RT Journal Article
SR Electronic
T1 A Clinical, Pathological, and Genetic Characterization of Methotrexate-associated Lymphoproliferative Disorders
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 293
OP 299
DO 10.3899/jrheum.130270
VO 41
IS 2
A1 Noriyuki Yamakawa
A1 Masakazu Fujimoto
A1 Daisuke Kawabata
A1 Chikashi Terao
A1 Momoko Nishikori
A1 Ran Nakashima
A1 Yoshitaka Imura
A1 Naoichiro Yukawa
A1 Hajime Yoshifuji
A1 Koichiro Ohmura
A1 Takao Fujii
A1 Toshiyuki Kitano
A1 Tadakazu Kondo
A1 Kimiko Yurugi
A1 Yasuo Miura
A1 Taira Maekawa
A1 Hiroh Saji
A1 Akifumi Takaori-Kondo
A1 Fumihiko Matsuda
A1 Hironori Haga
A1 Tsuneyo Mimori
YR 2014
UL http://www.jrheum.org/content/41/2/293.abstract
AB 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that patients in the EBVMCU, a specific clinical subgroup of MTX-LPD, had a better clinical outcome when MTX was withdrawn than did other patients with MTX-LPD.