Abstract
A 55 year old man with chronic lymphocytic leukaemia (CLL) and rheumatoid arthritis (RA), treated for four years with methotrexate (MTX), who developed a B cell non-Hodgkin's lymphoma (B-NHL), is described. The tumour was localised to the shoulder and axillary lymph nodes, and positive for Epstein-Barr viral antigens. After failure of radiation and chemotherapy, a complete remission was achieved with a combination of antibody treatment (rituximab) and EPOCH. The development of a second malignancy in a patient with RA receiving MTX has not been described before. The summation of T cell deficiencies induced by MTX, CLL, and RA may all have contributed to the development of the B-NHL.
MeSH terms
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Antibodies, Monoclonal / therapeutic use*
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Antibodies, Monoclonal, Murine-Derived
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Antineoplastic Agents / therapeutic use*
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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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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Humans
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Immunocompromised Host
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Leukemia, Lymphocytic, Chronic, B-Cell / complications
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Lymphoma, B-Cell / drug therapy*
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Lymphoma, B-Cell / etiology
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Male
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Methotrexate / adverse effects
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Methotrexate / therapeutic use*
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Middle Aged
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Neoplasms, Second Primary / drug therapy
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Neoplasms, Second Primary / etiology
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Rituximab
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Treatment Outcome
Substances
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Antibodies, Monoclonal
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Antibodies, Monoclonal, Murine-Derived
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Antineoplastic Agents
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Antirheumatic Agents
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Rituximab
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Methotrexate