与甲氨蝶呤相关的其他医源性免疫缺陷相关肺淋巴增生性疾病的发病率和预后：一项回顾性研究。

The incidence and prognosis of other iatrogenic immunodeficiency-associated lymphoproliferative disorders of the lung related to methotrexate: A retrospective study.

机构信息

Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan.

出版信息

Pulm Pharmacol Ther. 2024 Jun;85:102297. doi: 10.1016/j.pupt.2024.102297. Epub 2024 Mar 11.

DOI:10.1016/j.pupt.2024.102297

PMID:38467341

Abstract

BACKGROUND AND OBJECTIVE

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.

METHODS

Patients with OIIA-LPD of the lung treated at our institution between January 2008 and July 2020 were retrospectively analysed.

RESULTS

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).

CONCLUSION

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.

摘要

背景与目的

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。

方法

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。

结果

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]）。