Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan.
Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan.
Pulm Pharmacol Ther. 2024 Jun;85:102297. doi: 10.1016/j.pupt.2024.102297. Epub 2024 Mar 11.
Other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD) are rare but well-known diseases that manifest during or after methotrexate (MTX) administration. Limited information is available on the clinical characteristics of OIIA-LPD of the lung because only a few cases have been reported. Thus, we aimed to assess the incidence and prognosis of patients with OIIA-LPD of the lung.
Patients with OIIA-LPD of the lung treated at our institution between January 2008 and July 2020 were retrospectively analysed.
Among the 51 patients with OIIA-LPD, 16 (31.3%, 7 men, 9 women) had OIIA-LPD of the lung (median age, 69 [range, 63-82] years). Peripheral lesions were observed in 10 (62.5%), central lesions in two (12.5%), and both lesions in four (25.0%) patients. Nine of the 16 patients underwent bronchoscopic biopsy, seven were diagnosed (diagnostic yield, 77.8%) and, re-biopsy was performed in 2 patients. Eight (50.0%) patients had LPD and six (37.5%) had diffuse large B-cell lymphoma. In the 14 patients with confirmed treatment efficacy, the overall response rate to MTX withdrawal was 71.4%. However, chemotherapy was required in case of larger lesions (three patients). Death related to OIIA-LPD occurred in only one patient, and 11 of the 14 patients were alive during the study period (median follow-up time, 53.7 [range, 4.3-84.2] months).
The incidence of OIIA-LPD of the lung is 31.3% and higher than that reported previously. The treatment effect of MTX withdrawal seems to be sufficient; however, in some cases, chemotherapy may be required from the beginning.
其他医源性免疫缺陷相关淋巴组织增生性疾病（OIIA-LPD）较为罕见，但广为人知，多发生于甲氨蝶呤（MTX）治疗期间或之后。由于仅有少数病例报道，因此关于肺部 OIIA-LPD 的临床特征，目前仅有有限的信息。因此，我们旨在评估肺部 OIIA-LPD 患者的发病情况和预后。
回顾性分析了 2008 年 1 月至 2020 年 7 月在我院治疗的肺部 OIIA-LPD 患者。
在 51 例 OIIA-LPD 患者中，有 16 例（31.3%，7 男，9 女）为肺部 OIIA-LPD（中位年龄为 69 岁[范围，63-82 岁]）。10 例（62.5%）患者外周有病变，2 例（12.5%）患者中央有病变，4 例（25.0%）患者同时有外周和中央病变。16 例患者中有 9 例行支气管镜活检，7 例得到确诊（诊断率 77.8%），2 例患者再次行活检。8 例（50.0%）患者为 LPD，6 例（37.5%）为弥漫性大 B 细胞淋巴瘤。在 14 例有明确治疗效果的患者中，MTX 停药后的总缓解率为 71.4%。然而，对于较大的病变（3 例），需要化疗。仅 1 例患者因 OIIA-LPD 死亡，14 例患者在研究期间存活（中位随访时间为 53.7 个月[范围，4.3-84.2 个月]）。
肺部 OIIA-LPD 的发病率为 31.3%，高于既往报道。MTX 停药的治疗效果似乎是足够的；然而，在某些情况下，可能需要从一开始就进行化疗。
