Distinct patterns of lymphocyte count transition in lymphoproliferative disorder in patients with rheumatoid arthritis treated with methotrexate

Shuntaro Saito, Yuko Kaneko, Kunihiro Yamaoka, Michihide Tokuhira, Tsutomu Takeuchi

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective. To clarify the characteristics of lymphoproliferative disorder (LPD) in patients with RA treated with MTX. Methods. Among 33 patients developing LPD during MTX treatment, 20 LPDs regressed spontaneously within 12 weeks after MTX cessation (regressive LPD), and 13 did not regress and most of them died or needed chemotherapy (persistent LPD). The control group consisted of 66 clinically matched MTX-treated RA patients without LPD. The clinical characteristics were compared between these three groups. Results. While no significant differences were found in clinical RA and LPD features among the three groups, the absolute lymphocyte number of the two LPD groups at LPD diagnosis was significantly lower than the control group (497/μl in the regressive vs 680/μl in the persistent vs 1400/μl in the control, P<0.05). After MTX withdrawal, the lymphocyte number in the regressive group rapidly recovered to 1214/μl (P<0.01) by week 2 and was thereafter maintained at an equivalent level to the control group. In contrast, lymphocyte level in the persistent group did not show significant increase throughout 12 weeks (620/μl at week 2, P = 0.57). Changes in lymphocyte number following MTX withdrawal clearly distinguished the regressive LPD from the persistent LPD. Conclusion. A significant decrease in lymphocyte count at the LPD diagnosis and its restoration after MTX withdrawal were markedly associated with spontaneous regression of LPD developing during MTX treatment.

Original languageEnglish
Article numberkex002
Pages (from-to)940-946
Number of pages7
JournalRheumatology (United Kingdom)
Volume56
Issue number6
DOIs
Publication statusPublished - 2017 Jun 1

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Lymphoproliferative Disorders
Lymphocyte Count
Methotrexate
Rheumatoid Arthritis
Control Groups
Lymphocytes

Keywords

  • Lymphocyte
  • Lymphoproliferative disorder
  • Methotrexate
  • Predictor
  • Prognosis
  • Regression
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)

Cite this

Distinct patterns of lymphocyte count transition in lymphoproliferative disorder in patients with rheumatoid arthritis treated with methotrexate. / Saito, Shuntaro; Kaneko, Yuko; Yamaoka, Kunihiro; Tokuhira, Michihide; Takeuchi, Tsutomu.

In: Rheumatology (United Kingdom), Vol. 56, No. 6, kex002, 01.06.2017, p. 940-946.

Research output: Contribution to journalArticle

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abstract = "Objective. To clarify the characteristics of lymphoproliferative disorder (LPD) in patients with RA treated with MTX. Methods. Among 33 patients developing LPD during MTX treatment, 20 LPDs regressed spontaneously within 12 weeks after MTX cessation (regressive LPD), and 13 did not regress and most of them died or needed chemotherapy (persistent LPD). The control group consisted of 66 clinically matched MTX-treated RA patients without LPD. The clinical characteristics were compared between these three groups. Results. While no significant differences were found in clinical RA and LPD features among the three groups, the absolute lymphocyte number of the two LPD groups at LPD diagnosis was significantly lower than the control group (497/μl in the regressive vs 680/μl in the persistent vs 1400/μl in the control, P<0.05). After MTX withdrawal, the lymphocyte number in the regressive group rapidly recovered to 1214/μl (P<0.01) by week 2 and was thereafter maintained at an equivalent level to the control group. In contrast, lymphocyte level in the persistent group did not show significant increase throughout 12 weeks (620/μl at week 2, P = 0.57). Changes in lymphocyte number following MTX withdrawal clearly distinguished the regressive LPD from the persistent LPD. Conclusion. A significant decrease in lymphocyte count at the LPD diagnosis and its restoration after MTX withdrawal were markedly associated with spontaneous regression of LPD developing during MTX treatment.",
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AU - Kaneko, Yuko

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AU - Tokuhira, Michihide

AU - Takeuchi, Tsutomu

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N2 - Objective. To clarify the characteristics of lymphoproliferative disorder (LPD) in patients with RA treated with MTX. Methods. Among 33 patients developing LPD during MTX treatment, 20 LPDs regressed spontaneously within 12 weeks after MTX cessation (regressive LPD), and 13 did not regress and most of them died or needed chemotherapy (persistent LPD). The control group consisted of 66 clinically matched MTX-treated RA patients without LPD. The clinical characteristics were compared between these three groups. Results. While no significant differences were found in clinical RA and LPD features among the three groups, the absolute lymphocyte number of the two LPD groups at LPD diagnosis was significantly lower than the control group (497/μl in the regressive vs 680/μl in the persistent vs 1400/μl in the control, P<0.05). After MTX withdrawal, the lymphocyte number in the regressive group rapidly recovered to 1214/μl (P<0.01) by week 2 and was thereafter maintained at an equivalent level to the control group. In contrast, lymphocyte level in the persistent group did not show significant increase throughout 12 weeks (620/μl at week 2, P = 0.57). Changes in lymphocyte number following MTX withdrawal clearly distinguished the regressive LPD from the persistent LPD. Conclusion. A significant decrease in lymphocyte count at the LPD diagnosis and its restoration after MTX withdrawal were markedly associated with spontaneous regression of LPD developing during MTX treatment.

AB - Objective. To clarify the characteristics of lymphoproliferative disorder (LPD) in patients with RA treated with MTX. Methods. Among 33 patients developing LPD during MTX treatment, 20 LPDs regressed spontaneously within 12 weeks after MTX cessation (regressive LPD), and 13 did not regress and most of them died or needed chemotherapy (persistent LPD). The control group consisted of 66 clinically matched MTX-treated RA patients without LPD. The clinical characteristics were compared between these three groups. Results. While no significant differences were found in clinical RA and LPD features among the three groups, the absolute lymphocyte number of the two LPD groups at LPD diagnosis was significantly lower than the control group (497/μl in the regressive vs 680/μl in the persistent vs 1400/μl in the control, P<0.05). After MTX withdrawal, the lymphocyte number in the regressive group rapidly recovered to 1214/μl (P<0.01) by week 2 and was thereafter maintained at an equivalent level to the control group. In contrast, lymphocyte level in the persistent group did not show significant increase throughout 12 weeks (620/μl at week 2, P = 0.57). Changes in lymphocyte number following MTX withdrawal clearly distinguished the regressive LPD from the persistent LPD. Conclusion. A significant decrease in lymphocyte count at the LPD diagnosis and its restoration after MTX withdrawal were markedly associated with spontaneous regression of LPD developing during MTX treatment.

KW - Lymphocyte

KW - Lymphoproliferative disorder

KW - Methotrexate

KW - Predictor

KW - Prognosis

KW - Regression

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