HODGKINS-DISEASE AND LYMPHOPROLIFERATIONS RESEMBLING HODGKINS-DISEASEIN PATIENTS RECEIVING LONG-TERM LOW-DOSE METHOTREXATE THERAPY

Recently, it has been shown that patients with rheumatologic diseases who are treated with methotrexate can develop immunosuppression-associ ated lymphoproliferative disorders. Although a variety of lymphoprolif erations have been described in the setting of methotrexate therapy, o nly rare cases of Hodgkin's disease (HD) have been reported. In this s tudy, we provide a more complete characterization of the spectrum of l ymphoproliferations that resemble HD or show features diagnostic of HD that occur in patients receiving long-term low-dose methotrexate ther apy. Eight patients were receiving methotrexate for various disorders. Four cases were considered to represent lymphoproliferations resembli ng HD; the other four cases were diagnosed as HD because they showed d iagnostic morphologic and immunophenotypic features. All three patient s with lymphoproliferations resembling HD on whom follow-up was availa ble experienced tumor regression with methotrexate withdrawal or with methotrexate withdrawal and steroids; none of these three patients req uired further therapy. All three patients with HD on whom follow-up wa s available are alive and free of disease following chemotherapy or ra diation therapy. In two of these patients, the tumor persisted or prog ressed despite discontinuation of methotrexate with observation; the t hird patient received chemotherapy at the same time methotrexate was s topped. Our findings indicate that a spectrum of lymphoproliferations resembling HD or diagnostic of HD can occur in patients receiving long term low-dose methotrexate therapy. Recognition of these lymphoprolife rative disorders is clinically important because a subset of these neo plasms will completely resolve with discontinuation of methotrexate, t hereby obviating the need for chemotherapy or radiation therapy.