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Methotrexate-associated mantle-cell lymphoma in an elderly man with myasthenia gravis

Nature Clinical Practice Oncology volume 5, pages 234–238 (2008)Cite this article

Abstract

Background A 75-year-old man on methotrexate immunosuppression for myasthenia gravis presented with a 2-month history of lymphocytosis and bilateral inguinal adenopathy. There were no constitutional symptoms of fever, night sweats, or weight loss.

Investigations Physical examination, blood tests, flow cytometry, fluorescent in situ hybridization, immunoglobulin gene sequencing, viral load quantification by real-time polymerase chain reaction, excisional lymph-node biopsy, bone-marrow biopsy, tumor morphology and immunohistochemistry, sequential CT and PET scans.

Diagnosis Methotrexate-associated mantle-cell lymphoma.

Management Cessation of methotrexate, anthracycline-based combination chemo-immunotherapy, and maintenance rituximab.

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Figure 1: Fluorescent in situ hybridization of peripheral blood imprints for t(11;14) translocation was performed using Vysis LSI IgH/CCND1 dual color, dual fusion translocation probe.
Figure 2: Cyclin D1 immunostaining of the patient's right inguinal lymph node.

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Acknowledgements

We would like to thank Dr RA Seaton for critically reading the manuscript. Written informed consent for release of clinical information was obtained from the patient.

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Authors and Affiliations

  1. H Tran is a trainee in Hematology, C Cheung is a Senior Scientist, D Gill is Head of Hematology, and R Boyle is Head of Neurology, all at the Princess Alexandra Hospital, and U Dua and J Nourse are Research Assistants and MK Gandhi is Head of Clinical Immunohematology, all at the Queensland Institute of Medical Research, Brisbane, Australia.,

    Huy Tran, Catherine Cheung, Devinder Gill, Ujjwal Dua, Jamie Nourse, Richard Boyle & Maher K Gandhi

  2. MK Gandhi is also a Consultant Hematologist at Princess Alexandra Hospital, Brisbane, Australia.,

    Maher K Gandhi

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  1. Huy Tran
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Corresponding author

Correspondence to Maher K Gandhi.

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Competing interests

MK Gandhi has received honoraria and research support from Roche. The other authors declared no competing interests.

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Tran, H., Cheung, C., Gill, D. et al. Methotrexate-associated mantle-cell lymphoma in an elderly man with myasthenia gravis. Nat Rev Clin Oncol 5, 234–238 (2008). https://doi.org/10.1038/ncponc1071

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