Methotrexate-induced Primary Cutaneous Diffuse Large B-cell Lymphoma in Patients with Erythrodermic Cutaneous T-cell Lymphoma

Delaleu, Jérémie; Maubec, E.; Rodrigues, F.; Lévy, A.; Szablewski, Vanessa; Laroche, L.; Dereure, O.

doi:10.2340/00015555-3554

Cited by 4 publications

(7 citation statements)

References 14 publications

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“…It is also worth noting that our patient used MTX as a treatment for rheumatoid arthritis for 27 years. There are reports about lymphoproliferative disorder (LPD) which occasionally develop in rheumatoid arthritis as induced by MTX (MTX-associated LPD; MTX-LPD) [21][22][23][24]. As in our patient, approximately half of MTX-LPD cases occur at primary extranodal sites, including the skin [21].…”

Section: Discussionmentioning

confidence: 51%

Unilateral lower extremity lymphedema as a first symptom of primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT)

Truszyński,

Brodowski,

Jeleń

et al. 2023

Acta Angiologica

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Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT), is a rare and aggressive variant of extranodal lymphoma. We report the case of a 64-year-old woman with unilateral lymphedema of the lower limb as the first and only symptom of PCDLBCL-LT for six months. Violaceous nodules were the second symptom and they progressively developed on the edematous calf. Initially, they were diagnosed as warty overgrowths, which are common skin changes in the course of chronic lymphedema. The lack of improvement in the violaceous nodules after compression therapy prompted to perform a skin biopsy. Histopathological evaluation revealed the presence of PCDLBCL-LT. In this article, we want to highlight the challenges of making a diagnosis of PCDLBCL-LT. To our knowledge, no other study has reported on lymphedema as an initial symptom of PCDLBCL-LT.

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Section: Discussionmentioning

confidence: 51%

Unilateral lower extremity lymphedema as a first symptom of primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT)

Truszyński,

Brodowski,

Jeleń

et al. 2023

Acta Angiologica

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“…MTX therapy has been implicated in the development of EBV‐positive B‐cell lymphoproliferative disease in case series (LoE 4) and reports (LoE 5) of patients with dermatomyositis, 63–68 psoriasis, 69–71 Sjogren's syndrome, 71 mycosis fungoides 72 and Sézary syndrome 72 . For some patient cases mentioned, once MTX was discontinued, the B‐cell lymphoma spontaneously resolved 64–67,71,72 …”

Section: Resultsmentioning

confidence: 99%

“…MTX therapy has been implicated in the development of EBVpositive B-cell lymphoproliferative disease in case series (LoE 4) and reports (LoE 5) of patients with dermatomyositis, [63][64][65][66][67][68] psoriasis, [69][70][71] Sjogren's syndrome, 71 mycosis fungoides 72 and Sézary syndrome. 72 For some patient cases mentioned, once MTX was discontinued, the B-cell lymphoma spontaneously resolved. [64][65][66][67]71,72 Grade C. Low-dose MTX may be associated with increased risk of malignancy; however, there are inconsistencies in the available literature.…”

Section: Methotrexatementioning

confidence: 99%

“…72 For some patient cases mentioned, once MTX was discontinued, the B-cell lymphoma spontaneously resolved. [64][65][66][67]71,72 Grade C. Low-dose MTX may be associated with increased risk of malignancy; however, there are inconsistencies in the available literature. There are a few reported cases of EBV-positive B-cell lymphoproliferative disease in those taking MTX.…”

Section: Methotrexatementioning

confidence: 99%

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Malignancy risk ofnon‐biologicimmunosuppressive therapies: A review of the literature withevidence‐basedtreatment recommendations

Stratman

Golpanian

Fayne

et al. 2022

Experimental Dermatology

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Non‐biologic immunosuppressive therapies are a mainstay in the treatment of various dermatologic conditions. However, the use of these therapies has been scrutinized for potentially increasing risk of haematologic or solid‐organ malignancies. Currently, there are no evidence‐based guidelines stratifying the risk of malignancy in patients receiving these immunosuppressive agents for the treatment of dermatologic disease. In our review, we evaluate the risk of solid organ and haematologic malignancies in patients receiving non‐biologic immunosuppressant therapy for dermatologic indications. A literature search was conducted on PubMed/MEDLINE. Search terms included commonly prescribed non‐biologic immunosuppressants and common dermatologic conditions for which non‐biologic immunosuppressants are typically prescribed. Levels of evidence and grades of recommendation were used for guidelines. All immunosuppressants evaluated, with the exception of cyclophosphamide, demonstrated low solid‐organ or haematologic malignancy potential. Co‐morbidities may play a role in malignancy risk in the context of immunosuppressant treatment, including autoimmune disease, which have been associated with increased risk of malignancy and confound overall risk. Duration and/or dosage of treatment may influence this risk as well. Limitations of the review include that the majority of studies were of small sample size, retrospective in nature, and there was lack of direct comparison trials.

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“…Nevertheless, treatment is primarily based on MTX withdrawal, with spontaneous remission observed in 60% to 88% of the cases. 10 , 17 , 20 In most cases, the lesions significantly improved within 1 to 3 months (ranging from 15 days to 5 months) after MTX discontinuation. 10 , 17 , 20 Chemotherapy regimens with or without rituximab (CHOP or R-CHOP) are recommended for patients with treatment failure or progressive disease.…”

Section: Discussionmentioning

confidence: 95%

Cutaneous Methotrexate-Related Epstein–Barr Virus-Positive Diffuse Large B-Cell Lymphoma in a Patient with Granulomatous Cutaneous T-Cell Lymphoma: A Case Report and Literature Review

Kositkuljorn,

Rutnin,

Rattananukrom

et al. 2023

CCID

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Methotrexate-related lymphoproliferative disorders (MTX-LPDs) are immunodeficiency diseases following methotrexate (MTX) administration, mainly occurring in rheumatoid arthritis patients. Although uncommon, MTX-LPDs have been reported in some patients with psoriasis, dermatomyositis, and cutaneous T-cell lymphoma (CTCL) who received MTX. Granulomatous mycosis fungoides (GMF) is a rare subtype of cutaneous T-cell lymphoma, where MTX is one of the treatment options in recalcitrant cases. Herein, we report a case of a 72-year-old female patient with GMF who additionally developed cutaneous Epstein–Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) during MTX treatment. According to the 5th edition of the WHO classification of Haematolymphoid Tumors (WHO-HAEM), this condition is currently categorized as “lymphoma arising in immunodeficiency/dysregulation”. In this article, we also reviewed published literature on cutaneous MTX-LPDs in the setting of CTCL. This entity should be considered in cases of new, atypical skin nodules and/or plaques in CTCL patients receiving long-term MTX treatment.

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Methotrexate-induced Primary Cutaneous Diffuse Large B-cell Lymphoma in Patients with Erythrodermic Cutaneous T-cell Lymphoma

Abstract: Fig. 1. Clinical presentation of patient 1. Solitary ulcerated nodule on the upper back 10 months after introduction of methotrexate.

Cited by 4 publications

References 14 publications

Unilateral lower extremity lymphedema as a first symptom of primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT)

Unilateral lower extremity lymphedema as a first symptom of primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT)

Malignancy risk ofnon‐biologicimmunosuppressive therapies: A review of the literature withevidence‐basedtreatment recommendations

Cutaneous Methotrexate-Related Epstein–Barr Virus-Positive Diffuse Large B-Cell Lymphoma in a Patient with Granulomatous Cutaneous T-Cell Lymphoma: A Case Report and Literature Review

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