Hodgkin's disease and lymphoproliferations resembling Hodgkin's disease in patients receiving long-term low-dose methotrexate therapy.
Recently, it has been shown that patients with rheumatologic diseases who are treated with methotrexate can develop immunosuppression-associated lymphoproliferative disorders. Although a variety of lymphoproliferations have been described in the setting of methotrexate therapy, only rare cases of Hodgkin's disease (HD) have been reported. In this study, we provide a more complete characterization of the spectrum of lymphoproliferations that resemble HD or show features diagnostic of HD that occur in patients receiving long-term low-dose methotrexate therapy. Eight patients were receiving methotrexate for various disorders. Four cases were considered to represent lymphoproliferations resembling HD; the other four cases were diagnosed as HD because they showed diagnostic morphologic and immunophenotypic features. All three patients with lymphoproliferations resembling HD on whom follow-up was available experienced tumor regression with methotrexate withdrawal or with methotrexate withdrawal and steroids; none of these three patients required further therapy. All three patients with HD on whom follow-up was available are alive and free of disease following chemotherapy or radiation therapy. In two of these patients, the tumor persisted or progressed despite discontinuation of methotrexate with observation; the third patient received chemotherapy at the same time methotrexate was stopped. Our findings indicate that a spectrum of lymphoproliferations resembling HD or diagnostic of HD can occur in patients receiving long-term low-dose methotrexate therapy. Recognition of these lymphoproliferative disorders is clinically important because a subset of these neoplasms will completely resolve with discontinuation of methotrexate, thereby obviating the need for chemotherapy or radiation therapy.
Kamel
O W
OW
Department of Pathology, Stanford University Medical Center, CA 94305-5302, USA.
Weiss
L M
LM
van de Rijn
M
M
Colby
T V
TV
Kingma
D W
DW
Jaffe
E S
ES
D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006566:Herpesviridae Infections / Q000473:pathology; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006689:Hodgkin Disease / Q000139:chemically induced* / Q000473:pathology / Q000821:virology; D006801:Humans; D016130:Immunophenotyping; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000139:chemically induced* / Q000473:pathology / Q000821:virology; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D016539:Reed-Sternberg Cells / Q000473:pathology; D014412:Tumor Virus Infections / Q000473:pathology
D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D008727:Methotrexate