Rituximab for rheumatoid arthritis-associated large granular lymphocytic leukemia, a retrospective case series.
Semin Arthritis Rheum
; 50(5): 1109-1113, 2020 10.
Article
em En
| MEDLINE
| ID: mdl-32920324
ABSTRACT
OBJECTIVES:
To assess the efficacy and tolerance profile of rituximab in rheumatoid arthritis (RA)-associated large granular lymphocyte leukemia (LGLL).METHODS:
Multicenter retrospective case series. Inclusion criteria were RA defined by the ACR/EULAR 2010 criteria and LGLL defined by absolute LGL count ≥ 0.3â¯×â¯109/L with evidence of an expanded clonal LGL population (flow cytometry, TCR-γ polymerase chain reaction, or Stat3 mutation).RESULTS:
Fourteen patients (10 women, mean age 55.2 ± 14.2 years) included; 13 were seropositive for anti-cyclic citrullinated peptides (nâ¯=â¯11) or rheumatoid factor (nâ¯=â¯10). LGLL diagnosis was made 9.5 [IQR 3.25;15.5] years after RA diagnosis. Thirteen patients had T-LGLL. Rituximab was the first-line therapy for LGLL for 4 patients. Previous treatment lines included methotrexate (nâ¯=â¯7), cyclophosphamide (nâ¯=â¯2), cyclosporin A (nâ¯=â¯1), or granulocyte colony-stimulating factor (nâ¯=â¯4). Rituximab was used in monotherapy (nâ¯=â¯8) or associated to methotrexate (nâ¯=â¯3), granulocyte colony-stimulating factor (nâ¯=â¯2), or alkylating agents (nâ¯=â¯1). The number of rituximab cycles ranged from 1 to 11 (median 6), with high heterogeneity in dosing regimens. Median duration response after rituximab initiation was 35 [IQR 23.5;41] months. The overall response rate was 100% 8 patients experienced complete response (normalization of blood count and LGL ≤ 0.3â¯×â¯109/L) and 6 experienced partial responses (improvement in blood counts without complete normalization). The tolerance profile was good, with no infectious complications.CONCLUSION:
rituximab appears as a valuable therapeutic option for RA-associated LGLL.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Artrite Reumatoide
/
Leucemia Linfocítica Granular Grande
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Female
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Humans
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Middle aged
Idioma:
En
Revista:
Semin Arthritis Rheum
Ano de publicação:
2020
Tipo de documento:
Article