The prognostic value of positron emission tomography/computed tomography in rheumatoid arthritis patients with methotrexate-associated lymphoproliferative disorders

Satoshi Takanashi, Tomonori Nakazato, Yoshinobu Aisa, Chisako Ito, Hideki Arakaki, Yuki Osada, Motoharu Hirano, Takehiko Mori

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Recently, methotrexate-associated lymphoproliferative disorders (MTX-LPDs) in rheumatoid arthritis (RA) have been found to commonly occur in association with iatrogenic immunodeficiency. Several factors have been reported to be related to the prognosis. We herein investigate the efficacy of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in predicting the prognosis of MTX-LPD. We performed a retrospective analysis of the clinical features, characteristics, and outcomes of 18 patients with MTX-LPDs who were treated from 2004 to 2015. All of the patients were diagnosed with MTX-LPD based on the histological examination of biopsy specimens. Spontaneous regression was detected after the cessation of MTX in 5 of 18 cases (28%). The maximum standardized uptake value (SUVmax) of the FDG uptake on PET/CT was significantly lower, and the maximum size of the LPD-associated tumor was significantly smaller among the patients who showed spontaneous regression (p = 0.01, p = 0.04, respectively). Both the SUVmax and the maximum tumor size were related to better overall survival (p = 0.02, p = 0.04, respectively). Thus, PET/CT can be used to predict spontaneous regression and the prognosis at the diagnosis of MTX/LPD. Cases that showed spontaneous regression never relapsed during the follow-up period, despite the usage of several anti-rheumatoid arthritis drugs, including biological agents. The early detection of LPDs and the early cessation of MTX are important for the management of RA patients. An evaluation by F-FDG-PET/CT can be useful for predicting spontaneous regression and the prognosis.

Original languageEnglish
Pages (from-to)1611-1618
Number of pages8
JournalAnnals of Hematology
Volume97
Issue number9
DOIs
Publication statusPublished - 2018 Sep 1

Fingerprint

Lymphoproliferative Disorders
Methotrexate
Rheumatoid Arthritis
Fluorodeoxyglucose F18
Biological Factors
Neoplasms
Biopsy
Survival
Positron Emission Tomography Computed Tomography
Pharmaceutical Preparations

Keywords

  • Lymphoproliferative disorder
  • Methotrexate
  • Positron emission tomography/computed tomography
  • Rheumatoid arthritis
  • Spontaneous regression

ASJC Scopus subject areas

  • Hematology

Cite this

The prognostic value of positron emission tomography/computed tomography in rheumatoid arthritis patients with methotrexate-associated lymphoproliferative disorders. / Takanashi, Satoshi; Nakazato, Tomonori; Aisa, Yoshinobu; Ito, Chisako; Arakaki, Hideki; Osada, Yuki; Hirano, Motoharu; Mori, Takehiko.

In: Annals of Hematology, Vol. 97, No. 9, 01.09.2018, p. 1611-1618.

Research output: Contribution to journalArticle

Takanashi, Satoshi ; Nakazato, Tomonori ; Aisa, Yoshinobu ; Ito, Chisako ; Arakaki, Hideki ; Osada, Yuki ; Hirano, Motoharu ; Mori, Takehiko. / The prognostic value of positron emission tomography/computed tomography in rheumatoid arthritis patients with methotrexate-associated lymphoproliferative disorders. In: Annals of Hematology. 2018 ; Vol. 97, No. 9. pp. 1611-1618.
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abstract = "Recently, methotrexate-associated lymphoproliferative disorders (MTX-LPDs) in rheumatoid arthritis (RA) have been found to commonly occur in association with iatrogenic immunodeficiency. Several factors have been reported to be related to the prognosis. We herein investigate the efficacy of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in predicting the prognosis of MTX-LPD. We performed a retrospective analysis of the clinical features, characteristics, and outcomes of 18 patients with MTX-LPDs who were treated from 2004 to 2015. All of the patients were diagnosed with MTX-LPD based on the histological examination of biopsy specimens. Spontaneous regression was detected after the cessation of MTX in 5 of 18 cases (28{\%}). The maximum standardized uptake value (SUVmax) of the FDG uptake on PET/CT was significantly lower, and the maximum size of the LPD-associated tumor was significantly smaller among the patients who showed spontaneous regression (p = 0.01, p = 0.04, respectively). Both the SUVmax and the maximum tumor size were related to better overall survival (p = 0.02, p = 0.04, respectively). Thus, PET/CT can be used to predict spontaneous regression and the prognosis at the diagnosis of MTX/LPD. Cases that showed spontaneous regression never relapsed during the follow-up period, despite the usage of several anti-rheumatoid arthritis drugs, including biological agents. The early detection of LPDs and the early cessation of MTX are important for the management of RA patients. An evaluation by F-FDG-PET/CT can be useful for predicting spontaneous regression and the prognosis.",
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AU - Takanashi, Satoshi

AU - Nakazato, Tomonori

AU - Aisa, Yoshinobu

AU - Ito, Chisako

AU - Arakaki, Hideki

AU - Osada, Yuki

AU - Hirano, Motoharu

AU - Mori, Takehiko

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AB - Recently, methotrexate-associated lymphoproliferative disorders (MTX-LPDs) in rheumatoid arthritis (RA) have been found to commonly occur in association with iatrogenic immunodeficiency. Several factors have been reported to be related to the prognosis. We herein investigate the efficacy of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in predicting the prognosis of MTX-LPD. We performed a retrospective analysis of the clinical features, characteristics, and outcomes of 18 patients with MTX-LPDs who were treated from 2004 to 2015. All of the patients were diagnosed with MTX-LPD based on the histological examination of biopsy specimens. Spontaneous regression was detected after the cessation of MTX in 5 of 18 cases (28%). The maximum standardized uptake value (SUVmax) of the FDG uptake on PET/CT was significantly lower, and the maximum size of the LPD-associated tumor was significantly smaller among the patients who showed spontaneous regression (p = 0.01, p = 0.04, respectively). Both the SUVmax and the maximum tumor size were related to better overall survival (p = 0.02, p = 0.04, respectively). Thus, PET/CT can be used to predict spontaneous regression and the prognosis at the diagnosis of MTX/LPD. Cases that showed spontaneous regression never relapsed during the follow-up period, despite the usage of several anti-rheumatoid arthritis drugs, including biological agents. The early detection of LPDs and the early cessation of MTX are important for the management of RA patients. An evaluation by F-FDG-PET/CT can be useful for predicting spontaneous regression and the prognosis.

KW - Lymphoproliferative disorder

KW - Methotrexate

KW - Positron emission tomography/computed tomography

KW - Rheumatoid arthritis

KW - Spontaneous regression

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