EBER-Negative, Double-Hit High-Grade B-Cell Lymphoma Responding to Methotrexate Discontinuation

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.