Methotrexate-associated lymphoproliferative disorders with angioimmunoblastic T-cell lymphoma-like features accompanied by gamma-heavy chain disease in a patient with rheumatoid arthritis

2018 ◽  
Vol 68 (8) ◽  
pp. 485-490 ◽  
Author(s):  
Junichi Kiyasu ◽  
Fumiko Arakawa ◽  
Shojiro Haji ◽  
Yoshimichi Tachikawa ◽  
Mariko Tsuda ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
T Cell ◽  
Heavy Chain ◽  
Cell Lymphoma ◽  
Lymphoproliferative Disorders ◽  
T Cell Lymphoma ◽  
Angioimmunoblastic T Cell Lymphoma ◽  
Heavy Chain Disease

scholarly journals Outcomes of Methotrexate-Associated T-Cell and NK/T-Cell Lymphoproliferative Disorders in Patients with a History of Rheumatological Disorders: A Retrospective Analysis of EBV-Association and Response to MTX Withdrawal

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5347-5347
Author(s):  
William T Johnson ◽  
Danielle Garfunkel ◽  
Misung Yi ◽  
Benjamin E Leiby ◽  
Saritha Kartan ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
T Cell ◽  
Median Duration ◽  
Cell Lymphoma ◽  
Cell Lineage ◽  
Lymphoproliferative Disorders ◽  
T Cell Lymphoma ◽  
Nk T Cell ◽  
Additional Therapy

Abstract Introduction: Methotrexate (MTX)-associated lymphoproliferative disorders (LPD) are iatrogenic lymphoid neoplasms typically of B-cell lineage and often (50%) associated with the Epstein-Barr virus (EBV). Up to 60% of cases are reported to regress with MTX withdrawal. The relative frequency, clinical-pathological spectrum, EBV association, and outcome following MTX withdrawal in patients with LPD of T/NK-cell lineage are not well-known and no large series have been published. Methods: We searched English language PubMed, Ovid and Scopus for keywords; methotrexate, T-cell lymphoma, lymphoproliferative disorder, NK/T cell lymphoma, EBV+ T-cell lymphoma, rheumatoid arthritis, and autoimmune. We reviewed each published case series and case report for unique cases. Case selection criteria included 1) pathologically proven diagnosis of T/NK-LPD, 2) ongoing MTX use at the time of diagnosis, and 3) withdrawal of MTX as initial intervention. Cases were defined as EBV+ (any positive staining for EBER-in situ hybridization (ISH) on tumor sample), EBV-, and EBVnr (not reported). No minimum follow-up was required, as long as the type of intervention(s) and outcome were reported. Clinical variables included: age, sex, EBV positivity, duration of RA, and duration of MTX use. Outcomes following MTX withdrawal included: 1) disease regression (as defined and reported by each paper) without need for additional therapy, 2) disease regression followed by additional therapy, 3) survival time at last follow up. Data analysis was performed using SAS 9.4. Results: We found 40 cases of T/NK-LPD developing during MTX use. Two cases were reported twice and two were excluded based on lack of intervention outcomes, leaving 36 assessable cases (22 F, 14 M), 34 of which had rheumatoid arthritis (RA). Median age at diagnosis of T/NK-LPD was 65 years (21-85). For the subsets of cases with available data, median duration of RA (N=21) and median duration of MTX use (N=23) prior to T/NK-LPD diagnosis were 10 years (6 months-33 years) and 48 months (6-144 months), respectively. MTX doses ranged from 4 mg/wk to 15 mg/wk. Use of other concomitant immunosuppressive drugs was reported in only 5 cases (cyclosporine 2; hydroxychloroquine 2; infliximab 1). Diagnoses included: peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS, 9), angioimmunoblastic T-cell lymphoma (AITL, 7), cutaneous T-cell lymphoma (CTCL, 6), extranodal NK/T-cell lymphoma (ENKTL, 6), anaplastic large cell lymphoma (ALCL, 4), large granular lymphocytic leukemia (LGL, 3) and adult T-cell leukemia/lymphoma (ATLL, 1). In total, 19 of 36 cases (53%) were EBV+ (6/6 ENKTL, 4/7 AITL, 4/9 PTCL-NOS, 3/6 CTCL ,1/3 LGL, 1/4 ALCL, 0/1 ATLL), 13 were EBV-, and 4 were EBVnr. Of the 19 EBV+ cases, 17 were initially treated with MTX withdrawal only and a sustained regression was observed in 12/17 cases (3 ENKTL, 3 CTCL, 2 AITL, 2 PTCL, NOS, 1 LGL, 1 ALCL). With a reported median follow-up of 18 months (3-48) none of the 12 patients had progression or required additional therapy. Two of the 17 patients (both AITL) had initial regression with MTX withdrawal, but then progressed and received chemotherapy. Two patients with ENKTL did not respond to MTX withdrawal alone. Disease regression following MTX withdrawal was also observed in 6 of 13 EBV- cases (2 AITL, 2 LGL, 1 PTCL, NOS and 1 CTCL). The median durations of RA and MTX use for EBV+ cases were longer than that for EBV negative cases (138 vs. 60 months and 69 vs. 24 months, respectively). Regressions with MTX withdrawal alone were more frequent in the 12/17 (71%) EBV+ lymphomas patients compared to 6/13 (46%) EBV- lymphomas. Conclusions: We report a series of MTX-associated T/NK-LPD, mostly in patients with RA. MTX withdrawal maybe a reasonable first-line treatment option in MTX-associated T/NK-LPD in both the EBV+, and EBV- cases. Disclosures Porcu: Innate Pharma: Consultancy.

scholarly journals Angioimmunoblastic T-Cell Lymphoma with Polyarthritis Resembling Rheumatoid Arthritis

2016 ◽  
Vol 14 (3-4) ◽  
pp. 159-162 ◽  
Author(s):  
Ralph Yachoui ◽  
Nouman Farooq ◽  
Jonathan V. Amos ◽  
Gene R. Shaw
Keyword(s):  
Rheumatoid Arthritis ◽  
T Cell ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Angioimmunoblastic T Cell Lymphoma

Methotrexate-associated lymphoproliferative disorders mimicking angioimmunoblastic T-cell lymphoma

2010 ◽  
Vol 206 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Kazuhito Hatanaka ◽  
Naoya Nakamura ◽  
Minoru Kojima ◽  
Kiyoshi Ando ◽  
Seiji Irie ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
Lymphoproliferative Disorders ◽  
T Cell Lymphoma ◽  
Angioimmunoblastic T Cell Lymphoma

No correlation between immunoglobulin heavy chain rearrangements and the prognosis of angioimmunoblastic T-cell lymphoma

2009 ◽  
Vol 83 (2) ◽  
pp. 159-160 ◽  
Author(s):  
Daisuke Niino ◽  
Riko Kawano ◽  
Fumiko Arakawa ◽  
Yasuo Sugita ◽  
Nobuko Suefuji ◽  
...  
Keyword(s):  
T Cell ◽  
Heavy Chain ◽  
Cell Lymphoma ◽  
Immunoglobulin Heavy Chain ◽  
T Cell Lymphoma ◽  
Angioimmunoblastic T Cell Lymphoma

Two Cases of Angioimmunoblastic T-cell Lymphoma Presenting with a Skin Eruption

2012 ◽  
Vol 74 (4) ◽  
pp. 399-404
Author(s):  
Kana KOZONO ◽  
Kazuhiko YAMAMURA ◽  
Toshihiko MASHINO ◽  
Masutaka FURUE ◽  
Hideki ASAOKU ◽  
...  
Keyword(s):  
T Cell ◽  
Skin Eruption ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Angioimmunoblastic T Cell Lymphoma

scholarly journals A novel prognostic model for angioimmunoblastic T-cell lymphoma: A retrospective study of 55 cases

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110132
Author(s):  
Jie Sun ◽  
Sha He ◽  
Hong Cen ◽  
Da Zhou ◽  
Zhe Li ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
T Cell ◽  
Prognostic Model ◽  
Proportional Hazards Model ◽  
Cell Lymphoma ◽  
Initial Diagnosis ◽  
Cox Proportional Hazards Model ◽  
T Cell Lymphoma ◽  
Chinese Patients ◽  
Angioimmunoblastic T Cell Lymphoma

Objective To explore prognostic factors and develop an accurate prognostic prediction model for angioimmunoblastic T-cell lymphoma (AITL). Methods Clinical data from Chinese patients with newly diagnosed AITL were retrospectively analysed. Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan-Meier method survival curves; prognostic factors were determined using a Cox proportional hazards model. The sensitivity and specificity of the predicted survival rates were compared using area under the curve (AUC) of receiver operating characteristic (ROC) curves. Results The estimated 5-year OS and PFS of 55 eligible patients with AITL were 22% and 3%, respectively. Multivariate analysis showed that the presence of pneumonia, and serous cavity effusions at initial diagnosis were significant prognostic factors for OS. Based on AUC ROC values, our novel prognostic model was superior to IPI and PIT based models and suggested better diagnostic accuracy. Conclusions Our prognostic model based on pneumonia, and serous cavity effusions at initial diagnosis enabled a balanced classification of AITL patients into different risk groups.

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