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[Three cases of methotrexate-associated lymphoproliferative disorder (MTX-LPD)]

Yoshiya Ishida1, Atsuyoshi Asahi, Tetsuji Wada

  • 1Department of Otolaryngology-Head and Neck Surgery, Kitami Red Cross Hospital, Kitami.

Nihon Jibiinkoka Gakkai Kaiho
|September 16, 2008
PubMed

Insights

Methotrexate (MTX) therapy for rheumatoid arthritis (RA) can lead to methotrexate-associated lymphoproliferative disorder (MTX-LPD). Discontinuing MTX treatment often results in the shrinkage of lymph nodes and lymphoma, avoiding chemotherapy.

Area of Science:

  • Oncology
  • Rheumatology
  • Pathology

Background:

  • Methotrexate (MTX) is a common treatment for rheumatoid arthritis (RA).
  • An increased incidence of methotrexate-associated lymphoproliferative disorder (MTX-LPD) has been observed in RA patients undergoing MTX therapy.
  • MTX-LPD is a rare but serious complication requiring careful monitoring.

Observation:

  • Three cases of RA patients developing MTX-LPD during MTX treatment are presented.
  • One patient presented with tonsil swelling diagnosed as diffuse large B-cell lymphoma (EBER1 positive).
  • Two patients presented with enlarged neck lymph nodes, also diagnosed as MTX-LPD.

Findings:

  • Discontinuation of MTX therapy led to significant shrinkage of affected lymph nodes and tonsils in all three cases.
  • Chemotherapy was not required for the patient with tonsil lymphoma after MTX withdrawal.
  • Patients experienced a good clinical course with no signs of recurrence after MTX cessation.

Implications:

  • MTX withdrawal is an effective initial strategy for managing MTX-LPD in RA patients.
  • This highlights the importance of considering MTX-LPD in RA patients presenting with lymphadenopathy.
  • Further review of the oncogenic potential of MTX in RA is warranted.

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