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Area of Science:

  • Hematology
  • Oncology
  • Immunology

Background:

  • High-grade B-cell lymphoma (HGBCL) is an aggressive lymphoid neoplasm often presenting with advanced clinical features.
  • Patients with autoimmune conditions like rheumatoid arthritis have an increased risk of developing aggressive non-Hodgkin lymphomas, including HGBCL.
  • HGBCL, classified in 2016, is characterized by oncogene rearrangements and can involve the central nervous system.

Observation:

  • A case of stage IV double-hit HGBCL with MYC and BCL6 gene rearrangements is presented.
  • The patient was an older veteran with a history of rheumatoid arthritis treated with methotrexate.
  • The patient experienced an excellent and sustained response to HGBCL treatment after discontinuing methotrexate.

Findings:

  • This is the first reported case of a patient with HGBCL achieving a sustained response after methotrexate discontinuation.
  • Methotrexate discontinuation was associated with a significant clinical improvement in HGBCL.
  • The findings suggest a potential link between methotrexate use and HGBCL progression or treatment response.

Implications:

  • Reducing immunosuppression should be considered for patients with lymphoproliferative disorders (LPDs) linked to autoimmune conditions or immunosuppressive drugs.
  • This case highlights the importance of evaluating and potentially modifying immunosuppressive therapy in patients with HGBCL.
  • Further research is warranted to explore the role of immunosuppressive medications in HGBCL pathogenesis and treatment.