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Distinct decrease in peripheral lymphocytes in EBER-positive cases of MTX-LPD.

Masahiro Kondo1, Yohko Murakawa1, Mayuko Moriyama1

  • 1Department of Rheumatology, Shimane University Faculty of Medicine, Shimane, Japan.

Modern Rheumatology
|February 21, 2020
PubMed
Summary

Methotrexate-associated lymphoproliferative disorder (MTX-LPD) may involve a decrease in peripheral blood lymphocytes (PBL), particularly in Epstein-Barr virus-encoded RNA (EBER)-positive cases. PBL counts may also decrease before relapse in patients with recurrent MTX-LPD.

Keywords:
EBVMTX-LPDRAlymphocyte

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Area of Science:

  • Rheumatology
  • Oncology
  • Immunology

Background:

  • Methotrexate (MTX) is a common disease-modifying antirheumatic drug (DMARD).
  • Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a rare but serious complication of MTX therapy.
  • Understanding the clinical characteristics of MTX-LPD is crucial for early diagnosis and management.

Purpose of the Study:

  • To determine the clinical characteristics of MTX-LPD.
  • To investigate the role of peripheral blood lymphocyte (PBL) count in MTX-LPD pathogenesis.
  • To explore the association between Epstein-Barr virus-encoded RNA (EBER) status and MTX-LPD characteristics.

Main Methods:

  • Assessment of 12 rheumatoid arthritis (RA) patients who developed MTX-LPD.
  • Comparison of PBL counts at MTX-LPD onset versus 6 months prior.
  • Analysis of PBL count changes after MTX withdrawal and in cases of LPD relapse.
  • Subgroup analysis based on EBER status.

Main Results:

  • Eight of 12 patients showed regression of LPD after MTX withdrawal.
  • A decrease in PBL count was observed at MTX-LPD onset compared to 6 months prior.
  • The decrease in PBL count was more pronounced in EBER-positive patients.
  • Four patients experienced LPD recurrence, also exhibiting decreased PBL counts before relapse.

Conclusions:

  • A decrease in PBL count may be implicated in MTX-LPD pathogenesis.
  • This association is particularly noted in EBER-positive cases.
  • Decreased PBL counts are also observed in patients with LPD relapse after initial improvement following MTX withdrawal.