METHOTREXATE IS EFFECTIVE THERAPY FOR LYMPHOMATOID PAPULOSIS AND OTHER PRIMARY CUTANEOUS CD30-POSITIVE LYMPHOPROLIFERATIVE DISORDERS

Background: The spectrum of primacy cutaneous CD30(+) lymphoprolifenti ve disease consists of lymphomatoid papulosis (LyP) at one extreme and CD30+ peripheral T-cell lymphoma (Ki-1(+) lymphoma) presenting in the skin at the other extreme. Methotrexate has been reported to be effec tive in LyP, but the experience has been Limited to single case report s or small series. Objective: The objective was to determine the effec tiveness of methotrexate in the treatment of primary cutaneous CD30+ l ymphoproliferative disease. Methods: We reviewed our 20-year experienc e with the use of methotrexate in 45 patients with relatively severe L yP, Ki-1(+) lymphoma, and interface presentations. Results: During ind uction of methotrexate therapy patient received maximum doses ranging from 10 to 60 mg/week (median, 20 mg/week). Clinical improvement usual ly occurred quickly, typically at doses of 15 to 20 mg weekly, and sat isfactory long-term control was achieved in 39 patients (87%) with mai ntenance doses given at 10- to 14-day intervals (range, 7 to 28 days). After methotrexate was discontinued, 10 patients remained free of CD3 0(+) lesions from more than 24 months to more than 227 months (median, more than 127 months). The median total duration of methotrexate ther apy for all patients exceeded 39 months (range, 2 to 205 months). Adve rse effects were generally mild and transient and included fatigue (47 %), nausea (22%), weight loss (13%), diarrhea or gastrointestinal cram ping (10%), increased serum hepatic transaminase levels (27%), anemia (11%), or leukopenia (9%). Early hepatic fibrosis was found in 5 of 10 patients, all of wham had been treated for more than 3 years (range, 38 to 111 months). Conclusion: Low-dose methotrexate (25 mg or less gi ven at 1- to 4-week intervals) is an effective and well-tolerated trea tment of selected patients with primary cutaneous CD30(+) lymphoprolif erative disease.