TY - JOUR T1 - A Clinical, Pathological, and Genetic Characterization of Methotrexate-associated Lymphoproliferative Disorders JF - The Journal of Rheumatology JO - J Rheumatol SP - 293 LP - 299 DO - 10.3899/jrheum.130270 VL - 41 IS - 2 AU - Noriyuki Yamakawa AU - Masakazu Fujimoto AU - Daisuke Kawabata AU - Chikashi Terao AU - Momoko Nishikori AU - Ran Nakashima AU - Yoshitaka Imura AU - Naoichiro Yukawa AU - Hajime Yoshifuji AU - Koichiro Ohmura AU - Takao Fujii AU - Toshiyuki Kitano AU - Tadakazu Kondo AU - Kimiko Yurugi AU - Yasuo Miura AU - Taira Maekawa AU - Hiroh Saji AU - Akifumi Takaori-Kondo AU - Fumihiko Matsuda AU - Hironori Haga AU - Tsuneyo Mimori Y1 - 2014/02/01 UR - http://www.jrheum.org/content/41/2/293.abstract N2 - Objective. Methotrexate-associated lymphoproliferative disorders (MTX-LPD) often regress spontaneously during MTX withdrawal, but the prognostic factors remain unclear. The aim of our study was to clarify the clinical, histological, and genetic factors that predict outcomes in patients with MTX-LPD. Methods. Patients with MTX-LPD diagnosed between 2000 and 2012 were analyzed retrospectively regarding their clinical course, site of biopsy, histological typing, Epstein-Barr virus (EBV) in situ hybridization and immunostaining, and HLA type. Results. Twenty-one patients, including 20 with rheumatoid arthritis (RA) and 1 with polymyositis, were analyzed. The mean dose of MTX was 6.1 mg/week and the mean duration of treatment was 71.1 months. Clinically, 5 patients were diagnosed with EBV-positive mucocutaneous ulcer (EBVMCU) and had polymorphic histological findings. The proportion of those patients successfully treated solely by withdrawal of MTX was significantly greater than that of those without EBVMCU (75% vs 7.7%, p = 0.015). The HLA-B15:11 haplotype was more frequent in patients with EBV+ RA with MTX-LPD than in healthy Japanese controls (p = 0.0079, Bonferroni’s method). EBV latency classification and HLA typing were not associated with the prognosis of MTX-LPD in our cohort. Conclusion. Our data demonstrate that patients in the EBVMCU, a specific clinical subgroup of MTX-LPD, had a better clinical outcome when MTX was withdrawn than did other patients with MTX-LPD. ER -