title: Methotrexate-associated lymphoproliferative disorders: management by watchful waiting and observation of early lymphocyte recovery after methotrexate withdrawal.
abstract: No optimum treatment of iatrogenic immunodeficiency-associated lymphoproliferative disorders due to methotrexate in patients with rheumatoid arthritis (MTX-LPD) has yet been established, although MTX withdrawal is known to have a substantial effect on tumor regression. Here, we retrospectively analyzed 20 cases of MTX-LPD. Tumor shrinkage occurred in 18 of 20 cases, but only following MTX withdrawal. This tumor regression ratio was considerably better than in previous reports, and appeared due to longer "watchful waiting." Lymphocyte recovery at 2 weeks after MTX withdrawal was significantly higher in cases with tumor regression in 1 month than in those without tumor regression (p = 0.001). Median time to maximal efficacy after MTX cessation in cases without chemotherapy was 12 weeks (range 2-76). In conclusion, watchful waiting for a longer period after MTX cessation with observation of early lymphocyte recovery and uninterrupted continuation of other anti-rheumatoid drugs may be an acceptable management plan for MTX-LPD.
authors.affiliation: a Division of Medical Oncology/Hematology, Department of Medicine , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Inui
authors.affiliation: a Division of Medical Oncology/Hematology, Department of Medicine , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsuoka
authors.affiliation: a Division of Medical Oncology/Hematology, Department of Medicine , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Kimikazu
authors.initials: K
authors.lastname: Yakushijin
authors.affiliation: a Division of Medical Oncology/Hematology, Department of Medicine , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Okamura
authors.affiliation: b Division of Clinical Oncology and Hematology, Jikei University School of Medicine , Tokyo , Japan.
authors.forename: Takaki
authors.initials: T
authors.lastname: Shimada
authors.affiliation: b Division of Clinical Oncology and Hematology, Jikei University School of Medicine , Tokyo , Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Yano
authors.affiliation: c Department of Pathology , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: d Laboratory of Hematology, Division of Medical Biophysics, Kobe University Graduate School of Health Sciences , Kobe , Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Ito
authors.affiliation: a Division of Medical Oncology/Hematology, Department of Medicine , Kobe University Graduate School of Medicine , Kobe , Japan.|e Hematology Division, Department of Medicine , Hyogo Cancer Center , Hyogo , Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Murayama
authors.affiliation: a Division of Medical Oncology/Hematology, Department of Medicine , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: c Department of Pathology , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Itoh
authors.affiliation: b Division of Clinical Oncology and Hematology, Jikei University School of Medicine , Tokyo , Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Aiba
authors.affiliation: a Division of Medical Oncology/Hematology, Department of Medicine , Kobe University Graduate School of Medicine , Kobe , Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Minami
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D015415:Biomarkers; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D018655:Lymphocyte Count; D008232:Lymphoproliferative Disorders / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D009365:Neoplasm Regression, Spontaneous; D011379:Prognosis; D012189:Retrospective Studies; D057832:Watchful Waiting
chemical_list: D018501:Antirheumatic Agents; D015415:Biomarkers; D007074:Immunoglobulin G; D008727:Methotrexate
keywords: ALC recovery; MTX withdrawal; MTX-LPD