Polymorphic lymphoproliferative disorders in patients with rheumatoid arthritis are associated with a better clinical outcome

Abstract

Objectives: The characteristics of lymphoproliferative disorders (LPD) in patients with rheumatoid arthritis (RA) remain unclear. Therefore, we retrospectively analyzed the clinical characteristics of these patients in our department.

Methods: Twenty RA patients who developed LPD between April 2003 and August 2016 in our department were analyzed.

Results: All of the RA patients who developed LPD had been treated with methotrexate (MTX). The median weekly and total dosages of MTX were 6.8 mg/week and 2530 mg, respectively. The median duration of MTX administration was eight years. Nineteen patients (95%) achieved complete remission (CR) and 15 (75%) achieved CR with MTX cessation alone. Based on the pathological findings, we divided MTX-associated LPD patients into two groups (n = 16); polymorphic LPD (31%) and other groups. CR with MTX cessation alone was achieved in 5 (100%) and 6 (54.5%) patients in the polymorphic LPD and other groups, respectively (p = .12). Moreover, the duration from the cessation of MTX to CR was significantly shorter in the polymorphic LPD group than in the other group (5.3 months vs 12.6 months, p = .01, respectively).

Conclusion: Polymorphic LPD, which was the most frequent pathological diagnosis in this cohort, was associated with a higher incidence of CR and a significantly shorter duration to CR.

Keywords:

• Rheumatoid arthritis
• methotrexate
• lymphoproliferative disorders
• MTX-associated LPD
• polymorphic LPD

Conflict of interest

HK has received consulting fees, speaking fees, and/or honoraria from Astellas, Eisai, Bristol-Myers, Pfizer Japan, Daiichi-Sankyo, Janssen, Novartis. SS has received honoraria from AbbVie, Eisai, Chugai, Takeda, Bristol-Myers Squibb, Astrazeneca and UCB. KK has received consulting fees, speaking fees, and/or honoraria from Pfizer, Chugai, Takeda, Mitsubishi Tanabe, AbbVie, outside the submitted work. KF has received financial support or fees from Astellas, BMS, Daiichi-Sankyo, Tanabe Mitsubishi, Pfizer, Santen, Takeda, Chugai, Eisai, Taisho Toyama, UCB, Japan, and Janssen. FN received speaking fees from Pfizer Japan Inc. MK has received speaking fees and/or honoraria from MSD, Kyowa Hakko Kirin, Nippon Shinyaku, Yakult, Pfizer, Shire Japan, Daiichi-Sankyo, Ono Pharmaceutical, Sumitomo Dainippon Pharma, Celgene, Bristol-Myers Squibb, and Takeda Pharmaceutical outside the summited work. MK has received financial support from Otsuka Pharmaceutical, Taiho Pharmaceutical, GlaxoSmithKline, Eisai, Nippon Shinyaku, Pfizer, Takeda Pharmaceutical, Eli Lilly Japan, Nippon Kayaku, MSD, Kyowa Hakko Kirin, Astellas, Taisho Toyama Pharmaceutical, Bristol-Myers Squibb, Asahi Kasei Pharmaceuticals, Novartis Pharmaceuticals, Toyama Chemical, and Chugai Pharmaceutical outside the submitted work. YK has received financial support or fees from AbbVie, Astellas, BMS, Daiichi-Sankyo, Tanabe Mitsubishi, Pfizer, Sanofi, Santen, Takeda, Teijin, Boehringer Ingelheim, Chugai, Eisai, Ono, Taisho Toyama, UCB Japan, ImmunoFuture, Asahi Kasei, and Janssen. Department of Immunotherapy Management, Graduate School of Medicine, University of Tokyo had courses endowed by Tanabe Mitsubishi Pharma, Chugai Pharmaceutical, Ayumi Pharmaceutical, Taisho Toyama Pharmaceutical, Nippon Kayaku, UCB Japan, AbbVie. The others author has declared no conflicts of interest.