METHOTREXATE-ASSOCIATED LYMPHOMA IN PATIENTS WITH RHEUMATOID-ARTHRITIS - REPORT OF 2 CASES

This report describes 2 patients with longstanding seropositive rheuma toid arthritis (RA) treated with oral methotrexate (MTX) who developed large cell lymphoma of B cell phenotype, In situ hybridization studie s showed nuclear staining for Epstein-Barr virus (EBV) within the mali gnant lymphoid cells, In both cases, the lymphoma was undetectable sev eral weeks after diagnostic biopsy followed by discontinuation of MTX, These observations suggest that, in patients with RA who develop an E BV-associated lymphoproliferative disorder, a trial of discontinuation of immunosuppressive agents may be warranted before chemotherapy is c onsidered, In addition, there is a need for a heightened awareness of the development of lymphoma in this patient population.