TY - JOUR
T1 - Outcomes of methotrexate-associated lymphoproliferative disorders in rheumatoid arthritis patients treated with disease-modifying anti-rheumatic drugs
AU - Harada, Takuya
AU - Iwasaki, Hiromi
AU - Muta, Tsuyoshi
AU - Urata, Shingo
AU - Sakamoto, Aiko
AU - Kohno, Kentaro
AU - Takase, Ken
AU - Miyamura, Tomoya
AU - Sawabe, Takuya
AU - Asaoku, Hideki
AU - Oryoji, Kensuke
AU - Fujisaki, Tomoaki
AU - Mori, Yasuo
AU - Yoshimoto, Goichi
AU - Ayano, Masahiro
AU - Mitoma, Hiroki
AU - Miyamoto, Toshihiro
AU - Niiro, Hiroaki
AU - Yamamoto, Hidetaka
AU - Oshiro, Yumi
AU - Miyoshi, Hiroaki
AU - Ohshima, Koichi
AU - Takeshita, Morishige
AU - Akashi, Koichi
AU - Kato, Koji
N1 - Funding Information:
The authors would like to thank Masatoshi Shimo, Kanae Fujii, Kensuke Sasaki, Takeshi Sugio, Kohta Miyawaki, Masanori Kadowaki, Satoshi Yamasaki, Yoshikane Kikushige, Takahiro Shima, Akihiko Numata, Yuya Kunisaki, Takahiro Maeda, Mitsuteru Akahoshi, Yojiro Arinobu for collecting information from the medical records and discussing the manuscript.
Publisher Copyright:
© 2021 British Society for Haematology and John Wiley & Sons Ltd
PY - 2021/7
Y1 - 2021/7
N2 - Recently, the use of targeted synthetic or biological disease-modifying anti-rheumatic drugs (ts/bDMARDs) in addition to conventional synthetic (cs)DMARDs including methotrexate (MTX) for rheumatoid arthritis (RA) has increased. However, whether ts/bDMARDs are associated with the development and clinicopathological features of MTX-associated lymphoproliferative disorder (MTX-LPD) in patients with RA remains unknown. Therefore, we evaluated the clinical outcomes of 121 patients with MTX-LPD. Results showed that prior use of ts/bDMARDs was not associated with the different histopathological subtypes of MTX-LPD. Patients with polymorphic-type LPD had a better event-free survival than those with diffuse large B-cell lymphoma (DLBCL), classical Hodgkin lymphoma and peripheral T-cell lymphoma. The pathological subtype of lymphoma could predict the clinical outcome of MTX-LPD. In patients with DLBCL, the use of tumour necrosis factor-alpha (TNF-α) inhibitors prior to MTX-LPD onset was associated with a higher non-relapse mortality. Further, patients with RA previously treated with Janus kinase (JAK) inhibitors more commonly required chemotherapy than those treated with csDMARDs alone, indicating disease aggressiveness. Hence, special caution should be observed when managing patients with MTX-LPD previously treated with JAK or TNF-α inhibitors for RA.
AB - Recently, the use of targeted synthetic or biological disease-modifying anti-rheumatic drugs (ts/bDMARDs) in addition to conventional synthetic (cs)DMARDs including methotrexate (MTX) for rheumatoid arthritis (RA) has increased. However, whether ts/bDMARDs are associated with the development and clinicopathological features of MTX-associated lymphoproliferative disorder (MTX-LPD) in patients with RA remains unknown. Therefore, we evaluated the clinical outcomes of 121 patients with MTX-LPD. Results showed that prior use of ts/bDMARDs was not associated with the different histopathological subtypes of MTX-LPD. Patients with polymorphic-type LPD had a better event-free survival than those with diffuse large B-cell lymphoma (DLBCL), classical Hodgkin lymphoma and peripheral T-cell lymphoma. The pathological subtype of lymphoma could predict the clinical outcome of MTX-LPD. In patients with DLBCL, the use of tumour necrosis factor-alpha (TNF-α) inhibitors prior to MTX-LPD onset was associated with a higher non-relapse mortality. Further, patients with RA previously treated with Janus kinase (JAK) inhibitors more commonly required chemotherapy than those treated with csDMARDs alone, indicating disease aggressiveness. Hence, special caution should be observed when managing patients with MTX-LPD previously treated with JAK or TNF-α inhibitors for RA.
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U2 - 10.1111/bjh.17456
DO - 10.1111/bjh.17456
M3 - Article
C2 - 33822354
AN - SCOPUS:85103598468
VL - 194
SP - 101
EP - 110
JO - British Journal of Haematology
JF - British Journal of Haematology
SN - 0007-1048
IS - 1
ER -