morioka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
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Aoki A, Kobayashi H, Abe S, Kimura T, Taguchi T, Yuuta H. [A case of methotrexate-associated diffuse large B-cell lymphoma with splenial lesions of the corpus callosum on brain MRI after complete remission with chemotherapy]. Nihon Ronen Igakkai Zasshi 2022; 59:96-101. [PMID: 35264540 DOI: 10.3143/geriatrics.59.96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An 86-year-old woman in a wheelchair was accompanied by her husband and son as she visited our outpatient clinic due to disturbed consciousness and fever. Twenty-seven years earlier, she had been diagnosed with rheumatoid arthritis and had been treated with methotrexate (MTX) and low-dose prednisolone (PSL). She stopped taking MTX four years previously when she was diagnosed with diffuse large B cell lymphoma of the paranasal sinus. Her lymphoma went into remission after six cycles of systemic immunochemotherapy. MRI after hospitalization revealed a lesion in the splenium of the corpus callosum that was hyperintense on diffusion-weighted imaging and which had low apparent diffusion coefficient values. An analysis of the cerebrospinal fluid revealed no atypical cells. The MRI findings were atypical, but her consciousness disturbance improved, leading to the diagnosis of mild encephalitis/encephalopathy with a reversible splenial lesion, which would be associated with a transient consciousness disturbance with a good course. However, her consciousness worsened over the next 3 weeks. One month later, a contrast-enhanced MRI showed an enlarged lesion in the callosum as well as new lesions, and the diagnosis of secondary CNS lymphoma was made. Brain biopsy is often not feasible. Less invasive and highly accurate diagnostic methods are needed, such as the identification of a spinal fluid tumor marker.
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Affiliation(s)
- Akiko Aoki
- Rheumatology, Tokyo Medical University Hachioji Medical Center
| | | | - Shine Abe
- Geriatric Medicine, Tokyo Medical University Hachioji Medical Center
| | | | | | - Hidehiro Yuuta
- Radiology, Tokyo Medical University Hachioji Medical Center
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