Efficacy of intralesional methotrexate in specific cutaneous involvement of B‐cell chronic lymphocytic leukaemia

Abstract

EditorSpecific cutaneous expression of B-cell chronic lymphocytic leukaemia (B-CLL), referred as leukaemia cutis (LC), is unusual. 1 Lesions present themselves clinically as solitary, grouped or generalized papules, nodules, plaques or large tumours. 1 Rare clinical manifestations include vesiculobullous eruptions, 1 chronic paronychia and subungual tumours. 2 Even though the occurrence of LC in B-CLL appears to have no impact on the prognosis, it is usually treated.A 72-year-old man presented to our outpatient clinic with multiple asymptomatic erythematous papules and nodules on the back (Fig. 1). Skin lesions appeared progressively in 6 months. The peripheral blood (PB) count was normal: red blood cells (RBC) 4.7 · 10 12 ⁄ L, white blood cells (WBC) 8.3 · 10 9 ⁄ L with 4.32 · 10 9 ⁄ L neutrophils, 2.57 · 10 9 ⁄ L lymphocytes and 228 · 10 9 ⁄ L platelets. The rest of the physical examination was normal. Lesional skin biopsy showed an intense infiltrate in the dermis and subcutis of small lymphocytes containing round, regular and scant cytoplasm with frequent smudge cell morphology. The nuclei had dense chromatin. Occasional mitotic figures were detected. No epidermotropism was found. The neoplastic cells expressed CD19 ⁄ CD20, CD23 and CD5 antigens. The cells were negative for CD3, CD30, CD4 and CD8. Four weeks later, a new

Intralesional methotrexate in dermatology: Diverse indications and practical considerations

“…1 Eight tumors, injected with 25 mg/ml IL-MTX over two sessions, showed complete regression at 2 months with no relapse at 12 months. 29 Biopsy showed chronic inflammation and fibroplasia, as found in PCALCL post-treatment with IL-MTX, with no residual tumor. 29 While there is no strong evidence to support the routine use of IL-MTX in cutaneous tumors, this treatment modality may offer a cost-effective alternative to newer and more costly therapies in cutaneous oncology and may be suitable in selected cases where systemic or surgical therapy is not possible.…”

Association rare d’une leucémie lymphoïde chronique et d’un lupus érythémateux systémique

“…D'ailleurs Les données de la pharmacovigilance française comportent un cas de LLC notifié avec le méthotrexate, après une durée de 19 ans, la patiente étant également traitée par anti-TNFalpha depuis cinq ans. Des cas de LLC traités par méthotrexate sont en revanche publiés, utilisés en intralésionnel [10], en intravitréen [11] et en intrathécal [12] avec une bonne efficacité. Une étude in vitro [13] suggère même l'utilité de l'hydroxychloroquine dans le traitement de la LLC en démontrant un effet pro-apoptotique par l'intermédiaire de la caspase 3 et de bcl2.…”

Intralesional Use of Chemotherapeutic and Biological Drugs in Dermatology

“…Yine primer kutanöz anaplastik büyük hücreli lenfomalı hastanın kemoterapi sonrası rezidüel nodüllerine İL metotreksat uygulanmış ve remisyon sağlandığı bildirilmiştir (28). Ayrıca lökemia kutis tanılı başka bir hastaya da, sistemik tedavi kriterlerini tam olarak karşılamadığı için, metotreksat İL olarak iki hafta arayla kullanılmış, bir yıllık takip süresince remisyonun devam ettiği gösterilmiştir (29).…”