Department of Hematology, Saitama Medical Center, Saitama Medical University , Saitama , Japan.
Department of Medicine, Division of Rheumatology, Keio University School of Medicine , Tokyo , Japan.
Leuk Lymphoma. 2019 Oct;60(10):2508-2515. doi: 10.1080/10428194.2019.1585841. Epub 2019 Apr 5.
Methotrexate (MTX) is one of the potent drugs for autoimmune diseases (ADs), especially for rheumatoid arthritis. Recent studies suggest that MTX should be immediately withdrawn when patients with AD develop lymphoproliferative disorder (LPD). However, biopsy cannot be performed for diagnosis because LPD regresses quickly after MTX withdrawal, thus making clinical MTX-LPD (c-MTX-LPD) challenging to diagnose. In this study, among the 28 patients with c-MTX-LPD, seven developed a proven LPD (p-LPD) after suspicious LPD (s-LPD) regression, six of which were Hodgkin lymphoma. Four of seven patients with p-LPD + died, whereas all patients with p-LPD- survived. The clinical manifestations indicative of p-LPD include fever, elevated serum C-reactive protein level, and soluble interleukin-2 receptor level. Anti-AD drugs did not appear to affect the pathogenesis of p-LPD development. P-LPD was not observed after 3 years from the time of s-LPD regression.
甲氨蝶呤（MTX）是治疗自身免疫性疾病（AD）的有效药物之一，尤其是类风湿关节炎。最近的研究表明，当 AD 患者发生淋巴增生性疾病（LPD）时，应立即停用 MTX。然而，由于 LPD 在 MTX 停药后迅速消退，无法进行活检以明确诊断，因此临床 MTX-LPD（c-MTX-LPD）的诊断极具挑战性。在这项研究中，28 例 c-MTX-LPD 患者中，7 例在可疑 LPD（s-LPD）消退后发展为明确的 LPD（p-LPD），其中 6 例为霍奇金淋巴瘤。7 例 p-LPD+患者中有 4 例死亡，而所有 p-LPD-患者均存活。预示 p-LPD 的临床表现包括发热、血清 C 反应蛋白水平和可溶性白细胞介素 2 受体水平升高。抗 AD 药物似乎不会影响 p-LPD 发展的发病机制。在 s-LPD 消退后 3 年内未观察到 p-LPD。
