Spontaneous Remission Of Low-grade B-cell Non-hodgkin's Lymphoma Following Withdrawal Of Methotrexate In A Patient With Rheumatoid Arthritis: Case Report And Review Of The Literature
Baird, R. D., van Zyl-Smit, R. N., Dilke, T., Scott, S. E., & Rassam, S. M. (2002). spontaneous remission of low-grade B-cell non-Hodgkin's lymphoma following withdrawal of methotrexate in a patient with rheumatoid ARThritis: case report and review of the literature. British journal of haematology, 118(2), 567–568. https://doi.org/10.1046/j.1365-2141.2002.03619.x
View Original Source →Abstract
. A 69‐year‐old woman, who had suffered from deforming rheumatoid arthritis since the age of 40 years, had been treated with methotrexate for 3 years. She presented with a 7 week history of neck lymphadenopathy. Biopsy revealed low‐grade marginal‐zone B‐cell non‐Hodgkin's lymphoma. Computerized tomography and bone marrow biopsy confirmed stage IIIA disease. Spontaneous complete remission of the lymphoma was achieved 14 months after withdrawing immune suppression with methotrexate.
Case Details
Disease Location
Neck, anterior and posterior cervical triangles
Personal Characteristics
69 -year-old female rheumatoid arthritis since 40 -year-old no foreign travel, tuberculosis or any pets
Clinical Characteristics
Arthritis improved with methotrexate treatment. Three weeks later, she presented to her gp with a 7 week history of progressive swellings on the right side of her neck. She reported 3kg weight loss in the preceding 3 months (<10% body weight) with no night sweats or fever. On examination, several enlarged and matted lymph nodes were felt in the right anterior and posterior cervical triangles. No hepatosplenomegaly was present. The rest of the exam was normal apart from rheumatoid features. There was mild normochromic normocytic anemia of 10.7g/dl with normal white cell and platelet counts, erythrocyte sedimentation rate of 60mm/h, and normal liver and renal function excision biospy revealed low-grade b-cell nhl of marginal zone type CT scan showed supraclavicular, mediastinal, axillary and inguinal adenopathy. Bone marrow aspirate was normal and trephine biopsy revealed small central lymphoid nodules thought to be reactive follicles. She was staged as iiia disease. Methotrexate was withdrawn november 1996
Remission Characteristics
After methotrexate withdrawal, arthritis flared, but lymphadenopathy started to resolve lymph nodes continued to regress and at 7 months after stopping treatment she only had a few 0.5cm nodes on the right side of her neck. 14 months, there was complete clinical remission
Treatment & Mechanisms
Proposed Remission Mechanisms
Withdrawal from mtreatment
Clinical Treatment
Methotrexate for arthritis prescribed at age 62 non-steroidal anti-inflammatory were still needed for arthritis
Non-Clinical Treatment
Withdrawal of mtreatment