Development of adult T-cell leukaemia/lymphoma during the treatment of rheumatoid arthritis

Abstract

Two patients with rheumatoid arthritis (RA) developed adult T-cell leukaemia/lymphoma (ATLL) in the course of RA treatment. We previously reported another case of ATLL that developed during RA treatment and summarised all three cases of ATLL. The mean age at onset of ATLL was 63.7 ± 9.6 years and treatment regimens included biological disease-modifying anti-rheumatic drugs (bDMARDs), such as abatacept (ABT) and tocilizumab, and conventional synthetic DMARDs (i.e. iguratimod (IGU) and methotrexate [MTX]) and/or glucocorticoids. Two patients were complicated with bronchiectasis and/or interstitial pneumonia and one patient developed ATLL after MTX-related lymphoproliferative disease. All three patients with ATLL were encountered for 5 years of clinical practice at our centre. The prevalence of ATLL that developed from 78 human T-cell leukaemia virus type 1 (HTLV)-1-seropositive RA patients was 3.85%. In conclusion, we described three cases of ATLL development during the treatment for RA. It is suggested that HTLV-1 seropositive RA patients should be managed and treated carefully. A nationwide survey is necessary to elucidate if the progression to ATLL after immunosuppressive treatment for RA occurs at higher in incidence than that in the natural course of an HTLV-1 infection.

Keywords:

• Rheumatoid arthritis
• adult T-cell leukaemia/lymphoma
• human T-cell leukaemia virus type 1
• immunosuppressive drugs
• disease-modifying anti-rheumatic drugs

Conflict of interest

None.