Tomohiro Kameda1, shusaku nakashima2, Masayuki Inoo3, Ikuko Onishi3, Noriyuki Kurata3, Hiromi Shimada1, Risa Wakiya1, Mikiya Kato1, taichi miyagi4, Yusuke Ushio5, Rina Mino6, Kanako Chujo7, norimitsu Kadowaki8 and Hiroaki Dobashi9, 1Kagawa University, Kagawa, Japan, 2Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa, Japan, 3Utazu Hospital, Yayauta-gun, Japan, 4Kagawa University, Kidagun, Japan, 5Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Miki, Kita District, Kagawa, Japan, 6Kagawa University, Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Miki-cho, Kita-gun, Japan, 7Kagawa University, Miki, Kita District, Kagawa, Japan, 8Kagawa University, Kita-Gun, Japan, 9Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa, Kagawa, Japan
Background/Purpose: Lymphoproliferative disorders (LPDs), including malignant lymphoma, are known to occur in RA patients treated with disease modified antirheumatic drugs (DMARDs). In particular, LPD associated with methotrexate (MTX)-treated RA is often referred to as MTX-associated LPD (MTX-LPD). Some MTX-LPDs spontaneously regress after discontinuation of MTX, even though they have been diagnosed with malignant lymphoma. However it is difficult to predict spontaneous regression (SR) of MTX-LPD. We clarified the predictive factors of spontaneous regression in accumulated MTX-LPD patients.
Methods: We enrolled 100 RA patients who diagnosed MTX-LPD from 2005 to 2021. We collected as follow data based on clinical reports retrospectively; 1) age, 2) gender, 3) duration from RA onset to LPD onset, 4) total dose of MTX, 5) duration of MTX administration, 6) presence of extranodal lesion 7) histological findings, 8) treatment for LPD. In addition, We divided these cases into spontaneous regression cases (SR group) and cases that treated with chemotherapy after MTX discontinuation (CTx group), and compared the difference of biomarker as follow subjects between two groups; serum LDH and sIL-2R at LPD onset, change in absolute number of peripheral lymphocytes (ΔALC) over follow-up.
Results: The mean age of 100 MTX-RA-LPD patients (M:F=30:70) were 66.7 ± 10.7 years old, and the duration from RA onset to LPD onset were 25.2 ± 11.0 years. The total dose of MTX and duration of MTX administration were over 2,600mg and over 5 years, respectively. The extranodal lesions were found in 51%, and diffuse large B cell lymphoma was the most common histological findings. Spontaneous regression was observed in 68%. In regards to the comparison between two groups, SR group and CTx group were 68 and 31cases respectively. The one case was unknown because of transfer to another hospital after LPD diagnosis. The level of sIL-2R and LDH was significantly lower in SR group. On the other hand, ΔALC was higher in the SR group.
Conclusion: We suggested that low level of serum sIL-2R and LDH at LPD onset was useful for predict of SR in MTX-LPD with RA patients.
Disclosures: T. Kameda, None; s. nakashima, None; M. Inoo, None; I. Onishi, None; N. Kurata, None; H. Shimada, None; R. Wakiya, None; M. Kato, None; t. miyagi, None; Y. Ushio, None; R. Mino, None; K. Chujo, None; n. Kadowaki, None; H. Dobashi, Bristol-Myers Squibb (BMS), Chugai, Eli Lilly, GlaxoSmithKlein (GSK), MSD, Novartis, Pfizer, UCB Pharma.
