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Outcomes of methotrexate‐associated lymphoproliferative disorders in rheumatoid arthritis patients treated with disease‐modifying anti‐rheumatic drugs
- Source :
- British Journal of Haematology. 194:101-110
- Publication Year :
- 2021
- Publisher :
- Wiley, 2021.
-
Abstract
- Recently, the use of targeted synthetic or biological disease-modifying anti-rheumatic drugs (ts/bDMARDs) in addition to conventional synthetic (cs)DMARDs including methotrexate (MTX) for rheumatoid arthritis (RA) has increased. However, whether ts/bDMARDs are associated with the development and clinicopathological features of MTX-associated lymphoproliferative disorder (MTX-LPD) in patients with RA remains unknown. Therefore, we evaluated the clinical outcomes of 121 patients with MTX-LPD. Results showed that prior use of ts/bDMARDs was not associated with the different histopathological subtypes of MTX-LPD. Patients with polymorphic-type LPD had a better event-free survival than those with diffuse large B-cell lymphoma (DLBCL), classical Hodgkin lymphoma and peripheral T-cell lymphoma. The pathological subtype of lymphoma could predict the clinical outcome of MTX-LPD. In patients with DLBCL, the use of tumour necrosis factor-alpha (TNF-α) inhibitors prior to MTX-LPD onset was associated with a higher non-relapse mortality. Further, patients with RA previously treated with Janus kinase (JAK) inhibitors more commonly required chemotherapy than those treated with csDMARDs alone, indicating disease aggressiveness. Hence, special caution should be observed when managing patients with MTX-LPD previously treated with JAK or TNF-α inhibitors for RA.
- Subjects :
- Male
Oncology
medicine.medical_treatment
Kaplan-Meier Estimate
Disease
Arthritis, Rheumatoid
0302 clinical medicine
immune system diseases
hemic and lymphatic diseases
Antineoplastic Combined Chemotherapy Protocols
skin and connective tissue diseases
Aged, 80 and over
Lymphoma, Non-Hodgkin
Hematology
Middle Aged
Progression-Free Survival
Dacarbazine
Treatment Outcome
Vincristine
Antirheumatic Agents
030220 oncology & carcinogenesis
Rheumatoid arthritis
Female
Rituximab
medicine.drug
Adult
musculoskeletal diseases
medicine.medical_specialty
Lymphoproliferative disorders
Vinblastine
Bleomycin
03 medical and health sciences
Internal medicine
medicine
Humans
Cyclophosphamide
Pathological
Aged
Janus Kinases
Proportional Hazards Models
Chemotherapy
Tumor Necrosis Factor-alpha
business.industry
medicine.disease
Lymphoproliferative Disorders
Lymphoma
Methotrexate
Doxorubicin
Prednisone
Janus kinase
business
Follow-Up Studies
030215 immunology
Subjects
Details
- ISSN :
- 13652141 and 00071048
- Volume :
- 194
- Database :
- OpenAIRE
- Journal :
- British Journal of Haematology
- Accession number :
- edsair.doi.dedup.....9909dabb647d79a4da09e94b0bab5050