ACUTE-LEUKEMIA AFTER LOW-DOSE METHOTREXATE THERAPY IN A PATIENT WITH RHEUMATOID-ARTHRITIS

An 83-year-old woman with seropositive rheumatoid arthritis (RA) devel oped acute myeloid leukemia after receiving weekly methotrexate (MTX) for 33 months (total dose 690 mg). Although cytogenetic abnormalities typical of damage by cytotoxic agents were not documented, our case ma y be the first report of acute myeloid leukemia in RA with MTX. We est imate that 6 similar cases should have been observed in France by chan ce alone. The absence of other reports suggests either that MTX posses ses a paradoxical protective effect or that it is not considered a ris k factor for malignancy by rheumatologists. Since the number of patien ts with RA taking MTX can be estimated with reasonable accuracy, the r eporting of all suspected cases could help to assess the safety of the drug in rheumatology.