Abstract
BackgroundLymphocyte expansion and true lymphocytosis are commonly observed in the everyday clinical practice. The meaning of such phenomenon is often poorly understood so that discrimination between benign and malignant lymphocytosis remains difficult to establish. This is mainly true when lymphocytosis rises in patients affected by immune-mediated chronic inflammatory diseases under immunosuppressive treatment, conditions potentially associated with lymphomagenesis. In this brief report the development of mild T CD4pos lymphocytosis in a group of patients with chronic arthritis under anti-TNF-α treatment is described.MethodsTwo hundred eight rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients have been evaluated longitudinally for at least 1-year before and 2-years after anti-TNF-α therapy introduction for the possible appearance of a lymphocyte expansion. In patients who developed lymphocyte expansion, T, B and NK cells were analysed.ResultsTwenty-five out of 208 (12%) subjects developed a mild T CD4pos lymphocytosis, during anti-TNF-α therapy, which reverted after its interruption. Higher lymphocyte count, more frequent use of steroids and shorter disease duration, before biological therapy start, have emerged as risk factors for lymphocytosis development.ConclusionsThis is the first longitudinal cohort study evaluating the onset of lymphocytosis in RA and PsA patients under anti-TNF-α treatment and its possible clinical relevance. A mild T CD4pos lymphocytosis has been observed in 12% of RA and PsA patients probably related to anti-TNF-α treatment as previously reported by anecdotal cases. Patients with higher baseline lymphocyte count, use of steroids and shorter disease duration before the introduction of biologic therapy, seem to be prone to develop this laboratory reversible abnormality.
Highlights
Lymphocyte expansion and true lymphocytosis are commonly observed in the everyday clinical practice
An increased risk for lymphoproliferative disorders has been reported in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients, with most of the studies indicating higher risk for Hodgkin’s and non-Hodgkin’s lymphomas (HL and NHL) [8,9,10]
After start of anti-tumor necrosis factor (TNF)-α treatment, in combination with preexisting synthetic immunosuppressants, 25/208 (12%, 15 RA and 10 PsA, Group A) showed a significant increase in the lymphocyte count leading to a mild lymphocytosis [from 2800 to 4000 mean cells/μl; P < 0.001; Fig. 1], whereas in the remaining 183 patients (Group B) lymphocyte count remained substantially stable (Table 1)
Summary
Lymphocyte expansion and true lymphocytosis are commonly observed in the everyday clinical practice The meaning of such phenomenon is often poorly understood so that discrimination between benign and malignant lymphocytosis remains difficult to establish. This is mainly true when lymphocytosis rises in patients affected by immune-mediated chronic inflammatory diseases under immunosuppressive treatment, conditions potentially associated with lymphomagenesis. Lymphocyte expansion and true lymphocytosis are commonly features in the everyday clinical practice The meaning of such phenomenon is frequently poorly clear, so that discrimination between benign and malignant. Four case reports of either T CD4pos or CD8pos lymphocytosis with an immunophenotype of large granular lymphocytes (LGL) [19, 20] and one case of T CD4pos lymphocyte polyclonal expansion [21] in RA patients under anti-TNF-α therapy have been described
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