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Immune response in LPD during methotrexate administration (MTX-LPD) in rheumatoid arthritis patients

Shuntaro Saito, Tsutomu Takeuchi

    Journal of Clinical and Experimental Hematopathology : JCEH
    |December 24, 2019
    PubMed

    Insights

    Methotrexate (MTX), a rheumatoid arthritis (RA) drug, may increase lymphoma risk. This review explores the immune responses involved in RA patients developing lymphoma during MTX treatment, noting potential MTX lymphomagenic roles.

    Area of Science:

    • Rheumatology
    • Immunology
    • Oncology

    Background:

    • Methotrexate (MTX) is a primary synthetic disease-modifying anti-rheumatic drug (DMARD) for rheumatoid arthritis (RA).
    • Rheumatoid arthritis inflammation itself elevates the risk of lymphoma development.
    • Spontaneous regression of lymphoma after MTX discontinuation suggests a potential lymphomagenic role for MTX.

    Purpose of the Study:

    • To review the immune responses implicated in the development of lymphoma during MTX therapy in RA patients.
    • To investigate the potential lymphomagenic effects of MTX in the context of RA.

    Main Methods:

    • Literature review focusing on immune responses in RA patients treated with MTX.
    • Analysis of studies reporting lymphoma development in RA patients undergoing MTX therapy.
    • Examination of cases with spontaneous lymphoma regression post-MTX discontinuation.

    Main Results:

    • Several immune response pathways are implicated in MTX-associated lymphoma (LPD) in RA patients.
    • The interplay between RA, MTX, and immune dysregulation contributes to lymphomagenesis.
    • Evidence suggests MTX may play a direct or indirect role in lymphoma development.

    Conclusions:

    • MTX's role in lymphoma development in RA patients warrants further investigation.
    • Understanding the immune mechanisms is crucial for managing MTX-treated RA patients at risk of lymphoma.
    • Risk-benefit assessment of MTX in RA should consider potential lymphomagenic effects.
    Keywords:
    Epstein-Barr virusImmune responseLymphoproliferative disorderMethotrexateRheumatoid arthritis

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