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Rituximab Monotherapy for Grade 2-3 Lymphomatoid Granulomatosis with Central Nervous System Involvement in a Patient
Hiroki Hosoi1, Ken Tanaka1,2, Ayaka Sakaki1
1Department of Hematology/Oncology, Wakayama Medical University, Japan.
Methotrexate-related lymphoproliferative disorder (LPD) with central nervous system involvement and lymphomatoid granulomatosis (LYG) histology can be effectively managed with rituximab monotherapy. This treatment showed success in a rheumatoid arthritis patient with LYG-like lesions.
Area of Science:
- Hematology
- Oncology
- Rheumatology
Background:
- Lymphomatoid granulomatosis (LYG) is a rare lymphoproliferative disorder (LPD).
- Optimal management for methotrexate (MTX)-related LPD with central nervous system (CNS) involvement and LYG histology is not well-defined.
- Rheumatoid arthritis patients on MTX are at risk for LPD.
Observation:
- A case of grade 2-3 LYG in a rheumatoid arthritis patient is presented.
- The patient developed an intracranial mass with hemorrhage, alongside pulmonary and skin lesions.
- Tumor cells in skin and brain exhibited monoclonal and oligoclonal proliferation, respectively.
Findings:
- Successful treatment of the patient was achieved with rituximab monotherapy.
- This suggests rituximab is a viable therapeutic option for MTX-LPD with CNS and LYG features.
- The patient's response indicates potential efficacy in similar complex cases.
Implications:
- Rituximab monotherapy may be an effective treatment for MTX-LPD with CNS involvement and LYG histology.
- This finding offers a potential therapeutic strategy for a rare and challenging condition.
- Further research into rituximab's role in managing MTX-induced LPD is warranted.
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