Lymphomas During Long-term Methotrexate Therapy

Abstract

PATIENTS WHO are immunocompromised are at an increased risk for developing malignant lymphoma. Until recently, immunodeficiency-related lymphomas have been described in 3 main groups of patients: solid organ transplant recipients who receive immunosuppressive therapy to prevent organ rejection, 1,2 patients with congenital immunodeficiency syndromes, 3,4 and patients with the acquired immunodeficiency syndrome. 5 However, during the last few years, several investigators have reported 6-21 the occurrence of immunodeficiency-related lymphomas in yet a fourth clinical setting: patients who are treated with immunomodulatory therapy for rheumatologic diseases. Although there are several clinicopathologic features associated with immunodeficiency-related lymphomas, the most characteristic finding is the presence of the Epstein-Barr virus (EBV) in the neoplastic lymphoid cells. See also page 867 In this issue of theArchives, Paul and colleagues 22 report the occurrence of an EBV-associated lymphoma in a patient receiving methotrexate therapy for psoriasis. The lymphoma that this patient developed is similar to