Clinicopathological evaluation of methotrexate-associated lymphoproliferative disorders with special focus on Epstein-Barr virus-positive mucocutaneous lesions
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- Shiraiwa Sawako
- Department of Pathology, Tokai University, School of Medicine, Isehara, Japan, Department of Hematology and Oncology, Tokai University, School of Medicine, Isehara, Japan,
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- Kikuti Yara Yukie
- Department of Pathology, Tokai University, School of Medicine, Isehara, Japan,
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- Carreras Joaquim
- Department of Pathology, Tokai University, School of Medicine, Isehara, Japan,
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- Hara Ryujiro
- Department of Hematology and Oncology, Tokai University, School of Medicine, Isehara, Japan,
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- Aoyama Yasuyuki
- Department of Hematology and Oncology, Tokai University, School of Medicine, Isehara, Japan,
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- Ogiya Daisuke
- Department of Hematology and Oncology, Tokai University, School of Medicine, Isehara, Japan,
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- Suzuki Rikio
- Department of Hematology and Oncology, Tokai University, School of Medicine, Isehara, Japan,
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- Toyosaki Masako
- Department of Hematology and Oncology, Tokai University, School of Medicine, Isehara, Japan,
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- Ohmachi Ken
- Department of Hematology and Oncology, Tokai University, School of Medicine, Isehara, Japan,
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- Ogawa Yoshiaki
- Department of Hematology and Oncology, Tokai University, School of Medicine, Isehara, Japan,
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- Kawada Hiroshi
- Department of Hematology and Oncology, Tokai University, School of Medicine, Isehara, Japan,
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- Sato Shinji
- Department of Rheumatology, Tokai University School of Medicine, Isehara, Japan
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- Nakamura Naoya
- Department of Pathology, Tokai University, School of Medicine, Isehara, Japan,
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- Ando Kiyoshi
- Department of Hematology and Oncology, Tokai University, School of Medicine, Isehara, Japan,
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抄録
<p>Some patients diagnosed with methotrexate-associated lymphoproliferative disorder (MTX-LPD) develop spontaneous regression upon the discontinuation of MTX, whereas others require chemotherapy. The mechanisms underlying this differential response and the capacity to spontaneously regress are not clearly understood. We evaluated numerous clinicopathological features in 63 patients diagnosed with MTX-LPD, with a special focus on those with Epstein-Barr virus (EBV)-positive mucocutaneous lesions (EBVMCL). The diagnosis of EBVMCL included cases of both EBV-positive mucocutaneous ulcers (EBVMCU) and diffuse gingival swelling associated with proliferation of EBV-positive large B-cells. Of the four subgroups of MTX-LPD, one-year treatment-free survival (TFS) after the discontinuation of MTX was achieved among those with EBVMCL (100%), diffuse large B-cell lymphoma (57%), Hodgkin-like lesions (60%), or classical Hodgkin lymphoma (29%); a significant difference in TFS was observed when comparing the responses of patients with EBVMCL to the those diagnosed with other subtypes. Multivariate analysis revealed predictive factors for prolonged TFS that included EBV-positive lesions and comparatively low levels of serum LDH. Taken together, our study suggests that a diagnosis of EBVMCL is related to the overall clinical outcome after the discontinuation of MTX.</p>
収録刊行物
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- Ｊｏｕｒｎａｌ ｏｆ Ｃｌｉｎｉｃａｌ ａｎｄ Ｅｘｐｅｒｉｍｅｎｔａｌ Ｈｅｍａｔｏｐａｔｈｏｌｏｇｙ
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Ｊｏｕｒｎａｌ ｏｆ Ｃｌｉｎｉｃａｌ ａｎｄ Ｅｘｐｅｒｉｍｅｎｔａｌ Ｈｅｍａｔｏｐａｔｈｏｌｏｇｙ 60 (4), 159-168, 2020
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