論文

査読有り 国際誌
2019年7月

Methotrexate-associated Lymphoproliferative Disorders in Patients With Rheumatoid Arthritis: Clinicopathologic Features and Prognostic Factors.

The American journal of surgical pathology
  • Daisuke Kurita
  • Hiroaki Miyoshi
  • Ayako Ichikawa
  • Koji Kato
  • Yoshitaka Imaizumi
  • Ritsuko Seki
  • Kensaku Sato
  • Yuya Sasaki
  • Keisuke Kawamoto
  • Joji Shimono
  • Kyohei Yamada
  • Reiji Muto
  • Masahiro Kizaki
  • Koji Nagafuji
  • Jun-Ichi Tamaru
  • Michihide Tokuhira
  • Koichi Ohshima
  • 全て表示

43
7
開始ページ
869
終了ページ
884
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1097/PAS.0000000000001271

Methotrexate (MTX) carries a risk of lymphoproliferative disorders (LPDs), but MTX-associated LPDs (MTX-LPDs) can resolve spontaneously after MTX withdrawal. However, the precise clinicopathologic features of MTX-LPD remain unclear. We aimed to investigate the clinicopathologic characteristics, outcomes, and prognostic factors for histologic types of MTX-LPD. Paraffin-embedded tissue samples of 219 patients with MTX-LPD were analyzed. In total, 30,33,106, and 26 had reactive lymphoid hyperplasia (RH), polymorphic-LPD (Poly-LPD), diffuse large B-cell lymphomas (DLBCLs), and classic Hodgkin lymphoma (CHL), respectively. The clinicopathologic features of RH, Poly-LPD, DLBCLs, and CHL were as follows: extranodal involvement: 13.8% (4/29), 36.4% (12/33), 69.5% (73/105), and 15.4% (4/26); Epstein-Barr virus encoded RNA positivity: 55.2% (16/29), 71.9% (23/32), 45.3% (48/106), and 76.9% (20/26); necrosis: 0% (0/29), 51.5% (17/33), 34.3% (36/105), and 12.0% (3/25); and Hodgkin Reed-Sternberg-like cells: 17.2% (5/29), 50% (14/28), and 19.8% (21/106). The median duration from MTX withdrawal to the time of disease regression was 10.4, 3.0, 4.2, and 2.7 months for RH, Poly-LPD, DLBCLs, and CHL. After MTX withdrawal, progression-free survival was the greatest for RH, followed by for Poly-LPD, DLBCL, and CHL (all P<0.05). Overall survival did not differ significantly between the groups. On univariate analysis, the predictive factors for progression-free survival included plasma cell infiltrate for CHL, eosinophil infiltrate, age above 70 years, and extensive necrosis for Poly-LPD, while they were Epstein-Barr virus encoded RNA positivity and International Prognostic Index risk for DLBCL on multivariate analysis. In conclusion, histologic categorization and histology-specific factors could be useful for predicting MTX-LPD progression after MTX withdrawal.

リンク情報
DOI
https://doi.org/10.1097/PAS.0000000000001271
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/31116708
ID情報
  • DOI : 10.1097/PAS.0000000000001271
  • PubMed ID : 31116708

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