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Outcomes of methotrexate‐associated lymphoproliferative disorders in rheumatoid arthritis patients treated with disease‐modifying anti‐rheumatic drugs
Author(s) -
Harada Takuya,
Iwasaki Hiromi,
Muta Tsuyoshi,
Urata Shingo,
Sakamoto Aiko,
Kohno Kentaro,
Takase Ken,
Miyamura Tomoya,
Sawabe Takuya,
Asaoku Hideki,
Oryoji Kensuke,
Fujisaki Tomoaki,
Mori Yasuo,
Yoshimoto Goichi,
Ayano Masahiro,
Mitoma Hiroki,
Miyamoto Toshihiro,
Niiro Hiroaki,
Yamamoto Hidetaka,
Oshiro Yumi,
Miyoshi Hiroaki,
Ohshima Koichi,
Takeshita Morishige,
Akashi Koichi,
Kato Koji
Publication year - 2021
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.17456
Subject(s) - medicine , rheumatoid arthritis , methotrexate , lymphoma , lymphoproliferative disorders , antifolate , immunology , oncology , antimetabolite
Summary 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.