Epstein-Barr virus-associated lymphoma in patients with dermatomyositis. Be aware of double immunosuppression

Selva-O’Callaghan, Albert; Palacios, Azucena; Soláns-Laqué, Roser; Labirua, Anne; Salcedo-Allende, Teresa; Vilardell‐Tarrés, Miquel

doi:10.1093/rheumatology/kep247

Cited by 7 publications

(3 citation statements)

References 7 publications

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“…However, as described by Chen, et al 26 , the malignancy risk in patients with myositis decreases with time, suggesting that the nature of inflammation, rather than immunosuppressive drugs, plays a pivotal role in the development of malignancy diseases. Additionally, the immunosuppressive agents in patients with PM/DM may lead to the reactivation of viral infection, which has been found to be associated with certain types of malignancies, such as Epstein-Barr virus, lymphoma, and others 39 . Accordingly, the role of virus in malignancy development in patients with PM/DM cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

Polymyositis/dermatomyositis and Malignancy Risk: A Metaanalysis Study

Yang

Lin²,

Qin³

et al. 2014

J Rheumatol

151

117

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Section: Discussionmentioning

confidence: 99%

Polymyositis/dermatomyositis and Malignancy Risk: A Metaanalysis Study

Yang

Lin²,

Qin³

et al. 2014

J Rheumatol

151

117

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show abstract

“…For the systematic literature review, we searched English‐language literature published prior to November 2022 in PubMed using the keywords (“idiopathic inflammatory myopathies” OR “myositis” OR “rheumatic diseases” OR “autoimmune diseases”) AND (“Epstein–Barr virus”) AND (“malignant lymphoma” OR “lymphoproliferative disorders”). We found 12 articles 2,7–17 that reported 19 cases of EBV‐associated OIIA‐LPD in patients with IIM (Table 1). Myositis‐associated antibodies were evaluated in 6: anti‐aminoacyl‐tRNA synthetase antibodies in 5, and anti‐signal recognition particle antibodies in the remaining one.…”

Section: Discussionmentioning

confidence: 99%

Other iatrogenic immunodeficiency‐associated lymphoproliferative disorders in a patient with anti‐melanoma differentiation‐associated gene 5‐positive dermatomyositis: A case report and systematic literature review

et al. 2023

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A 58‐year‐old man with anti‐melanoma differentiation‐associated gene 5‐positive dermatomyositis (MDA5‐DM) developed Epstein–Barr virus (EBV)‐associated malignant lymphoma as other iatrogenic immunodeficiency‐associated lymphoproliferative disorders (OIIA‐LPD) during the combined immunosuppressive therapy of high‐dose prednisolone, tacrolimus, and intravenous cyclophosphamide for MDA5‐DM. Serum EBV DNA was detected, and EBV‐encoded small RNA was positive in the tissue sample of LPD, indicating that EBV reactivation contributed to the pathogenesis of LPD in our case. The patient underwent chemotherapy, including rituximab, promptly after discontinuation of tacrolimus and cyclophosphamide, resulting in complete remission of the malignant lymphoma, and MDA5‐DM has not recurred with 3.5 mg/d of prednisolone monotherapy. We reviewed 19 cases of OIIA‐LPD in patients with idiopathic inflammatory myopathies and herein report the first case of MDA5‐DM complicated with OIIA‐LPD. Among the 19 patients, 7 showed regression of LPD only following withdrawal of immunosuppressants, 9 took chemotherapy for LPD, and 5 died. It should be noted that patients with MDA5‐DM‐associated rapidly progressive interstitial lung disease could develop OIIA‐LPD because they receive aggressive immunosuppressive therapy.

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“…Nevertheless, there are several case reports of post-transplantation lymphoproliferative disorders (PTLD), usually diffuse large B cell lymphomas, in patients with severe immunodepression for refractory myositis, mainly due to the combination of at least two immunosuppressive drugs (i.e., azathioprine plus methotrexate or azathioprine plus mycophenolate mofetil). However, this is an unusual scenario [ 22 ].…”

Section: Treatmentmentioning

confidence: 99%

Management of Cancer-Associated Myositis

Selva-O’Callaghan

Trallero-Araguás

Ros

et al. 2022

Curr Treat Options in Rheum

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Purpose of the Review Cancer-associated myositis (CAM) is defined as when cancer appears within 3 years of myositis onset. Dermatomyositis and seronegative immune–mediated necrotizing myopathy are the phenotypes mostly related to cancer. In general, treatment principles in myositis patients with and without CAM are similar. However, some aspects of myositis management are particular to CAM, including (a) the need for a multidisciplinary approach and a close relationship with the oncologist, (b) the presence of immunosuppressive and antineoplastic drug interactions, and (c) the role of the long-term immunosuppressive therapy as a risk factor for cancer relapse or development of a second neoplasm. In this review, we will also discuss immunotherapy in patients treated with checkpoint inhibitors as a treatment for their cancer. Recent Findings Studies on cancer risk in patients treated with long-term immunosuppressive drugs, in autoimmune diseases such as systemic lupus erythematosus or rheumatoid arthritis, and in solid organ transplant recipients have shed some light on this topic. Immunotherapy, which has been a great advance for the treatment of some types of malignancy, may be also of interest in CAM, given the special relationship between both disorders. Summary Management of CAM is a challenge. In this complex scenario, therapeutic decisions must consider both diseases simultaneously. Supplementary Information The online version contains supplementary material available at 10.1007/s40674-022-00197-2.

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Epstein-Barr virus-associated lymphoma in patients with dermatomyositis. Be aware of double immunosuppression

Cited by 7 publications

References 7 publications

Polymyositis/dermatomyositis and Malignancy Risk: A Metaanalysis Study

Polymyositis/dermatomyositis and Malignancy Risk: A Metaanalysis Study

Other iatrogenic immunodeficiency‐associated lymphoproliferative disorders in a patient with anti‐melanoma differentiation‐associated gene 5‐positive dermatomyositis: A case report and systematic literature review

Management of Cancer-Associated Myositis

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