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Clinical characteristics of methotrexate-associated lymphoproliferative disorders: relationship between absolute lymphocyte count recovery and spontaneous regression

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Abstract

Several reports have shown that patients with rheumatoid arthritis (RA) are at increased risk of developing lymphoproliferative disorders (LPD). Methotrexate (MTX) has been recognized as a major cause of LPD. Sometimes spontaneous regression (SR) occurs after withdrawal of MTX. Recent studies suggest that the early recovery of the absolute lymphocyte count (ALC) after withdrawal of MTX is associated with the spontaneous regression of MTX–LPD. We retrospectively analyzed 26 patients with MTX–LPD to identify predictive factors for spontaneous regression. The spontaneous regression after withdrawal of MTX occurred in 13 of 26 (50%) cases. We assessed the ALC at the time of MTX cessation and 1 month after cessation in 23 evaluable cases. The spontaneous regression was observed in 3 of 11 in the ALC recovery group (27%) and in 8 of the 12 in the ALC non-recovery group (67%). Thus, we could not detect any relationship between the recovery of ALC after withdrawal of MTX and the spontaneous regression. The patients in the ALC recovery group had a poorer prognosis than those in the ALC non-recovery group (2-year overall survival: 65.6 vs. 100%, p = 0.05). According to these results, the recovery of the ALC might not be useful as a predictor of the spontaneous regression. Furthermore, the existence of extranodal sites and advanced-stage were associated with non-SR. It is suspected that MTX–LPD patients with high disease activity at the time of their diagnosis might have little hope of spontaneous regression. This result indicated the importance of the early detection of MTX–LPD.

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Authors and Affiliations

  1. Department of Rheumatology, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan

    Satoshi Takanashi, Yuichiro Amano & Motoharu Hirano

  2. Department of Hematology, Yokohama Municipal Citizen’s Hospital, 56 Okazawacho, Hodogaya-ku, Yokohama, 240-8555, Japan

    Satoshi Takanashi, Yoshinobu Aisa, Chisako Ito, Hideki Arakaki, Yuki Osada & Tomonori Nakazato

Authors
  1. Satoshi Takanashi
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  2. Yoshinobu Aisa
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  3. Chisako Ito
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  4. Hideki Arakaki
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  5. Yuki Osada
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  6. Yuichiro Amano
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  7. Motoharu Hirano
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  8. Tomonori Nakazato
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Corresponding author

Correspondence to Tomonori Nakazato.

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No specific funding was obtained to support the conduct of this study.

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All authors have no potential conflicts of interest to report.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Takanashi, S., Aisa, Y., Ito, C. et al. Clinical characteristics of methotrexate-associated lymphoproliferative disorders: relationship between absolute lymphocyte count recovery and spontaneous regression. Rheumatol Int 37, 1629–1633 (2017). https://doi.org/10.1007/s00296-017-3764-8

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  • DOI: https://doi.org/10.1007/s00296-017-3764-8

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