[Aggressive non-Hodgkin lymphoma in 3 patients with rheumatoid arthritis: discontinue the use of methotrexate].
3 female patients who were being treated with methotrexate developed a non-Hodgkin lymphoma. The first patient, 67 years old, presented with an enlarged thyroid gland. The cytological punction was inconclusive and an open biopsy revealed a B cell non-Hodgkin lymphoma, which was localised. A week before the biopsy the methotrexate was discontinued. The patient herself reported that the swelling of her thyroid gland was diminished after cessation of methotrexate. The lymphoma showed a complete remission without chemotherapy being given. The second patient, a 78-year-old woman, developed a non-Hodgkin lymphoma in one of her tonsils that showed a partial remission after withdrawal of the methotrexate therapy. The third patient, a 66-year-old woman, presented herself with a pulmonary non-Hodgkin lymphoma. In this patient withdrawal of the methotrexate resulted in a complete remission of the non-Hodgkin lymphoma as well. Although no epidemiological study has shown an increased risk of lymphoproliferative disorders during the use of methotrexate, these spontaneous remissions suggest an aetiological link. If a non-Hodgkin lymphoma develops in a patient being treated with methotrexate then the therapy should be discontinued and chemotherapy should not be given straightaway.
van Poppel
P C M
PC
Jeroen Bosch Ziekenhuis, locatie Groot Ziekengasthuis, Postbus 90.153, 5200 ME's-Hertogenbosch. p.v.poppel@jbz.nl
Fijnheer
R
R
Haverman
J F
JF
Sinniqe
H A M
HA
D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000139:chemically induced*; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D012075:Remission, Spontaneous
D018501:Antirheumatic Agents; D008727:Methotrexate