1. The clinical impact of absolute lymphocyte count in peripheral blood among patients with methotrexate - associated lymphoproliferative disorders
- Author
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Masahiro Kizaki, Shuju Momose, Michihide Tokuhira, Morihiro Higashi, Reiko Nakaseko, Junichi Watanabe, Yasuyuki Takahashi, Jun-ichi Tamaru, Yuta Kimura, Yuka Tanaka, Koichi Amano, Takayuki Tabayashi, Morihiko Sagawa, Tatsuki Tomikawa, and Tomoe Anan
- Subjects
rheumatoid arthritis ,Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Lymphoproliferative disorders ,Gastroenterology ,methotrexate ,absolute leukocyte count ,Pathogenesis ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,hemic and lymphatic diseases ,medicine ,Humans ,Lymphocyte Count ,Receptor ,Aged ,Retrospective Studies ,Aged, 80 and over ,Chemotherapy ,lymphoproliferative disorders ,business.industry ,Absolute lymphocyte count ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Peripheral blood ,relapse/regrowth ,030220 oncology & carcinogenesis ,Rheumatoid arthritis ,Antirheumatic Agents ,Methotrexate ,Original Article ,Female ,business ,030215 immunology ,medicine.drug - Abstract
Regressive lymphoproliferative disorders (R-LPD) after methotrexate (MTX) withdrawal are one of the specific features of methotrexate - associated lymphoproliferative disorders (MTX-LPD). Although the impact of the absolute lymphocyte count (ALC) on the pathogenesis of R-LPD has been recently emphasized, understanding relapse/regrowth events (RRE) and differences among LPD subtypes is necessary. In this study, we confirmed ALC recovery in the regressive group (R-G; R-LPD without RRE) and relapse/regrowth group (R/R-G; R-LPD with RRE). The increase in ALC lasted at least 2 years in R-G, whereas it decreased within 3 years in R/R-G, supporting the better overall survival (OS) in R-G, as previously reported. In addition, our study suggested that an ALC of 1000/µL at the time of development of LPD is a significant predictor for treatment-free survival (TFS). Furthermore, an ALC of 1000/µL at 6 months after MTX withdrawal was found to be a significant indicator of TFS and OS for R-G and R/R-G. The ALC decreased gradually before LPD development in R/R-G, whereas it decreased 6 months before LPD development in R-G, confirming the important role of ALC in the pathogenesis of MTX-LPD such as regressive events and RRE. In addition to ALC, other predictive factors, such as serum C-reactive protein and soluble interleukin-2 receptors, may be helpful in the management of MTX-LPD, including the decision making for an additional chemotherapy for regressive LPD after MTX withdrawal.
- Published
- 2020