Contributions
Abstract: PB1756
Type: Publication Only
Background
Methotrexate-associated lymphoproliferative disorders (MTX-LPD) are included in category of other iatrogenic immunodeficiency-associated LPD in WHO 2016 classification. Although tumor regression by MTX discontinuation without any additional treatment is often observed, proportion of these phenomenon remains unclear. Risk factors for MTX-LPD development, and appropriate treatment strategy have not been well-known.
Aims
We conducted a retrospective observational study to characterize MTX-LPD and to evaluate prognostic factors.
Methods
We reviewed laboratory data and medical record of the pathologically confirmed MTX-LPD patients between Jan 2012 and Dec 2016 in our hospital.
Results
A total of 31 patients (23 females and 8 males; median age 71 years old, ranging 41-87 years old) were included in this study. Median observation period was 27.4 months (range 1.0-62 months). Histological diagnoses were as follows: 21 diffuse large B-cell lymphoma, 4 follicular lymphoma, 3 T-cell lymphoma, 2 Marginal zone lymphoma, one NK/T cell lymphoma.
Spontaneous tumor regression within 3 months after MTX discontinuation was observed in 16 (51%) patients. Nine of them maintained remission without any additional therapy for MTX-LPD. Remaining seven patients received chemotherapy because of regrowth of LPD. Totally, 21 patients received chemotherapy. Median duration from the diagnosis to chemotherapy initiation was one month (range 3 days-38.6 months). Complete response and partial response was obtained in 11 (61%) and 5 (28%) patients. Therefore, overall response rate was 16/18(88%). Estimated 1-year overall survival (OS) rate was 93% and 3-yr OS rate was 69%. Kaplan-Meier plots demonstrated that following clinical variables were associated with worse OS: older age (65 years or older) (3-years OS, 52% vs 93%, log rank test, P=0.0019), higher serum LDH (>upper limit of normal range) (3-year OS, 62% vs 100%, log rank test, P=0.034 ), lower serum albumin (< 3.8g/dL) (3-year OS, 42% vs 85%, log rank test, P=0.063), higher IPI risk categories (High-Int, and High risk groups) (3-year OS, 70% vs 80%, log rank test, P=0.024), and poorer performance status (PS score, 2 or higher) (3-year OS, 25% vs 80%, log rank test, P=0.012).
Conclusion
In conclusion, 10 (32%) patients were alive without chemotherapy after MTX discontinuation. Older age, higher serum LDH, higher IPI risk categories, and poorer PS predict survival of patients with MTX-LPD.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Methotrexate, Non-Hodgkin's lymphoma
Abstract: PB1756
Type: Publication Only
Background
Methotrexate-associated lymphoproliferative disorders (MTX-LPD) are included in category of other iatrogenic immunodeficiency-associated LPD in WHO 2016 classification. Although tumor regression by MTX discontinuation without any additional treatment is often observed, proportion of these phenomenon remains unclear. Risk factors for MTX-LPD development, and appropriate treatment strategy have not been well-known.
Aims
We conducted a retrospective observational study to characterize MTX-LPD and to evaluate prognostic factors.
Methods
We reviewed laboratory data and medical record of the pathologically confirmed MTX-LPD patients between Jan 2012 and Dec 2016 in our hospital.
Results
A total of 31 patients (23 females and 8 males; median age 71 years old, ranging 41-87 years old) were included in this study. Median observation period was 27.4 months (range 1.0-62 months). Histological diagnoses were as follows: 21 diffuse large B-cell lymphoma, 4 follicular lymphoma, 3 T-cell lymphoma, 2 Marginal zone lymphoma, one NK/T cell lymphoma.
Spontaneous tumor regression within 3 months after MTX discontinuation was observed in 16 (51%) patients. Nine of them maintained remission without any additional therapy for MTX-LPD. Remaining seven patients received chemotherapy because of regrowth of LPD. Totally, 21 patients received chemotherapy. Median duration from the diagnosis to chemotherapy initiation was one month (range 3 days-38.6 months). Complete response and partial response was obtained in 11 (61%) and 5 (28%) patients. Therefore, overall response rate was 16/18(88%). Estimated 1-year overall survival (OS) rate was 93% and 3-yr OS rate was 69%. Kaplan-Meier plots demonstrated that following clinical variables were associated with worse OS: older age (65 years or older) (3-years OS, 52% vs 93%, log rank test, P=0.0019), higher serum LDH (>upper limit of normal range) (3-year OS, 62% vs 100%, log rank test, P=0.034 ), lower serum albumin (< 3.8g/dL) (3-year OS, 42% vs 85%, log rank test, P=0.063), higher IPI risk categories (High-Int, and High risk groups) (3-year OS, 70% vs 80%, log rank test, P=0.024), and poorer performance status (PS score, 2 or higher) (3-year OS, 25% vs 80%, log rank test, P=0.012).
Conclusion
In conclusion, 10 (32%) patients were alive without chemotherapy after MTX discontinuation. Older age, higher serum LDH, higher IPI risk categories, and poorer PS predict survival of patients with MTX-LPD.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Methotrexate, Non-Hodgkin's lymphoma