Acute Myeloid Leukemia in the Setting of Low Dose Weekly Methotrexate Therapy for Rheumatoid Arthritis

Methotrexate is in widespread use as second-line therapy for rheumatoid arthritis. Treatment with methotrexate in this and other settings has not been associated with the development of therapy-related leukemias. Four patients with rheumatoid arthritis are reported who developed acute myeloid leukem...

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Bibliographic Details
Published in:Leukemia & lymphoma 2001, Vol.42 (3), p.371-378
Main Authors: Kolte, Bharati, Baer, Alan N., Sait, Sheila N.J., Oloughlin, Kieran L., Stewart, Carleton C., Barcos, Maurice, Wetzler, Meir, Baer, Maria R.
Format: Article
Language:English
Subjects:
acute myeloid leukemia
Aged
Arthritis, Rheumatoid - drug therapy
Bone Marrow - pathology
Drug Resistance, Multiple
Female
Humans
Immunophenotyping
Immunosuppressive Agents - adverse effects
In Situ Hybridization, Fluorescence
Leukemia, Myeloid, Acute - chemically induced
Leukemia, Myeloid, Acute - diagnosis
Male
methotrexate
Methotrexate - adverse effects
Middle Aged
Retrospective Studies
rheumatoid arthritis
trisomy 13
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Summary:Methotrexate is in widespread use as second-line therapy for rheumatoid arthritis. Treatment with methotrexate in this and other settings has not been associated with the development of therapy-related leukemias. Four patients with rheumatoid arthritis are reported who developed acute myeloid leukemia (AML) while receiving low dose weekly methotrexate therapy in the absence of previous or concomitant treatment with known leukemogenic agents. AML in these four patients was of different morphologic subtypes and was associated with heterogeneous cytogenetic abnormalities, cell surface marker expression and multidrug resistance protein expression. None of the recognized features of therapy-related leukemia were present in these four nor in five previously-reported patients. It is likely that the occurrence of AML in patients with rheumatoid arthritis in the setting of methotrexate therapy represents the coincidence of these two diseases, and does not reflect a causal relationship.
ISSN:1042-8194
1029-2403
DOI:10.3109/10428190109064593