Onco Wiki / Rote Flagge

Long-term low-dose methotrexate exposure (≥1-2 years, ≥15 mg/week cumulative or PO 7.5-25...

Deterministische Ansicht der Quelle YAML Entität. Klinische Autorität bleibt mit den zitierten Quell-IDs und Rezensenten Sign-off Zustand.

IDRF-IATROGENIC-METHOTREXATE-LONGTERM-LYMPHOMA-PREVENTION
ArtWarnhinweis
Statusreviewed 2026-05-19 | pending_clinical_signoff
ErkrankungenDIS-DLBCL-NOS
QuellenSRC-NCCN-BCELL-2025

Ursprung der Roten Flagge

BegriffsbestimmungLong-term low-dose methotrexate exposure (≥1-2 years, ≥15 mg/week cumulative or PO 7.5-25 mg/week chronic) for autoimmune indications including rheumatoid arthritis, psoriasis, psoriatic arthritis, Crohn's disease — associated with methotrexate-associated lymphoproliferative disorders (MTX-LPD), most commonly diffuse large B-cell lymphoma (DLBCL) or polymorphic LPD with EBV co-positivity in many cases. Incidence ~1-3% over 5 years of cumulative exposure; Japanese rheumatoid cohorts show higher signal (likely population EBV seroprevalence). Distinctive feature: ~30-60% of MTX-LPD cases regress on MTX withdrawal alone (no chemotherapy needed) — this signature uniquely identifies the iatrogenic etiology. Risk also modestly elevated for solid cancers (skin SCC, melanoma) — separate signal. Prevention-persona RedFlag (§20, v0.3 iatrogenic expansion).
Klinische RichtungUntersuchung
KategorieSonstige

Logik auslösen

{
  "any_of": [
    {
      "finding": "methotrexate_longterm_low_dose_autoimmune",
      "value": true
    },
    {
      "finding": "methotrexate_ge_1y_cumulative",
      "value": true
    },
    {
      "finding": "mtx_lpd_susceptible_cohort",
      "value": true
    }
  ],
  "type": "lab_value"
}

Anmerkungen

Präventionspersona RedFlag für Langzeit-Tiefdosis-MTX-Exposition (RA, Psoriasis, IBD). Überwachung: Niedrige Schwellen-Workup für ungeklärte Lymphadenopathie, B-Symptome, Organomegalie, Masse — MTX-Entzug + 8-12 Wochen vorher beobachten (~50% Regression); persistent → DLBCL-Stil-WorkUp. Hautuntersuchung jährlich. STUB bis Zwei-Co-Lead-Auszeichnung pro CHARTER §6.1 dev-Modus.

Verwendet von

Anwendungsgebiet