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Kaga M, Amano H, Kon T, Harada S, Ogura K. Other iatrogenic immunodeficiency-associated lymphoproliferative disorder presenting with multiple facial tumors. JAAD Case Rep 2024; 49:8-10. [PMID: 38873250 PMCID: PMC11170344 DOI: 10.1016/j.jdcr.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Affiliation(s)
- Maya Kaga
- Department of Dermatology and Allergy, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hirofumi Amano
- Department of Rheumatology and Internal Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takayuki Kon
- Department of Rheumatology and Internal Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Sakiko Harada
- Department of Hematology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kanako Ogura
- Department of Pathology, Juntendo University Nerima Hospital, Tokyo, Japan
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2
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Manabe M, Nagano Y, Okuno T, Inoue T, Koh KR. Methotrexate‑associated B‑cell lymphoproliferative disease that exhibits hematuria due to urinary bladder lesions: A case report. MEDICINE INTERNATIONAL 2024; 4:44. [PMID: 38912416 PMCID: PMC11190731 DOI: 10.3892/mi.2024.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/03/2024] [Indexed: 06/25/2024]
Abstract
Methotrexate (MTX)-related lymphoproliferative disease (LPD) is one of the most prominent late complications associated with MTX treatment. Although MTX-related LPD exhibits a relatively high incidence of extranodal disease, the incidence of disease in a urinary bladder is very low. The present study reports the case of a patient with MTX-related LPD involving a urinary bladder mass. A 75-year-old female patient, who had been receiving MTX for ~15 years, was referred to the hospital due to fever and hematuria. A computed tomography scan revealed the thickening of the urinary bladder wall, hydronephrosis and lymph node swelling. The histopathological findings of the urinary bladder mass resulted in a diagnosis of MTX-related LPD. Although MTX withdrawal did not have any effect, the subsequent chemotherapy resulted in complete remission. Although MTX-related LPD in the bladder is rare, it is pertinent to consider MTX-related LPD when hematuria is observed during MTX therapy.
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Affiliation(s)
- Masahiro Manabe
- Department of Hematology, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan
| | - Yuki Nagano
- Department of Urology, Minamiosaka Hospital, Osaka 559-0012, Japan
| | - Takahiro Okuno
- Department of Pathology, Minamiosaka Hospital, Osaka 559-0012, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka 534-0021, Japan
| | - Ki-Ryang Koh
- Department of Hematology, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan
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Torii A, Oki M, Iida H, Yamada A, Kogure Y, Kitagawa C, Saka H. The incidence and prognosis of other iatrogenic immunodeficiency-associated lymphoproliferative disorders of the lung related to methotrexate: A retrospective study. Pulm Pharmacol Ther 2024; 85:102297. [PMID: 38467341 DOI: 10.1016/j.pupt.2024.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/14/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
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.
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Affiliation(s)
- Atsushi Torii
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan.
| | - Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan
| | - Hiroatsu Iida
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Japan
| | - Arisa Yamada
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan
| | - Yoshihito Kogure
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan
| | - Chiyoe Kitagawa
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan
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Tsujii H, Nakayama R, Funakoshi S, Tsuji S, Haga H, Ono K. Polymorphic lymphoproliferative disorder arising in a rheumatoid arthritis patient, presenting as fibrin-associated large B-cell lymphoma-like lesions in aortic and mitral valves. Pathol Int 2024; 74:285-291. [PMID: 38563592 DOI: 10.1111/pin.13424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
We herein report a case of methotrexate-associated lymphoproliferative disorder (MTX-LPD) showing fibrin-associated large B-cell lymphoma-like heart valve lesions, and Epstein-Barr virus (EBV)-positive mucocutaneous ulcer-like cutaneous and oral mucosal lesions. MTX-LPD is a critical complication that can occur in RA patients who are treated with MTX. EBV also plays a defining or important role in LPDs. Among the sites of MTX-LPD, 40-50% occur in extranodal sites, including the gastrointestinal tract, skin, liver, lung, and kidney. There are few reports of MTX-LPDs involving the heart valves, and to the best of our knowledge, this is the first case to be reported in the English literature. The possibility of EBV-positive LPD should be considered in RA patients, even in patients with an atypical site, as in this case.
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Affiliation(s)
- Hideaki Tsujii
- Department of Diagnostic Pathology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
- Department of Diagnostic Pathology, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Ryuko Nakayama
- Department of Diagnostic Pathology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Sohei Funakoshi
- Department of Rheumatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Shuhei Tsuji
- Department of Cardiovascular Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Kazuo Ono
- Department of Diagnostic Pathology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
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5
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Li JJ, Chen L, Zhao Y, Yang XQ, Hu FB, Wang L. Data mining and safety analysis of traditional immunosuppressive drugs: a pharmacovigilance investigation based on the FAERS database. Expert Opin Drug Saf 2024; 23:513-525. [PMID: 38533933 DOI: 10.1080/14740338.2024.2327503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/13/2023] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The purpose of this study aimed to explore the new and serious adverse events(AEs) of Tacrolimus(FK506), cyclosporine(CsA), azathioprine(AZA), mycophenolate mofetil(MMF), cyclophosphamide(CTX) and methotrexate(MTX), which have not been concerned. METHODS The FAERS data from January 2016 and December 2022 were selected for disproportionality analysis to discover the potential risks of traditional immunosuppressive drugs. RESULTS Compared with CsA, FK506 has more frequent transplant rejection, and is more related to renal impairment, COVID-19, cytomegalovirus infection and aspergillus infection. However, CsA has a high infection-related fatality rate. In addition, we also found some serious and rare AE in other drugs which were rarely reported in previous studies. For example, AZA is closely related to hepatosplenic T-cell lymphoma with high fatality rate and MTX is strongly related to hypofibrinogenemia. CONCLUSION The AEs report on this study confirmed that the results were basically consistent with the previous studies, but there were also some important safety signals that were inconsistent with or not mentioned in previous published studies. EXPERT OPINION The opinion section discusses some of the limitations and shortcomings, proposing the areas where more effort should be invested in order to improve the safety of immunosuppressive drugs.
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Affiliation(s)
- Juan-Juan Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu, Sichuan, China
- Department of Pharmacy, Guangyuan Central Hospital, Guanyuan, Sichuan, China
| | - Li Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu, Sichuan, China
| | - Yang Zhao
- Department of Pharmacy, Guangyuan Central Hospital, Guanyuan, Sichuan, China
| | - Xue-Qin Yang
- Department of Pharmacy, Guangyuan Central Hospital, Guanyuan, Sichuan, China
| | - Fa-Bin Hu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu, Sichuan, China
- Department of Pharmacy, Jinniu Maternity and Child Health Hospital of Chengdu, Chengdu, Sichuan, China
| | - Li Wang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Ministry of Education, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Chengdu, Sichuan, China
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Medeiros LJ, Chadburn A, Natkunam Y, Naresh KN. Fifth Edition of the World Health Classification of Tumors of the Hematopoietic and Lymphoid Tissues: B-cell Neoplasms. Mod Pathol 2024; 37:100441. [PMID: 38309432 DOI: 10.1016/j.modpat.2024.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/05/2024]
Abstract
We review B-cell neoplasms in the 5th edition of the World Health Organization classification of hematolymphoid tumors (WHO-HEM5). The revised classification is based on a multidisciplinary approach including input from pathologists, clinicians, and other experts. The WHO-HEM5 follows a hierarchical structure allowing the use of family (class)-level definitions when defining diagnostic criteria are partially met or a complete investigational workup is not possible. Disease types and subtypes have expanded compared with the WHO revised 4th edition (WHO-HEM4R), mainly because of the expansion in genomic knowledge of these diseases. In this review, we focus on highlighting changes and updates in the classification of B-cell lymphomas, providing a comparison with WHO-HEM4R, and offering guidance on how the new classification can be applied to the diagnosis of B-cell lymphomas in routine practice.
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Affiliation(s)
- L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Yasodha Natkunam
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Kikkeri N Naresh
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle; Section of Pathology, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle
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Hayashi I, Toida M. A Rare Case of Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders With Multiple Oral Mucosal Lesions During Methotrexate Therapy. Cureus 2024; 16:e58995. [PMID: 38800284 PMCID: PMC11127638 DOI: 10.7759/cureus.58995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
As of the most recent WHO classification of immunodeficiency diseases, lymphoproliferative disorders that occur during treatment with immunosuppressive drugs are classified as "other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPDs)" other than post-transplant lymphoproliferative disorders. Most patients with OIIA-LPD have rheumatoid arthritis as the underlying disease. Research indicates that approximately half of people diagnosed with OIIA-LPD see a remission of their lesion after stopping treatment with methotrexate (MTX), a drug used in rheumatoid arthritis treatment. Hereby, we present the case of an 81-year-old woman with rheumatoid arthritis who developed OIIA-LPD at the bilateral lingual margins. The patient had been receiving MTX for the preceding 10 years. After determining that OIIA-LPD was MTX-related, the patient underwent MTX withdrawal and was treated conservatively. The lesion resolved one month after MTX withdrawal. This case report confirms immunosuppressive drug withdrawal as a potentially effective treatment for multiple OIIA-LPDs of the oral mucosa.
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Affiliation(s)
- Itsuki Hayashi
- Department of Oral and Maxillofacial Surgery, Sugita Genpaku Memorial Obama Public Hospital, Obama, JPN
| | - Makoto Toida
- Department of Oral and Maxillofacial Surgery, Sugita Genpaku Memorial Obama Public Hospital, Obama, JPN
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Gunasingha RMKD, Herrick-Reynolds K, Sanford JA, Radowsky J. Iatrogenic immunodeficiency-associated lymphoproliferative disorder presenting as small bowel perforation. BMJ Case Rep 2024; 17:e257148. [PMID: 38553024 PMCID: PMC10982773 DOI: 10.1136/bcr-2023-257148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
A woman in her late 50s on mycophenolate for limited systemic sclerosis presented with abdominal pain. Vital signs and investigative evaluations were normal. Cross-sectional imaging identified gastric and small bowel wall thickening, free fluid, and pneumoperitoneum. In the operating room, a small bowel perforation was found and resected. Postoperatively, immunosuppression was held and she completed a course of amoxicillin/clavulanate. She discharged home and re-presented on postoperative day 8 with seizures and was found to have a frontal brain mass which was biopsied. Pathology from both the resected bowel and brain biopsy demonstrated Epstein-Barr virus-positive B-cell lymphoproliferative disorder with polymorphic B-cell features. The patient's immunosuppression was discontinued, and she was enrolled in a clinical trial for chemotherapy. Lymphoproliferative disorder can present years after immunosuppression initiation with either spontaneous perforation or solid tumour. Pathological assessment determines treatment options. Heightened concern for atypical clinical presentations in immunosuppressed patients is always warranted.
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Affiliation(s)
| | | | - Jeffrey A Sanford
- Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jason Radowsky
- General Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Carbone A, Chadburn A, Gloghini A, Vaccher E, Bower M. Immune deficiency/dysregulation -associated lymphoproliferative disorders. Revised classification and management. Blood Rev 2024; 64:101167. [PMID: 38195294 DOI: 10.1016/j.blre.2023.101167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/13/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024]
Abstract
Significant advances in the field of lymphoma have resulted in two recent classification proposals, the International Consensus Classification (ICC) and the 5th edition WHO. A few entities are categorized differently in the ICC compared to the WHO. Nowhere is this more apparent than the immunodeficiency lymphoproliferative disorders. The three previous versions of the WHO classification (3rd, 4th and revised 4th editions) and the ICC focused on four clinical settings in which these lesions arise for primary categorization. In contrast the 2023 WHO 5th edition includes pathologic characteristics including morphology and viral status, in addition to clinical setting, as important information for lesion classification. In addition, the 2023 WHO recognizes a broader number of clinical scenarios in which these lesions arise, including not only traditional types of immune deficiency but also immune dysregulation. With this classification it is hoped that new treatment strategies will be developed leading to better patient outcomes.
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Affiliation(s)
- Antonino Carbone
- Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, National Cancer Institute, Aviano, Italy.
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States of America.
| | - Annunziata Gloghini
- Department of Advanced Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Emanuela Vaccher
- Infectious Diseases and Tumors Unit, Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy.
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK.
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10
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Nicol JTJ, Mazzoni E, Iaquinta MR, De Pace R, Gaboriaud P, Maximova N, Cason C, De Martino E, Mazziotta C, Coursaget P, Touzé A, Boz V, Comar M, Tognon M, Martini F. Prevalence of IgG antibodies against Malawi polyomavirus in patients with autoimmune diseases and lymphoproliferative disorders subjected to bone marrow transplantation. Front Immunol 2024; 14:1293313. [PMID: 38299147 PMCID: PMC10827882 DOI: 10.3389/fimmu.2023.1293313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Human polyomaviruses (HPyVs) cause persistent/latent infections in a large fraction of the population. HPyV infections may cause severe diseases in immunocompromised patients. Malawi polyomavirus (MWPyV) is the 10th discovered human polyomavirus (HPyV 10). MWPyV was found in stool samples of healthy children. So far, the few investigations carried out on HPyV 10 did not find an association with human disease. Methods In this study, to verify the putative association between MWPyV and human diseases, MWPyV seroprevalence was investigated in patients affected by i) lymphoproliferative disorders (LPDs) and ii) immune system disorders, i.e., autoimmune diseases (ADs), and in iii) healthy subjects. An indirect ELISA, employing virus-like particles (VLPs) to detect serum IgG antibodies against MWPyV/HPyV 10, was carried out. The study also revealed the prevalence of another polyomavirus, Merkel cell polyomavirus (MCPyV). Results Sera from patients with distinct autoimmune diseases (n = 44; mean age 20 years) had a prevalence of MWPyV antibodies of 68%, while in patients with lymphoproliferative disorders (n = 15; mean age 14 years), subjected to bone marrow transplantation, the prevalence was 47%. In healthy subjects (n = 66; mean age 13 years), the prevalence of MWPyV antibodies was 67%. Our immunological investigation indicates that MWPyV/HPyV 10 seroconversion occurs early in life and MWPyV/HPyV 10 appears to be another polyomavirus ubiquitous in the human population. A significantly lower MWPyV antibody reactivity together with a lower immunological profile was detected in the sera of LPD patients compared with HS2 (*p < 0.05) (Fisher's exact test). LPD and AD patients have a similar MCPyV seroprevalence compared with healthy subjects. Discussion MWPyV seroprevalence indicates that this HPyV is not associated with lymphoproliferative and autoimmune diseases. However, the ability to produce high levels of antibodies against MWPyV appears to be impaired in patients with lymphoproliferative disorders. Immunological investigations indicate that MWPyV seroconversion occurs early in life. MCPyV appears to be a ubiquitous polyomavirus, like other HPyVs, in the human population.
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Affiliation(s)
- Jérôme T. J. Nicol
- UMR 1282 ISP Team Biologie des Infections à Polyomavirus, Faculty of Pharmacy, University of Tours, Tours, France
| | - Elisa Mazzoni
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | | | - Raffaella De Pace
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Pauline Gaboriaud
- UMR 1282 ISP Team Biologie des Infections à Polyomavirus, Faculty of Pharmacy, University of Tours, Tours, France
| | - Natalia Maximova
- Onco-Hematology Division, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Carolina Cason
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Eleonora De Martino
- Laboratory of Pediatric Immunology, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Chiara Mazziotta
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Pierre Coursaget
- UMR 1282 ISP Team Biologie des Infections à Polyomavirus, Faculty of Pharmacy, University of Tours, Tours, France
| | - Antoine Touzé
- UMR 1282 ISP Team Biologie des Infections à Polyomavirus, Faculty of Pharmacy, University of Tours, Tours, France
| | - Valentina Boz
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Manola Comar
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Mauro Tognon
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Fernanda Martini
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Laboratory for Technologies of Advanced Therapies, University of Ferrara, Ferrara, Italy
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Spadaro JZ, Perzia B, Perincheri S, Habib L. A Rare Case of Methotrexate-Associated Lymphoproliferative Disease in the Orbit. Ophthalmic Plast Reconstr Surg 2024; 40:e28-e31. [PMID: 37791841 DOI: 10.1097/iop.0000000000002528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
An 80-year-old Caucasian female with a history of rheumatoid arthritis presented with a 6-month history of progressive right upper eyelid ptosis, edema, erythema, and pain. MRI demonstrated a superior orbital mass. An incisional biopsy was performed, and pathologic analysis revealed an atypical lymphoid infiltrate, co-expressing both B and T-cell markers, with a low proliferation rate. Flow cytometry and IgH rearrangement study did not demonstrate any B- or T-cell monoclonal proliferation. Based on these findings, she was diagnosed with an iatrogenic immunodeficiency-associated lymphoproliferative disorder. Discontinuation of methotrexate resulted in the complete resolution of her symptoms, and she remains in remission 18 months later. Given the increased risk of lymphoproliferative disease in patients with rheumatoid arthritis, careful evaluation and close monitoring upon immunosuppressive medication withdrawal is necessary to confirm the diagnosis.
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Affiliation(s)
- Jane Z Spadaro
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, Connecticut, U.S.A
- Kahana Oculoplastic and Orbital Surgery, Michigan, U.S.A
| | - Brittany Perzia
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, Connecticut, U.S.A
| | - Sudhir Perincheri
- Department of Pathology, Yale University School of Medicine, Connecticut, U.S.A
| | - Larissa Habib
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, Connecticut, U.S.A
- Northeast Ophthalmic Plastic and Reconstructive Surgery, Connecticut, U.S.A
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Miyamoto Y, Kawasoe C, Ito K, Oguri N, Murashima T, Kamibeppu T, Nagai T, Takamori H, Kamimura T, Mukai S, Sato Y, Kamoto T. Hepatic and lung methotrexate-associated polymorphic lymphoproliferative disorders arising during postoperative follow-up of renal cell carcinoma: a case report. J Med Case Rep 2023; 17:524. [PMID: 38129899 PMCID: PMC10740260 DOI: 10.1186/s13256-023-04288-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Methotrexate induces lymphoproliferative disorders on rare occasions; however, its pathogenesis remains unknown. A clinical diagnosis based on imaging studies alone is often difficult. CASE PRESENTATION A 57-year-old Japanese woman was referred to our department for the evaluation of multiple lung and hepatic nodules that developed during methotrexate treatment for rheumatoid arthritis. Since she had a history of nephrectomy for localized renal cell carcinoma, multiple lung and hepatic metastases were initially considered. However, pathological diagnosis of the lung nodules (needle biopsy) revealed methotrexate-associated polymorphic-type lymphoproliferative disorders. After methotrexate discontinuation, continuous smooth shrinkage of the lung and liver lymphoproliferative disorders was observed. CONCLUSION Methotrexate-associated lymphoproliferative disorders should be considered in the event of newly appearing neoplastic lesions, even during follow-up for renal cell carcinoma, if methotrexate is being administered.
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Affiliation(s)
- Yoshi Miyamoto
- Department of Urology, Faculty of Medicine, Miyazaki University Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Chihiro Kawasoe
- Department of Urology, Faculty of Medicine, Miyazaki University Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Kaoru Ito
- Department of Urology, Faculty of Medicine, Miyazaki University Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Nobuyuki Oguri
- Department of Diagnostic Pathology, Faculty of Medicine, Miyazaki University Hospital, Miyazaki, Japan
| | - Takaya Murashima
- Department of Urology, Faculty of Medicine, Miyazaki University Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | | | - Takahiro Nagai
- Department of Urology, Faculty of Medicine, Miyazaki University Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hiroki Takamori
- Department of Urology, Faculty of Medicine, Miyazaki University Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Toshio Kamimura
- Department of Urology, Faculty of Medicine, Miyazaki University Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Shoichiro Mukai
- Department of Urology, Faculty of Medicine, Miyazaki University Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Yuichiro Sato
- Department of Diagnostic Pathology, Faculty of Medicine, Miyazaki University Hospital, Miyazaki, Japan
| | - Toshiyuki Kamoto
- Department of Urology, Faculty of Medicine, Miyazaki University Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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13
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Gao HX, Duan YL, Zhou CJ, Zhang NN, Jin L, Yang J, Huang S, Zhang M, Zhang YH. [Other iatrogenic immunodeficiency associated lymphoproliferative diseases in children with lymphoma: a case report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:1045-1048. [PMID: 38503532 PMCID: PMC10834865 DOI: 10.3760/cma.j.issn.0253-2727.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Indexed: 03/21/2024]
Affiliation(s)
- H X Gao
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - Y L Duan
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - C J Zhou
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - N N Zhang
- Department of Imaging, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - L Jin
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - J Yang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - S Huang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - M Zhang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - Y H Zhang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
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14
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Takanashi S, Kondo Y, Saito S, Kikuchi J, Hanaoka H, Takeuchi T, Kaneko Y. Effectiveness and safety of rituximab in special types of rheumatoid arthritis. Int J Rheum Dis 2023; 26:2240-2247. [PMID: 37705311 DOI: 10.1111/1756-185x.14920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES To elucidate the efficacy and safety of rituximab in special types of rheumatoid arthritis. METHODS We retrospectively reviewed all patients with rheumatoid arthritis with lymphoproliferative disorder or vasculitis treated with rituximab between April 2010 and June 2022 at Keio University Hospital. We assessed the effectiveness of rituximab using the Disease Activity Score for 28 joints-erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), and safety of rituximab during the disease course. We also assessed the glucocorticoid-sparing effects of rituximab. RESULTS We included eight patients with a history of lymphoproliferative disorder and five patients with rheumatoid vasculitis. They were treated with rituximab without high-dose glucocorticoid. The mean DAS28-ESR and CDAI scores significantly improved 12 months after rituximab administration (DAS28-ESR, 4.7 vs. 2.7, p < .001; CDAI, 16.0 vs. 5.1, p = .006, respectively), and the dose of prednisolone was reduced from a mean of 7.4 mg/day to 4.0 mg/day at 12 months (p = .05) and 3.2 mg/day at the last visit (p = .04). During the mean follow-up period of 52 months, we recorded one recurrence of lymphoproliferative disorder (not B-cell type) in patients with a history of lymphoproliferative disorder and remarkable improvement of skin ulcers in patients with vasculitis. CONCLUSION B-cell depletion by rituximab may be a useful treatment option for patients with lymphoproliferative disorder and rheumatoid vasculitis.
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Affiliation(s)
- Satoshi Takanashi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Kondo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuntaro Saito
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hironari Hanaoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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15
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Obama K, Yamamoto H, Inoue H. Complete remission of aggressive Epstein-Barr virus-positive diffuse large B-cell lymphoma following withdrawal of tacrolimus and low-dose anticancer drugs. EJHAEM 2023; 4:1160-1163. [PMID: 38024598 PMCID: PMC10660111 DOI: 10.1002/jha2.761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 12/01/2023]
Abstract
A 66-year-old woman who had received tacrolimus for more than 11 years was admitted with high fever, generalized lymphadenopathy, and persistent gastrointestinal bleeding. Histopathological evaluation of the lymph nodes and colonic mucosa confirmed the diagnosis of Epstein-Barr virus-positive diffuse large B-cell lymphoma. After discontinuation of tacrolimus, the lymphoma did not improve, and low-dose chemotherapy was introduced, which resulted in a recovery of lymphocyte counts and induction of complete remission. Low-dose anticancer treatments that suppress tumor growth while awaiting normal lymphocyte recovery for several weeks may be a useful therapeutic option even for aggressive lymphomas that develop during immunosuppressant therapy.
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Affiliation(s)
- Kosuke Obama
- Department of HematologyImakiire General HospitalKagoshimaJapan
| | - Hana Yamamoto
- Department of HematologyImakiire General HospitalKagoshimaJapan
| | - Hirosaka Inoue
- Department of HematologyImakiire General HospitalKagoshimaJapan
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16
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Ueda Y, Tanaka T, Asakura S, Yano T. A case of classic Hodgkin lymphoma arising after remission of methotrexate-associated follicular lymphoma. J Clin Exp Hematop 2023; 63:177-180. [PMID: 37518272 PMCID: PMC10628826 DOI: 10.3960/jslrt.23016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Here we describe our experience with a rare case of methotrexate (MTX)-associated lymphoproliferative disorder (LPD) initially diagnosed as follicular lymphoma (FL) and then in relapse as classic Hodgkin lymphoma (CHL). A 66-year-old man was admitted to the hospital with fever and abdominal and lower back pain after a transient remission of MTX-associated FL (MTX-FL) following MTX withdrawal. Computed tomography (CT) showed para-aortic lymphadenopathy, which was compatible with one of the previous FL lesions. We considered a relapse of FL and started bendamustine and rituximab. Although his initial symptoms and para-aortic lymphadenopathy regressed after the first course, he began to have dorsal pain, and multiple osteolytic lesions were detected on CT. We biopsied a Th4 vertebra osteolytic lesion, and the results indicated MTX-associated CHL (MTX-CHL). We successfully treated advanced MTX-CHL with brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD). This case suggests the importance of repeat biopsy of a new lesion arising after resolution of previously affected sites in MTX-LPD and the effectiveness of A+AVD in treating advanced MTX-CHL.
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17
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Tseng CW, Gupta L. Other iatrogenic immunodeficiency-associated lymphoproliferative disorders in anti-melanoma differentiation-associated protein 5 associated myositis-Truly iatrogenic or primary immunodeficiency? Int J Rheum Dis 2023; 26:1653-1655. [PMID: 37664961 DOI: 10.1111/1756-185x.14788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Chih-Wei Tseng
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
- Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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18
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Yamaoka K, Oku K. JAK inhibitors in rheumatology. Immunol Med 2023; 46:143-152. [PMID: 36744577 DOI: 10.1080/25785826.2023.2172808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/22/2023] [Indexed: 02/07/2023] Open
Abstract
Janus kinase inhibitors (JAKis) are a group of drugs with a different mechanism of action from biologics and are most rapidly uptaken in the rheumatology field. JAK is a protein kinase activated in the cytoplasm by multiple cytokines and hormones involved in inflammatory pathology. The expression of JAK has been observed in various diseases, indicating the utility of JAK inhibitors in a wide variety of immune-mediated inflammatory diseases. Clinical trials are underway for a number of different rheumatic diseases based on the therapeutic efficacy of JAKis, which is comparable to that of biologics. This article will review the current status of JAKis for rheumatic diseases in terms of efficacy and safety and extend to future clinical applications for rare diseases.
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Affiliation(s)
- Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kenji Oku
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
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19
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Sato D, Takami H, Takayanagi S, Taoka K, Tanaka M, Matsuura R, Tanaka S, Saito N. Lymphoproliferative disorder during temozolomide therapy; a representative case of a formidable complication and management challenges. BMC Neurol 2023; 23:224. [PMID: 37296412 DOI: 10.1186/s12883-023-03274-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Lymphoproliferative disorder represents a heterogeneous clinicopathological spectrum characterized by uncontrolled proliferation of lymphocytes. Immunodeficiency is a major trigger of its development. While induction of immunodeficiency is a well-known adverse effect of temozolomide therapy, development of lymphoproliferative disorder following temozolomide therapy has not previously been described. CASE PRESENTATION A patient with brainstem glioma developed constitutional symptoms, pancytopenia, splenomegaly and generalized lymphadenopathy during the 2nd cycle of maintenance therapy following induction therapy with temozolomide. Epstein-Barr virus-infected lymphocytes were observed histopathologically and "other iatrogenic immunodeficiency-associated lymphoproliferative disorder" (OIIA-LPD) was diagnosed. Although discontinuation of temozolomide led to rapid remission, relapse was observed 4 months later. CHOP chemotherapy was induced, resulting in secondary remission. Vigilant follow-up for another 14 months showed radiologically stable brainstem glioma and no further recurrence of OIIA-LPD. CONCLUSIONS This is the first report documenting OIIA-LPD during temozolomide administration. Timely diagnosis of the disease and discontinuation of the causative agent were considered to be the management of choice. Close monitoring for relapse should be continued. Finding a balance between glioma management and controlling the remission of OIIA-LPD remains to be clarified.
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Affiliation(s)
- Daisuke Sato
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Hirokazu Takami
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Shunsaku Takayanagi
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kazuki Taoka
- Department of Hematology and Oncology, The University of Tokyo Hospital, Tokyo, Japan
| | - Mariko Tanaka
- Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan
| | - Reiko Matsuura
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Shota Tanaka
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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Kitamura T, Shigemura T, Yamamoto Y, Murata Y. Pathological Vertebral Fracture Arising From Methotrexate-Associated Lymphoproliferative Disorder in a Patient With Systemic Lupus Erythematosus. Cureus 2023; 15:e40079. [PMID: 37425534 PMCID: PMC10326866 DOI: 10.7759/cureus.40079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
The incidence of lymphoproliferative disorders associated with methotrexate is rising in patients with rheumatoid arthritis. These disorders typically exhibit spontaneous tumor regression upon discontinuation of methotrexate therapy. Spinal lesions associated with these diseases are extremely rare. We present a case of systemic lupus erythematosus in which the patient developed lumbar spine lymphoproliferative disorders secondary to methotrexate therapy, which failed to regress despite discontinuation of the drug, ultimately leading to pathological fracture necessitating posterior spinal fixation. A 60-year-old woman had been diagnosed with systemic lupus erythematosus at the age of 55 years and had been taking prednisolone, hydroxychloroquine, and methotrexate. Throughout the course of her treatment, she experienced recurrent tumefaction and lymph node swelling in various locations. These masses and lymphadenopathy were believed to be potential complications of methotrexate-associated lymphoproliferative disorders, leading to the discontinuation of methotrexate. One month prior to cessation of methotrexate therapy, the patient presented to an orthopedic clinic with lower back pain, and T2-weighted magnetic resonance imaging revealed low signal intensity in the Th10 and L2 vertebrae, initially misdiagnosed as lumbar spinal stenosis. The patient was eventually referred to our department under suspicion of malignant pathology. Computed tomography identified a vertical fracture of the L2 vertebra, which, in conjunction with the imaging results, led to the diagnosis of pathological fracture secondary to methotrexate-associated lymphoproliferative disorder. Following admission to our department, bone biopsy and percutaneous pedicle screw fixation were performed one week later. Pathological examination confirmed the diagnosis of methotrexate-associated lymphoproliferative disorder. Given the possibility of pathological fracture in patients on methotrexate therapy experiencing severe back pain, additional imaging studies should be considered.
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Affiliation(s)
- Takaki Kitamura
- Orthopaedics, Chiba University, Graduate School of Medicine, Chiba, JPN
| | | | - Yohei Yamamoto
- Orthopaedics, Teikyo University Chiba Medical Center, Ichihara, JPN
| | - Yasuaki Murata
- Orthopaedics, Teikyo University Chiba Medical Center, Ichihara, JPN
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21
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Classification of B-Cell Lymphomas and Immunodeficiency-Related Lymphoproliferations: What’s New? HEMATO 2023. [DOI: 10.3390/hemato4010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
New insights from genomic studies have had an impact on the definition and the diagnosis of several lymphoid tumors including follicular B-cell lymphomas, aggressive diffuse large B-cell lymphomas, and lymphoproliferations associated with acquired and posttransplant immunodeficiencies. Follicular lymphoma (FL) includes tumors whose behavior varies widely from indolent/early lesions to aggressive/transformed lymphomas. Although some large B-cell lymphomas can be subclassified as specific entities, the majority lack the characteristics necessary for subclassification and, thus, are termed diffuse large B-cell lymphoma, NOS. There have been, however, some changes in the classification of specific subtypes of large B-cell lymphoma as well as the addition of new entities, a few of which are highlighted in this article. The immunodeficiency-related lymphoproliferative disorders are currently divided into four major categories based on the clinical setting in which they arose: primary immune deficiency, post-transplant, HIV infection, and iatrogenic immunosuppression. In the two upcoming classifications systems for hematolymphoid neoplasms, International Consensus Classification (ICC) and WHO-HAEM-5, there is a divergence in the approach to categorize these lesions. Furthermore, whereas the WHO-HAEM-5 confirms the ability to classify a spectrum of EBV+ lesions as EBV+ DLBCL, NOS, the ICC has separated out lesions that are composed of a heterogenous cellular infiltrate into a new separate category, “EBV-positive polymorphic B cell lymphoproliferative disorder, NOS”. Both WHO-HAEM-5 and ICC recognize a number of KSHV/HHV8-associated lymphoid lesions and acknowledge that there is significant overlap among the different lesions. In the future, translation of these innovations in general practice requires further validation.
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22
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MIZUSHIMA M, ISHI Y, IKEDA H, ECHIZENYA I, OTSUKA T, MITSUHASHI T, YAMAGUCHI S, FUJIMURA M. Successful Treatment of Intracranial Methotrexate-associated Lymphoproliferative Disorder without Epstein-Barr Virus Infection Using Rituximab, Methotrexate, Procarbazine, and Vincristine: A Case Report. NMC Case Rep J 2022; 9:237-242. [PMID: 36061907 PMCID: PMC9398467 DOI: 10.2176/jns-nmc.2022-0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/08/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Makoto MIZUSHIMA
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Yukitomo ISHI
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Hiroshi IKEDA
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Ikuma ECHIZENYA
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | | | | | - Shigeru YAMAGUCHI
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Miki FUJIMURA
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
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23
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FDG-PET findings associated with various medical procedures and treatments. Jpn J Radiol 2022; 41:459-476. [PMID: 36575286 PMCID: PMC9794480 DOI: 10.1007/s11604-022-01376-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established modality with high sensitivity for the diagnosis and staging of oncologic patients. FDG is taken up by the glucose transporter of the cell membrane and becomes trapped within the cell. In addition to malignant neoplasms, active inflammatory lesions and some kinds of benign tumors also accumulate FDG. Moreover, the degree of uptake into normal organs and tissues depends on various physiological conditions, which is affected by various medical procedures, treatments, and drugs. To avoid misleading interpretations, it is important to recognize possible situations of unexpected abnormal accumulation that mimic tumor lesions. In this review, we present various FDG findings associated with surgical or medical procedures and treatments. Some findings reflect the expected physiological reaction to treatment, and some show inflammation due to prior procedures. Occasionally, FDG-PET visualizes other disorders that are unrelated to the malignancy, which may be associated with the adverse effects of certain drugs that the patient is taking. Careful review of medical records and detailed interviews of patients are thus necessary.
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24
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Ueno H, Ohno N, Abe T, Kimoto K, Matsuoka C, Giga M, Naito H, Kono T, Takasu M, Kidani N, Yamasaki R, Ichimura K, Nomura E. Prognosis Prediction Using Magnetic Resonance Spectroscopy and Oligoclonal Bands in Central Nervous System Methotrexate-associated Lymphoproliferative Disorder. Intern Med 2022; 61:3733-3738. [PMID: 35598995 PMCID: PMC9841117 DOI: 10.2169/internalmedicine.9296-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Central nervous system methotrexate-associated lymphoproliferative disorder (CNS-MTX-LPD) is rare, but its spontaneous regression has been observed in some patients after withdrawal of agents. We herein report three cases of primary CNS-MTX-LPD that received oral MTX for rheumatoid arthritis. Epstein-Barr virus and oligoclonal bands (OCBs) were positive, while proton magnetic resonance spectroscopy (1H-MRS) showed an elevated lipid peak and slightly elevated choline/N-acetylaspartate ratio in common. After MTX withdrawal, brain lesions showed spontaneous regression in all cases. Our patient's 1H-MRS findings and OCBs may reflect a non-monoclonal lymphoproliferative histology as benign-type lesions in CNS-MTX-LPD.
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Affiliation(s)
- Hiroki Ueno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Narumi Ohno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Takafumi Abe
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Kazuki Kimoto
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Chika Matsuoka
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Mayumi Giga
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Hiroyuki Naito
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Miyuki Takasu
- Department of Radiology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Naoya Kidani
- Department of Neurosurgery and Neuroendovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Rie Yamasaki
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Koichi Ichimura
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Japan
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25
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Ito K, Uchino Y, Hirano K, Sekiguchi N. Other iatrogenic immunodeficiency lymphoproliferative disorder induced by corticosteroid used for an autoimmune disorder. J Int Med Res 2022; 50:3000605221144149. [PMID: 36518090 PMCID: PMC9761222 DOI: 10.1177/03000605221144149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Other iatrogenic immunodeficiency lymphoproliferative disorders (oii-LPD) are defined as lymphoid proliferations or lymphomas that occur in patients taking immunosuppressive agents (ISA) for autoimmune disorders (AID). Although methotrexate and tumor necrosis factor-alpha inhibitors cause oii-LPD, the association between corticosteroids and lymphomagenesis remains unknown. Herein, we present the case of a 51-year-old woman with oii-LPD caused by corticosteroid use for autoimmune hemolytic anemia (AIHA). The diagnosis of AIHA was made in May 2016, and AIHA had been well-controlled for 5 years with oral prednisolone (PSL). During a regular follow-up visit in March 2022, an abnormal increase in atypical lymphoid cells in the peripheral blood was found. The bone marrow biopsy specimens showed local aggregations of large cells that were identified as lymphoplasmacytic cells and plasma cells, and that were positive for cluster of differentiation (CD)19 and CD20, with apparent nucleoli among the diffuse infiltration of atypical small lymphocytes. The large cells were partially positive for the Epstein-Barr encoding region in situ hybridization and latent membrane protein 1, which confirmed Epstein-Barr virus (EBV)-affected lymphomagenesis. To our knowledge, this is the first report of an oii-LPD case shown to be induced by corticosteroid use for AID.
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Affiliation(s)
- Kenichi Ito
- Hematology Division, National Hospital Organization Disaster
Medical Center, Tokyo, Japan
| | - Yoshihito Uchino
- Hematology Division, National Hospital Organization Disaster
Medical Center, Tokyo, Japan
| | - Kazuhiko Hirano
- Laboratory and Pathology Division, National Hospital
Organization Disaster Medical Center, Tokyo, Japan
| | - Naohiro Sekiguchi
- Hematology Division, National Hospital Organization Disaster
Medical Center, Tokyo, Japan,Clinical Research Division, National Hospital Organization
Disaster Medical Center, Tokyo, Japan,Naohiro Sekiguchi, Hematology Division,
National Hospital Organization Disaster Medical Center, 3256 Midori-cho,
Tachikawa, Tokyo 190-0014, Japan.
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26
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Kurisu N, Hiyama T, Harada Y, Fukushima N, Katsuya N, Ureshino H, Ichinohe T, Kiuchi Y. Vitreoretinal Lymphoma in a Patient with Rheumatoid Arthritis with a History of Methotrexate-associated Lymphoproliferative Disorders. Ocul Immunol Inflamm 2022:1-6. [PMID: 36395469 DOI: 10.1080/09273948.2022.2144384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
Methotrexate (MTX) may induce immunosuppression and facilitate the onset of lymphoproliferative disorders (LPD). Most cases of MTX-LPD occur in patients with rheumatoid arthritis; the incidence is high in Japan. Vitreoretinal lymphoma (VRL) is a rare non-Hodgkin's lymphoma that can masquerade as steroid-resistant chronic uveitis, leading to fatal diagnostic delay. A 68-year-old woman exhibited optic disc swelling and retinal vasculitis causing floaters in the right eye. She was undergoing long-term MTX treatment for rheumatoid arthritis; she previously had been diagnosed with MTX-LPD, which regressed upon discontinuation of MTX. Steroid therapy was ineffective for optic disc swelling and retinal vasculitis; her best-corrected visual acuity decreased to 20/400. Vitreous biopsy revealed VRL, which was successfully treated with high-dose MTX-based systemic chemotherapy and intravitreal injections of MTX. To our knowledge, this is the first case report of VRL in a patient with an autoimmune disease who have a history of MTX-LPD.
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Affiliation(s)
- Naho Kurisu
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
- Department of Ophthalmology, Miyoshi Central Hospital, Hiroshima, Japan
| | - Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Noriyasu Fukushima
- Department of Haematology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Narutaka Katsuya
- Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Ureshino
- Department of Haematology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Tatsuo Ichinohe
- Department of Haematology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Watanabe T, Teratani Y. Unusual manifestation of methotrexate-associated lymphoproliferative disorder as a palatal mass. BMJ Case Rep 2022; 15:e250616. [PMID: 36175042 PMCID: PMC9528599 DOI: 10.1136/bcr-2022-250616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Methotrexate-associated lymphoproliferative disorder (MTX-LPD) can occur in the oral cavity, and only a few cases with palatal involvement have been reported. Chemotherapy may be needed if there is no remission after the withdrawal of MTX. We report a case of MTX-LPD presenting with a swelling of the palate that required chemotherapy. A woman in her 70s with rheumatoid arthritis reported a swelling on the left side of the palate. Her condition was diagnosed as Epstein-Barr virus-negative diffuse large B-cell lymphoma (MTX-LPD). Since the mass did not remit after MTX withdrawal, she underwent five courses of chemotherapy. Currently, the patient is in complete remission. In patients on MTX who develop a swelling on the palate, MTX-LPD should be included among the differential diagnostic possibilities. Diagnosis and treatment of MTX-LPD call for consultation with a haematologist. If the mass fails to regress following withdrawal of MTX, appropriate chemotherapy is indicated.
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Affiliation(s)
- Takuma Watanabe
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukina Teratani
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ohgaki F, Takemoto Y, Paku S, Tatezuki J, Kumagai J, Shuto T, Mochimatsu Y. Primary central nervous system other iatrogenic immunodeficiency-associated lymphoproliferative disorders presenting as extraosseous plasmacytoma with a progressive clinical course: A case report and literature review. Neuropathology 2022; 43:151-157. [PMID: 36065518 DOI: 10.1111/neup.12863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/07/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022]
Abstract
Other iatrogenic immunosuppressive-associated lymphoproliferative disorders (OIIA-LPDs) rarely occur in the central nervous system (CNS). Additionally, they almost always present as lymphoma and withdrawal by cessation of immunosuppressive treatment. We report a case of primary CNS OIIA-LPD that presented as extraosseous plasmacytoma (EP) with a progressive clinical course in spite of immunosuppressive treatment cessation. A 78-year-old man with a history of rheumatoid arthritis (RA) presented with a month-long headache. Magnetic resonance imaging showed mass lesions in the left temporal lobe, left middle fossa, and intradural cervical spine. The left temporal lesion was resected and diagnosed as EP histologically, and OIIA-LPD presented as plasmacytoma integrally due to his history of immunosuppressive treatment using tacrolimus for RA. Despite immunosuppressive treatment cessation, OIIA-LPD lesions did not regress but, on the contrary, showed a progressive clinical course. Considering his advanced age and renal dysfunction, postoperative treatment with radiation and moderate chemotherapy using prednisolone were administrated. Subsequently, the disease state stabilized, and the patient had a Karnofsky performance status score of 90 for 6 months; however, the tumor recurred with meningeal dissemination, and he died 8 months after treatment. Types of OIIA-LPD onset as EP and its progressive clinical course resistant to cessation of immunosuppressive treatment are rare. Moreover, this OIIA-LPD disease state worsened despite its radiosensitivity. We believe the progressive clinical course of this OIIA-LPD case with its high cell proliferation is similar to Epstein-Barr virus negative plasmablastic lymphoma, which could lead to a poor outcome.
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Affiliation(s)
- Fukutaro Ohgaki
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Yasunori Takemoto
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Sujong Paku
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Junya Tatezuki
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Jiro Kumagai
- Department of Pathology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Takashi Shuto
- Department of Stereotactic Radiotherapy Center, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yasuhiko Mochimatsu
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
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Umekita K. Effect of HTLV-1 Infection on the Clinical Course of Patients with Rheumatoid Arthritis. Viruses 2022; 14:v14071460. [PMID: 35891440 PMCID: PMC9323945 DOI: 10.3390/v14071460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 02/06/2023] Open
Abstract
Human T-cell leukemia virus type 1 (HTLV-1) is the causative agent of adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The effects of HTLV-1 on health are not fully elucidated. Epidemiological studies have shown that the prevalence of HTLV-1 infection is high in patients with rheumatic diseases. The prevalence of comorbidities, such as Sjögren’s syndrome and rheumatoid arthritis (RA), is higher in patients with HAM/TSP than the in general population. Studies have shown the effects of HTLV-1-infection on the clinical course of RA. Major questions on the association between HTLV-1 infection and RA: (1) Is it possible that HTLV-1 infection causes RA? (2) Do patients with RA who are infected with HTLV-1 have different clinical features? (3) Are immunosuppressants associated with an increased prevalence of HAM/TSP or ATL in RA patients with HTLV-1 infection? Is ATL an immunosuppressive therapy-associated lymphoproliferative disorder? No large-scale studies have investigated the incidence of ATL in patients with RA. However, several studies have reported the development of ATL in patients with RA who have HTLV-1 infection. This review aimed to shed light on the association between HTLV-1 infection and RA and summarize the unmet medical needs of RA patients with HTLV-1 infection.
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Affiliation(s)
- Kunihiko Umekita
- Division of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
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Afonso C, Roque A, Almeida C, Pimentão MB, Julião MJ, Silva R, Geraldes C, Gomes M. Methotrexate-Associated Lymphoproliferative Disorder in a Patient with Psoriasis: A Case Report and Review of the Literature. Case Rep Hematol 2022; 2022:7178065. [PMID: 35535243 PMCID: PMC9078817 DOI: 10.1155/2022/7178065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022] Open
Abstract
Iatrogenic immunodeficiency-associated lymphoproliferative disorders (LPDs) are heterogeneous clinicopathological entities developing in patients receiving immunosuppression. Outside the posttransplant setting, methotrexate (MTX), a drug commonly used for the treatment of autoimmune diseases, is an immunosuppressive agent frequently reported to be associated with LPD. MTX-associated LPD (MTX-LPD) includes a spectrum of lymphocytic proliferations, ranging from polyclonal hyperplasia to malignant lymphoma. MTX-LPD diagnosis can be challenging, as signs and symptoms are often nonspecific and may overlap with those of several other conditions, including exacerbation of the underlying autoimmune disease. Spontaneous regression of LPD after MTX discontinuation is characteristic of MTX-LPD, therefore avoiding chemotherapeutic intervention in a significant proportion of patients. Other cases, however, should receive chemotherapy.
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Affiliation(s)
- Carolina Afonso
- Hematology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Adriana Roque
- Hematology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cátia Almeida
- Hematology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria Beatriz Pimentão
- Pathology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria José Julião
- Pathology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rodolfo Silva
- Nuclear Medicine Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Catarina Geraldes
- Hematology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marília Gomes
- Hematology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Kawano H, Kitamura T, Higuchi K, Nozaki K. Primary Central Nervous System T-cell Lymphoma as Methotrexate-associated Lymphoproliferative Disorders: Case Report. NMC Case Rep J 2022; 8:253-259. [PMID: 35079472 PMCID: PMC8769407 DOI: 10.2176/nmccrj.cr.2020-0234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/11/2020] [Indexed: 11/20/2022] Open
Abstract
We report a rare case of primary central nervous system (CNS) lymphoma as methotrexate-associated lymphoproliferative disorders (MTX-LPD). A 75-year-old woman who had been treated for rheumatoid arthritis (RA) with MTX for 3 years was admitted to our hospital complaining of unsteady gait, nausea, and vomiting. T2-weighted image of magnetic resonance imaging (MRI) showed multiple high intensity mass-like lesions including right lateral, frontal and temporal lobes, and right cerebellar hemisphere. We performed surgical biopsy, and the pathological and immunohistochemical examinations identified T-cell lymphoma. The tumor regressed and the symptoms were resolved soon after MTX withdrawal. Primary CNS lymphoma due to MTX-LPD is a rare disease and only eight cases including ours are reported.
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Affiliation(s)
- Hiroto Kawano
- Department of Neurosurgery, Japanese Red Cross Nagahama Hospital, Nagahama, Shiga, Japan.,Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tomoaki Kitamura
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kazushi Higuchi
- Department of Neurosurgery, Japanese Red Cross Nagahama Hospital, Nagahama, Shiga, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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Takada H, Kaneko Y, Nakano K, Tanaka M, Fujii T, Saito K, Sugimoto N, Sasaki S, Saito S, Saito R, Kuramoto N, Harigai M, Suzuki Y. Clinicopathological characteristics of lymphoproliferative disorders in 232 patients with rheumatoid arthritis in Japan: A retrospective, multicenter, descriptive study. Mod Rheumatol 2022; 32:32-40. [PMID: 33705243 DOI: 10.1080/14397595.2021.1899570] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the clinicopathological characteristics of lymphoproliferative disorders (LPDs) in patients with rheumatoid arthritis (RA). METHODS In this multicenter case series, we retrospectively reviewed the medical records of RA patients who were newly diagnosed as having LPDs with or without biopsy confirmation between 2000 and 2017 in eight hospitals in Japan. RESULTS We included 232 patients with LPDs. The median age was 67 years (interquartile range [IQR], 60-73 years), and 77.1% were female. At the time of LPD diagnosis, 94.8% and 62.6% of the patients were methotrexate users and in remission or had low RA disease activity, respectively; lymphadenopathy and extranodal involvement were present in 77.1% and 51.9%, respectively. Major extranodal sites were the lungs and oral/oropharyngeal mucosa. The most common LPD pathological subtype was diffuse large B-cell lymphoma (40.5%), followed by classic Hodgkin lymphoma (10.8%), Epstein-Barr virus-positive mucocutaneous ulcer (7.7%), and reactive lymphoid hyperplasia (6.2%). The clinical and laboratory characteristics varied across the pathological subtypes. CONCLUSION LPD occurred mainly in methotrexate users, while RA disease activity did not seem to be associated with LPD development. Although the clinical manifestations vary among pathological subtypes, manifestations of LPD in patients with RA can include lymphadenopathy, extranodal mass, and mucocutaneous ulcer.
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Affiliation(s)
- Hideto Takada
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhisa Nakano
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Fujii
- Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Japan
| | | | - Naoki Sugimoto
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Shoh Sasaki
- Division of Rheumatology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Shuntaro Saito
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Rintaro Saito
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuo Kuramoto
- Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuo Suzuki
- Division of Rheumatology, Tokai University Hachioji Hospital, Tokyo, Japan
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Disappearance of bulky diffuse large B-cell lymphoma after methotrexate/infliximab withdrawal. Int J Hematol 2021; 115:1-2. [PMID: 34813047 DOI: 10.1007/s12185-021-03255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
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Derise N, Karas A, Marshall R, Smith N. Rare case of iatrogenic immunodeficiency associated lymphoproliferative disorder with superimposed infection causing airway obstruction requiring emergent tracheostomy. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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35
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Aoki Y, Hasegawa S, Miyabe S, Nagao T. Spontaneous regression of malignant lymphoma of the maxillary gingiva following biopsy. Int J Oral Maxillofac Surg 2021; 51:1145-1148. [PMID: 34561111 DOI: 10.1016/j.ijom.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/07/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
Abstract
A case of spontaneous regression of malignant lymphoma of the maxillary gingiva following a biopsy is reported. An 84-year-old man was referred to the hospital with chief complaints of swelling of the anterior maxillary gingiva. A non-tender swelling with an ulcer was observed. There was no abnormal bone resorption in the anterior maxillary region and no swelling of the cervical lymph nodes. A biopsy was performed, and the patient was diagnosed with diffuse large B-cell lymphoma. The lesion regressed spontaneously 3 weeks after the initial biopsy. Two years have passed since the spontaneous regression and no recurrence has been observed. If malignant lymphoma regresses on biopsy, observation is considered to be sufficient.
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Affiliation(s)
- Y Aoki
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - S Hasegawa
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan; Department of Oral and Maxillofacial Surgery, Toyota Wakatake Hospital, Aichi, Japan.
| | - S Miyabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - T Nagao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
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Nagata H, Kuriyama K, Nishikawa R, Ohshiro M, Yamamoto-Sugitani M, Fujimoto-Hirakawa Y, Matsumoto Y, Iwai T, Tsukamoto T, Mizutani S, Shimura Y, Kobayashi T, Fukuda W, Uchiyama H, Kuroda J. Iguratimod triggers the relapse of methotrexate-associated lymphoproliferative disorder. Ann Hematol 2021; 100:2849-2850. [PMID: 34420071 DOI: 10.1007/s00277-021-04645-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Hiroaki Nagata
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Kodai Kuriyama
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Rina Nishikawa
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Muneo Ohshiro
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | | | | | - Yosuke Matsumoto
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Toshiki Iwai
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Taku Tsukamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shinsuke Mizutani
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuji Shimura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tsutomu Kobayashi
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Wataru Fukuda
- Center for Rheumatic Disease, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Hitoji Uchiyama
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
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Osaki Y, Kawaratani H, Kachi H, Matsuura K, Tsuji Y, Ozutsumi T, Takagi H, Furukawa M, Sawada Y, Mitoro A, Yamao J, Yoshiji H. Small intestinal follicular lymphoma induced by methotrexate: a case report. BMC Gastroenterol 2021; 21:280. [PMID: 34238226 PMCID: PMC8268449 DOI: 10.1186/s12876-021-01849-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023] Open
Abstract
Background Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a rare but critical complication that develops in patients treated with MTX. Although MTX-LPD has been recently reported, the incidence of follicular lymphoma in the intestine is very low. Case presentation A 73-year-old woman who had been receiving MTX for over 10 years visited our hospital complaining of postprandial abdominal pain and nausea. Upper and lower digestive tract endoscopies did not show any abnormal findings. A patency capsule was stagnated at the proximal part of the ileum with a mild dilation on the oral side. An oral balloon endoscopy revealed shallow ulcerative lesions in the jejunum. She was diagnosed with MTX-LPD based on histopathological findings. The symptoms did not improve with the discontinuation of MTX, and the patient required partial resection of the small intestine. The test result for Epstein-Barr virus-encoded small RNA was negative. She was diagnosed with follicular lymphoma based on the histology findings of a surgical specimen. Postoperative positron emission tomography-computed tomography and bone marrow aspiration did not show any findings of lymphoma. On follow-up, no recurrence was noted four years after the surgery. Conclusions Herein, we report the first case of follicular lymphoma that occurred in the small intestine, negative for Epstein-Barr virus-encoded small RNA. If intestinal symptoms occur during MTX administration, it is important to directly observe by endoscopy and perform histological examination.
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Affiliation(s)
- Yui Osaki
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Hideto Kawaratani
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan.
| | - Hiroki Kachi
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Kyohei Matsuura
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Yuki Tsuji
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Takahiro Ozutsumi
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Hirotetsu Takagi
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Masanori Furukawa
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Yasuhiko Sawada
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Akira Mitoro
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Junichi Yamao
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Hitoshi Yoshiji
- The Department of Gastroenterology and Metabolism, Nara Medical University, Kashihara, Nara, 634-8522, Japan
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Tokumaru M, Ohba K, Kakudo K, Suda T, Oki Y, Goto Y. Importance of Imaging Procedures in the Evaluation of Methotrexate-Associated Lymphoproliferative Disorder of the Thyroid Gland: A Case Study. Eur Thyroid J 2021; 10:434-436. [PMID: 34540714 PMCID: PMC8406244 DOI: 10.1159/000507826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/09/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Kenji Ohba
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- *Kenji Ohba, Medical Education Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192 (Japan),
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaka Oki
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshie Goto
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
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Hanai S, Kobayashi K, Kawashima I, Ichijo M, Nakagomi D. Disappearance of bilateral adrenal tumours: immunodeficiency-associated lymphoproliferative disorder in a patient with rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:e255-e257. [PMID: 33576392 DOI: 10.1093/rheumatology/keab138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Ichiro Kawashima
- Department of Hematology and Oncology, University of Yamanashi, Yamanashi, Japan
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40
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Robinett DM, Hummers LK, Morris M, Duffield AS, Shah AA. Primary CNS lymphoma in scleroderma: a case series. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2021; 6:214-219. [PMID: 34350365 PMCID: PMC8330379 DOI: 10.1177/2397198320970395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022]
Abstract
Many studies have demonstrated an increased risk of cancer in patients with rheumatologic diseases, including systemic sclerosis. Less explored is the role of immunosuppressive therapy as a contributing factor in cancer emergence or detection. This series introduces two cases of patients with systemic sclerosis who demonstrated clinical improvement in their rheumatic disease process with immunosuppression, but both of whom developed neurologic symptoms in the setting of decreasing or discontinuing immunosuppressive therapy, leading to the ultimate diagnosis of Epstein Barr Virus positive (EBV+) diffuse large B cell lymphoma of the CNS. To our knowledge, primary CNS lymphoma has not been previously described in systemic sclerosis patients. Immunosuppressive therapies could promote the development of virus-associated malignancies due to decreased viral clearance. We hypothesize that removing immunosuppression could allow the immune system to generate an inflammatory response to an underlying tumor or viral antigen, contributing to development of neurologic symptoms and detection of underlying disease.
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Affiliation(s)
- Danielle M Robinett
- Division of Rheumatology, School
of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Laura K Hummers
- Division of Rheumatology, School
of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Meaghan Morris
- Department of Pathology, School of
Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Amy S Duffield
- Department of Pathology, School of
Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Ami A Shah
- Division of Rheumatology, School
of Medicine, The Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Scleroderma Center,
Baltimore, MD, USA
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41
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Moriya K, Kikuti YY, Carreras J, Kondo Y, Shiraiwa S, Nakamura N. Methotrexate-associated lymphoproliferative disorder demonstrating composite lymphoma of EBV-negative diffuse large B-cell lymphoma and EBV-positive mucocutaneous ulcer. J Clin Exp Hematop 2021; 60:11-16. [PMID: 32224560 PMCID: PMC7187679 DOI: 10.3960/jslrt.19038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Other iatrogenic immunodeficiency-associated lymphoproliferative disorders induced by immunosuppressive drugs, such as methotrexate (MTX-LPD), exhibit numerous pathological findings. We report the case of an 81-year-old Japanese woman diagnosed with MTX-LPD exhibiting two distinct pathological features from two different sites. Excisional biopsy of the left cervical lymph node revealed EBV-negative diffuse large B-cell lymphoma and biopsy of a pharyngeal ulcer revealed EBV-positive mucocutaneous ulcer. She was treated using an R-CHOP regimen and maintained complete remission for years. This case demonstrates the heterogeneous pathology of MTX-LPD and suggests the necessity of multiple biopsy.
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Affiliation(s)
- Keiichi Moriya
- Department of Hematology, Shinmatsudo Central General Hospital, Matsudo, Japan.,Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Yara Yukie Kikuti
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Joaquim Carreras
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Yusuke Kondo
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Sawako Shiraiwa
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
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42
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Nomura M, Sumiya R, Ono H, Nagai T, Kumazawa K, Shimizu A, Endo D, Aoyanagi N. Cessation of methotrexate and a small intestinal resection provide a good clinical course for a patient with a jejunum perforation induced by a methotrexate-associated lymphoproliferative disorder: a case report. World J Surg Oncol 2021; 19:4. [PMID: 33388058 PMCID: PMC7778788 DOI: 10.1186/s12957-020-02114-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/16/2020] [Indexed: 01/17/2023] Open
Abstract
Background Methotrexate (MTX) is a frequently used drug in the treatment of rheumatoid arthritis (RA), but occurrences of lymphoproliferative disorders (LPD) have been reported in patients undergoing an MTX regimen. Almost half of the patients with methotrexate-associated lymphoproliferative disorders (MTX-LPD) have extranodal lesions; moreover, although extremely rare, digestive tract perforations resulting from the extranodal lesions of MTX-LPD have also been reported. Case presentation We describe the case of an 81-year-old woman with RA who had been prescribed MTX at 6 mg per week for the past 11 years. She was admitted to our hospital with occasional abdominal pain and was first diagnosed with enteritis. Her abdominal pain did not improve, and a computed tomography scan showed abdominal effusion and free air in the abdominal cavity. She was diagnosed with a digestive tract perforation and underwent emergency surgery. The perforation site was identified in the jejunum, and she underwent small intestinal resection around the perforated region. The pathological findings showed an ulcer in the jejunum and infiltration of large atypical lymphocytes around the perforated region. An immunohistochemical examination revealed the expression of a cluster of differentiation 20 and latent membrane protein 1. Considering the patient’s history of RA treated with MTX, she was diagnosed as having Epstein–Barr virus (EBV)-related MTX-LPD with a histological diagnosis of EBVMCU. MTX was discontinued after the surgery, and her soluble interleukin-2 receptor (sIL-2R) levels had returned to normal 1 year later. She has had a good course for the 2 years since surgery and remains asymptomatic with no recurrence of MTX-LPD, as confirmed by the sIL-2R levels. Conclusion We experienced a rare case of the jejunum perforation induced by MTX-LPD. Since only a few cases have been reported of a patient with small intestinal perforation induced by MTX-LPD, further research is necessary to evaluate the clinicopathological features of MTX-LPD. The patient had disease remission after surgery and by discontinuing MTX treatment; our case did not require chemotherapy. EBV-positive patients, especially those with a pathological presentation of EBVMCU, could have a higher likelihood of remission, which could have been a factor in the present case.
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Affiliation(s)
- Masahiro Nomura
- Department of Surgery, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Konodai, Ichikawa-shi, Chiba, 272-8156, Japan
| | - Ryusuke Sumiya
- Department of Surgery, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Konodai, Ichikawa-shi, Chiba, 272-8156, Japan.
| | - Hayato Ono
- Department of Surgery, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Konodai, Ichikawa-shi, Chiba, 272-8156, Japan
| | - Takeshi Nagai
- Department of Surgery, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Konodai, Ichikawa-shi, Chiba, 272-8156, Japan
| | - Keigo Kumazawa
- Department of Surgery, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Konodai, Ichikawa-shi, Chiba, 272-8156, Japan
| | - Atsushi Shimizu
- Department of Surgery, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Konodai, Ichikawa-shi, Chiba, 272-8156, Japan
| | - Daisuke Endo
- Department of Surgery, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Konodai, Ichikawa-shi, Chiba, 272-8156, Japan
| | - Nobuyoshi Aoyanagi
- Department of Surgery, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Konodai, Ichikawa-shi, Chiba, 272-8156, Japan
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43
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Fujiwara-Kuroda A, Iwashiro N, Kimura N. A case of resected pulmonary lymphomatoid granulomatosis. Respir Med Case Rep 2020; 32:101327. [PMID: 33437613 PMCID: PMC7787962 DOI: 10.1016/j.rmcr.2020.101327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/25/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022] Open
Abstract
Lymphomatoid granulomatosis (LYG) is a rare Epstein-Barr virus-associated B-cell lymphoproliferative disorder and was incorporated into the WHO classification of Tumours of the Lung, Pleura, Thymus and Heart in 2015. LYG is known to be associated with the host's immune function, and can be caused by some immunosuppressive agents, including methotrexate. A woman in her sixties with an 18-year history of methotrexate treatment for rheumatoid arthritis visited our hospital after detection of an abnormal chest shadow on her radiograph. She had been having anemia and a slight fever. Computed tomography (CT) revealed a 2.9-cm sized nodule in her left lung and hilar adenopathy, which suggested a primary lung carcinoma or an inflammatory lesion. We performed a left upper lobectomy with lymph node dissection for the purpose of diagnosis and treatment. Pathologic findings revealed that the tumor was a grade 3 LYG based on the number of EBV-positive B cells. The patient was treated with two chemotherapy regimens including R–CHOP at another hospital, and survived for four years after resection without recurrence in the lung. It is rare to find a case resected LYG, and the clinical or pathological findings of our case are expected to be extremely helpful in studying this disease and improving the understanding of this disease.
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Affiliation(s)
- Aki Fujiwara-Kuroda
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, 0608638, Sapporo, Hokkaido, Japan.,Department of Thoracic Surgery, Hakodate National Hospital, 0418512, Hakodate, Hokkaido, Japan
| | - Nozomu Iwashiro
- Department of Thoracic Surgery, Hakodate National Hospital, 0418512, Hakodate, Hokkaido, Japan
| | - Noriko Kimura
- Department of Pathology, Hakodate National Hospital, 0418512, Hakodate, Hokkaido, Japan
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44
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Shiraiwa S, Kikuti YY, Carreras J, Hara R, Aoyama Y, Ogiya D, Suzuki R, Toyosaki M, Ohmachi K, Ogawa Y, Kawada H, Sato S, Nakamura N, Ando K. Clinicopathological evaluation of methotrexate-associated lymphoproliferative disorders with special focus on Epstein-Barr virus-positive mucocutaneous lesions. J Clin Exp Hematop 2020; 60:159-168. [PMID: 33148934 PMCID: PMC7810250 DOI: 10.3960/jslrt.20041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/09/2020] [Accepted: 09/12/2020] [Indexed: 11/25/2022] Open
Abstract
Some patients diagnosed with methotrexate-associated lymphoproliferative disorder (MTX-LPD) develop spontaneous regression upon the discontinuation of MTX, whereas others require chemotherapy. The mechanisms underlying this differential response and the capacity to spontaneously regress are not clearly understood. We evaluated numerous clinicopathological features in 63 patients diagnosed with MTX-LPD, with a special focus on those with Epstein-Barr virus (EBV)-positive mucocutaneous lesions (EBVMCL). The diagnosis of EBVMCL included cases of both EBV-positive mucocutaneous ulcers (EBVMCU) and diffuse gingival swelling associated with proliferation of EBV-positive large B-cells. Of the four subgroups of MTX-LPD, one-year treatment-free survival (TFS) after the discontinuation of MTX was achieved among those with EBVMCL (100%), diffuse large B-cell lymphoma (57%), Hodgkin-like lesions (60%), or classical Hodgkin lymphoma (29%); a significant difference in TFS was observed when comparing the responses of patients with EBVMCL to the those diagnosed with other subtypes. Multivariate analysis revealed predictive factors for prolonged TFS that included EBV-positive lesions and comparatively low levels of serum LDH. Taken together, our study suggests that a diagnosis of EBVMCL is related to the overall clinical outcome after the discontinuation of MTX.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Disease-Free Survival
- Epstein-Barr Virus Infections/chemically induced
- Epstein-Barr Virus Infections/metabolism
- Epstein-Barr Virus Infections/mortality
- Epstein-Barr Virus Infections/therapy
- Female
- Herpesvirus 4, Human/metabolism
- Hodgkin Disease/chemically induced
- Hodgkin Disease/metabolism
- Hodgkin Disease/mortality
- Hodgkin Disease/therapy
- Humans
- Lymphoma, Large B-Cell, Diffuse/chemically induced
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Methotrexate/administration & dosage
- Methotrexate/adverse effects
- Middle Aged
- Retrospective Studies
- Survival Rate
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45
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Fujimi A, Nagamachi Y, Yamauchi N. Primary cutaneous diffuse large B-cell lymphoma, leg type, in a patient with rheumatoid arthritis undergoing etanercept therapy. Mod Rheumatol Case Rep 2020; 5:195-199. [PMID: 33238812 DOI: 10.1080/24725625.2020.1857008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
An 84-year-old woman, who was diagnosed with rheumatoid arthritis (RA) and was treated with methotrexate and, subsequently, etanercept (ETN) for 6 years, presented with rapidly progressing painful cutaneous mass on the right medial malleolus. The patient was eventually diagnosed with primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL-LT). ETN therapy was promptly discontinued expecting spontaneous regression of the lymphoma, which was thought to have developed as other iatrogenic immunodeficiency-associated lymphoproliferative disorders. However, no tumour regression was noted. Chemoimmunotherapy was subsequently initiated, which resulted in partial remission. PCLBCL-LT rarely occurs in patients with RA. Here, we report the first case of PCLBCL-LT that developed in a patient with RA receiving ETN therapy.
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Affiliation(s)
- Akihito Fujimi
- Department of Hematology, Sapporo Kiyota Hospital, Sapporo, Japan
| | | | - Naofumi Yamauchi
- Department of Hematology, Sapporo Kiyota Hospital, Sapporo, Japan
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46
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Urano Y, Ohe R, Yamada A, Kabasawa T, Suzuki K, Kitaoka T, Tamazawa N, Aung NY, Utsunomiya A, Toubai T, Ishizawa K. Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorders, Diffuse Large B-Cell Lymphoma Type, in a Patient with Behçet's Disease Treated with Cyclosporine A. Case Rep Oncol 2020; 13:1145-1151. [PMID: 33082762 PMCID: PMC7548881 DOI: 10.1159/000510362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/22/2022] Open
Abstract
A 40-year-old man had been treated for Behçet's disease (BD) with cyclosporine A (CsA) for 14 years. He presented multiple lymphadenopathies with fever. Histological examination of surgical biopsy showed other iatrogenic immunodeficiency-associated lymphoproliferative disorders, diffuse large B-cell lymphoma type with positivity for Epstein-Barr virus encoding RNA-1 (EBER-1). BCL2-IgH, BCL6-IgH, and MYC-IgH translocations were not detected. CsA was stopped, and R-CHOP therapy was initiated. However, his lymphoma was chemotherapy resistant and rapidly progressed. To the best of our knowledge, this is the first case of diffuse large B-cell lymphoma that occurred in a BD patient treated with CsA reported in English. Both BD and CsA are associated with the pathogenesis of lymphoma. We also describe extremely rare cases in the form of a literature review.
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Affiliation(s)
- Yuka Urano
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Rintaro Ohe
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Akane Yamada
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takanobu Kabasawa
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kazushi Suzuki
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takumi Kitaoka
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Nobuyuki Tamazawa
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Naing Ye Aung
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Aya Utsunomiya
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomomi Toubai
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kenichi Ishizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology, Yamagata University Faculty of Medicine, Yamagata, Japan
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47
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Taliaferro A, Samhouri Y, Rice J, Khan CM, Cillo JE. Rare Oral Presentation of a Mycophenolate Mofetil-Related Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorder (MMF-OIA-LPD) Lesion: A Case Report and Literature Review. J Oral Maxillofac Surg 2020; 79:398-403. [PMID: 32916134 DOI: 10.1016/j.joms.2020.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 01/26/2023]
Abstract
Oral manifestations of side effects of medications, such as methotrexate (MTX) for management of rheumatoid arthritis (RA) and mycophenolate mofetil (MMF) for solid organ transplant (SOT), are very rare. The known side effects include entities called other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD) due to immunosuppression caused by these medications. While there has been an increased incidence of oral cavity LPD reported in the literature associated with MTX, oral presentations that involve MMF are rare. This case report will detail a 74-year-old man with scleroderma treated with MMF who developed Epstein-Barr virus + polymorphic B-cell lymphoproliferative disorder in the right maxillary gingiva presenting as osteonecrosis of the jaw (ONJ). His oral presentation was successfully treated with a combination of surgery and MMF dosage reduction with an oral presentation free of disease at 6 months follow-up. This is the first known case report of an oral manifestation of MMF-related OIIA-LPD.
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Affiliation(s)
- Andrew Taliaferro
- Resident, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Pittsburgh PA
| | - Yazan Samhouri
- Attending Physician, Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Allegheny General Hospital, Pittsburgh PA
| | - Jeremy Rice
- Resident, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Pittsburgh PA
| | - Cyrus M Khan
- Attending Physician, Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Allegheny General Hospital, Pittsburgh PA
| | - Joseph E Cillo
- Division Chief, Residency Program Director, Director of Research, and Associate Professor, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Pittsburgh PA.
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48
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Sekiguchi Y, Iizuka H, Takizawa H, Sugimoto K, Sakajiri S, Inano T, Fukuda Y, Shirane S, Hamano Y, Tomita S, Izumi H, Okubo M, Nakamura N, Sawada T, Sekiguchi N, Noguchi M. Methotrexate-associated Hodgkin Lymphoma in a Patient with Rheumatoid Arthritis Successfully Treated with Brentuximab Vedotin in Combination with Doxorubicin, Vinblastine, and Dacarbazine (BV+AVD). Intern Med 2020; 59:2165-2171. [PMID: 32461524 PMCID: PMC7516310 DOI: 10.2169/internalmedicine.4417-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A 53-year-old woman had been diagnosed with rheumatoid arthritis (RA) in X-6. She was started on methotrexate (MTX) in X-1. She developed a cough, and chest computed tomography showed abnormalities. In X, MTX was discontinued, but the cough persisted. A lung biopsy revealed a diagnosis of nodular sclerosis classic Hodgkin lymphoma (CHL-NS). She was considered to have "other iatrogenic immunodeficiency-associated lymphoproliferative disorders" (OIIA-LPD), MTX-associated Hodgkin lymphoma (MTX-HL). She received six courses of brentuximab vedotin (BV) in addition to AVD (BV+AVD). A complete metabolic response was obtained, and the RA went into remission. This is the fourth reported case of BV+AVD for MTX-HL.
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Affiliation(s)
| | - Hiroko Iizuka
- Department of Hematology, Juntendo University Urayasu Hospital, Japan
| | - Haruko Takizawa
- Department of Hematology, Juntendo University Urayasu Hospital, Japan
| | - Keiji Sugimoto
- Department of Hematology, Juntendo University Urayasu Hospital, Japan
| | - Sakura Sakajiri
- Department of Hematology, Juntendo University Urayasu Hospital, Japan
| | - Tadaaki Inano
- Department of Hematology, Juntendo University Hospital, Japan
| | - Yasutaka Fukuda
- Department of Hematology, Juntendo University Hospital, Japan
| | - Syuichi Shirane
- Department of Hematology, Juntendo University Hospital, Japan
| | - Yasuharu Hamano
- Department of Hematology, Juntendo University Hospital, Japan
| | - Shigeki Tomita
- Department of Pathology, Juntendo University Urayasu Hospital, Japan
| | - Hiroshi Izumi
- Department of Pathology, Juntendo University Urayasu Hospital, Japan
| | - Mitsuo Okubo
- Department of Transfusion Medicine, Juntendo University Urayasu Hospital, Japan
| | - Noriko Nakamura
- Department of Clinical Laboratory, Juntendo University Urayasu Hospital, Japan
| | - Tomohiro Sawada
- Department of Clinical Laboratory, Juntendo University Urayasu Hospital, Japan
| | | | - Masaaki Noguchi
- Department of Hematology, Juntendo University Urayasu Hospital, Japan
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49
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A methotrexate-associated lymphoproliferative disorder expressing CD10 and BCL6 with the IGH/CCND1 translocation. Ann Hematol 2020; 99:2449-2451. [PMID: 32851455 DOI: 10.1007/s00277-020-04218-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
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50
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Saito S, Takeuchi T. Immune response in LPD during methotrexate administration (MTX-LPD) in rheumatoid arthritis patients. J Clin Exp Hematop 2020; 59:145-155. [PMID: 31866617 PMCID: PMC6954173 DOI: 10.3960/jslrt.19028] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Methotrexate (MTX) is known as a first-line synthetic disease-modifying anti-rheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA). Although the risk of LPD development increases by RA inflammation itself, observation of spontaneous regression of LPD after MTX discontinuation lead to the theory of lymphomagenic role of MTX. In this review, we focused on the several immune response involved in LPD that developed under MTX administration in RA patients.
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