Fig. 2.

Clinical management of methotrexate-associated lymphoproliferative disorders (MTX-LPD)

The first step after MTX-LPD development is watchful waiting (WW) following the cessation of immunosuppressive drugs (ISDs). Additional therapy is not required for patients without relapse/regrowth event (RRE, R-G, [1]), but chemotherapy is administered when RRE develops (R/R-G, [2]). Chemotherapy is also considered for patients with non-regressive LPD under WW (persistent group, P-G, [3]). On the other hand, WW therapy is not suitable for patients with aggressive LPD, and chemotherapy is initiated without confirmation of the regressive phase (chemotherapy group, Ch-G, [4]). Furthermore, chemotherapy is initiated if the LPD remains in partial response or exhibits a low response during regression (included in P-G, [5]). The details are also described in the text.