Abstract
A patient with rheumatoid arthritis (RA) developed an atypical lymphoproliferative disorder (LPD) after methotrexate and cyclosporine A, which regressed after suspension of both drugs. After subsequent treatment with rituximab, the LPD was still undetectable. Anti-tumor necrosis factor a therapy was used when the arthritis relapsed, but an aggressive B-cell non Hodgkin's lymphoma developed. Molecular analyses showed an oligoclonal B-cell expansion at the LPD step. A minor clone with significant sequence homology to B-cell lymphomas arising in Sjogren's syndrome and mixed cryoglobulinemia syndrome, given rise to the non-Hodgkin's lymphoma. Treatment of rheumatoid arthritis associated with lymphoproliferation represents a clinical challenge, and common pathogenetic pathways to lymphoma may occur in different autoimmune diseases.
Publication types
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Case Reports
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Research Support, Non-U.S. Gov't
MeSH terms
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Aged
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Antibodies, Monoclonal / therapeutic use
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Antibodies, Monoclonal, Murine-Derived
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Antirheumatic Agents / adverse effects
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Antirheumatic Agents / therapeutic use*
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Arthritis, Rheumatoid / complications*
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Arthritis, Rheumatoid / drug therapy
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Autoimmune Diseases / complications
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Contraindications
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Cyclosporine / adverse effects
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Cyclosporine / therapeutic use
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DNA, Neoplasm / genetics
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Disease Progression
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Disease Susceptibility
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Etanercept
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Female
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Gene Rearrangement, B-Lymphocyte, Heavy Chain
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Gene Rearrangement, B-Lymphocyte, Light Chain
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Genes, Immunoglobulin
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Humans
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Immunocompromised Host
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Immunoglobulin G / adverse effects
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Immunoglobulin G / therapeutic use
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Immunosuppressive Agents / adverse effects
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Immunosuppressive Agents / therapeutic use*
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Lymphoma, Large B-Cell, Diffuse / etiology*
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Lymphoma, Large B-Cell, Diffuse / genetics
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Lymphoproliferative Disorders / complications*
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Lymphoproliferative Disorders / genetics
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Methotrexate / adverse effects
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Methotrexate / therapeutic use
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Neoplasm Proteins / analysis
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Neoplasm Proteins / genetics
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Receptors, Tumor Necrosis Factor / therapeutic use
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Rituximab
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Tumor Necrosis Factor-alpha / antagonists & inhibitors
Substances
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Antibodies, Monoclonal
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Antibodies, Monoclonal, Murine-Derived
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Antirheumatic Agents
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DNA, Neoplasm
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Immunoglobulin G
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Immunosuppressive Agents
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Neoplasm Proteins
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Receptors, Tumor Necrosis Factor
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Tumor Necrosis Factor-alpha
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Rituximab
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Cyclosporine
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Etanercept
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Methotrexate