Vonderheid E C, Sajjadian A, Kadin M E
Department of Dermatology, Medical College of Pennsylvania, Philadelphia, USA.
J Am Acad Dermatol. 1996 Mar;34(3):470-81. doi: 10.1016/s0190-9622(96)90442-9.
The spectrum of primary cutaneous CD30+ lymphoproliferative disease consists of lymphomatoid papulosis (LyP) at one extreme and CD30+ peripheral T-cell lymphoma (Ki-1+ lymphoma) presenting in the skin at the other extreme. Methotrexate has been reported to be effective in LyP, but the experience has been limited to single case reports or small series.
The objective was to determine the effectiveness of methotrexate in the treatment of primary cutaneous DC30+ lymphoproliferative disease.
We reviewed our 20-year experience with the use of methotrexate in 45 patients with relatively severe LyP, Ki-1+ lymphoma, and interface presentations.
During induction of methotrexate therapy patients received maximum doses ranging from 10 to 60 mg/week (median, 20 mg/week). Clinical improvement usually occurred quickly, typically at doses of 15 to 20 mg weekly, and satisfactory long-term control was achieved in 39 patients (87%) with maintainance doses given at 10 to 14-day intervals (range, 7 to 28 days). After methotrexate was discontinued, 10 patients remained free of CD30+ lesions from more than 24 months to more than 227 months (median, more than 127 months). The median total duration of methotrexate therapy for all patients exceeded 39 months (range, 2 to 205 months). Adverse effects were generally mild and transient and included fatigue (47%), nausea (22%), weight loss (13%), diarrhea or gastrointestinal cramping (10%), increased serum hepatic transaminase levels (27%), anemia (11%), or leukopenia (9%). Early hepatic fibrosis was found in 5 of 10 patients, all of whom had been treated for more than 3 years (range, 38 to 111 months).
Low-dose methotrexate (25 mg or less given at 1-to 4-week intervals) is an effective and well-tolerated treatment of selected patients with primary cutaneous CD30+ lymphoproliferative disease.
原发性皮肤CD30+淋巴增殖性疾病的谱系一端为淋巴瘤样丘疹病（LyP），另一端为皮肤表现的CD30+外周T细胞淋巴瘤（Ki-1+淋巴瘤）。据报道，甲氨蝶呤对LyP有效，但经验仅限于单例报告或小系列病例。
确定甲氨蝶呤治疗原发性皮肤CD30+淋巴增殖性疾病的有效性。
我们回顾了20年来使用甲氨蝶呤治疗45例相对严重的LyP、Ki-1+淋巴瘤和界面表现患者的经验。
在甲氨蝶呤诱导治疗期间，患者接受的最大剂量为每周10至60毫克（中位数为每周20毫克）。临床改善通常很快出现，通常在每周15至20毫克的剂量时出现，39例患者（87%）通过每10至14天（范围为7至28天）给予维持剂量实现了满意的长期控制。停用甲氨蝶呤后，10例患者在超过24个月至超过227个月（中位数为超过127个月）的时间内未出现CD30+病变。所有患者甲氨蝶呤治疗的总持续时间中位数超过39个月（范围为2至205个月）。不良反应一般较轻且为短暂性，包括疲劳（47%）、恶心（22%）、体重减轻（13%）、腹泻或胃肠道痉挛（10%）、血清肝转氨酶水平升高（27%）、贫血（11%）或白细胞减少（9%）。10例患者中有5例发现早期肝纤维化，所有这些患者的治疗时间均超过3年（范围为38至111个月）。
低剂量甲氨蝶呤（每1至4周给予25毫克或更少）是治疗部分原发性皮肤CD30+淋巴增殖性疾病患者的一种有效且耐受性良好的治疗方法。
