[Aggressive non-Hodgkin lymphoma in 3 patients with rheumatoid arthritis: discontinue the use of methotrexate]

Ned Tijdschr Geneeskd. 2008 Oct 25;152(43):2351-6.
[Article in Dutch]

Abstract

3 female patients who were being treated with methotrexate developed a non-Hodgkin lymphoma. The first patient, 67 years old, presented with an enlarged thyroid gland. The cytological punction was inconclusive and an open biopsy revealed a B cell non-Hodgkin lymphoma, which was localised. A week before the biopsy the methotrexate was discontinued. The patient herself reported that the swelling of her thyroid gland was diminished after cessation of methotrexate. The lymphoma showed a complete remission without chemotherapy being given. The second patient, a 78-year-old woman, developed a non-Hodgkin lymphoma in one of her tonsils that showed a partial remission after withdrawal of the methotrexate therapy. The third patient, a 66-year-old woman, presented herself with a pulmonary non-Hodgkin lymphoma. In this patient withdrawal of the methotrexate resulted in a complete remission of the non-Hodgkin lymphoma as well. Although no epidemiological study has shown an increased risk of lymphoproliferative disorders during the use of methotrexate, these spontaneous remissions suggest an aetiological link. If a non-Hodgkin lymphoma develops in a patient being treated with methotrexate then the therapy should be discontinued and chemotherapy should not be given straightaway.

Publication types

  • Case Reports
  • Comment
  • English Abstract

MeSH terms

  • Aged
  • Antirheumatic Agents / adverse effects*
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid / drug therapy
  • Female
  • Humans
  • Lymphoma, Non-Hodgkin / chemically induced*
  • Methotrexate / adverse effects*
  • Methotrexate / therapeutic use
  • Remission, Spontaneous

Substances

  • Antirheumatic Agents
  • Methotrexate