Upadacitinib as Novel Treatment for Rheumatoid Arthritis with T-Cell Granular Lymphocytic Leukemia: A Case Report and Narrative Review

Y. Cho, Erik W Anderson, Sara Guevara, Santiago J. Miyara, Aqsa Iqbal, J. Aronsohn, E. Molmenti, James M. Mumford, B. Keber, Farideh Zonouzi-Zadeh, You-kyung Ha, P. Nikolinakos, Brent Flickinger
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引用次数: 1

Abstract

T-cell large granular lymphocyte (T-LGL) leukemia is a rare and indolent clonal disorder of LGLs, associated with rheumatoid arthritis and neutropenia. The authors present a case of a 62-year-old male with rheumatoid arthritis (RA) who was diagnosed with T-LGL leukemia, with predominant neutropenia, and a poor response to conventional treatment. Subsequently, tofacitinib (a Janus Kinase 1 and 3 inhibitor, [JAK1/3 inhibitor]) resulted in improvement of the patient’s RA symptoms and temporary improvement of the neutropenia. Ultimately, upadacitinib (a specific JAK1 inhibitor) resulted in further improvement of the neutropenia and control of his RA. To the best of our knowledge, this is the first case report of coexisting RA and LGL leukemia that was treated with upadacitinib and showed clinical improvement.
Upadacitinib治疗类风湿性关节炎伴T细胞颗粒淋巴细胞白血病的新方法:病例报告和叙述性综述
T细胞大颗粒淋巴细胞(T-LGL)白血病是一种罕见的、惰性的LGL克隆性疾病,与类风湿性关节炎和中性粒细胞减少症有关。作者介绍了一例62岁男性类风湿性关节炎(RA)患者,他被诊断为T-LGL白血病,主要是中性粒细胞减少症,对常规治疗反应不佳。随后,托法替尼(一种Janus激酶1和3抑制剂,[JAK1/3抑制剂])改善了患者的RA症状,并暂时改善了中性粒细胞减少症。最终,乌帕替尼(一种特异性JAK1抑制剂)进一步改善了中性粒细胞减少症并控制了他的RA。据我们所知,这是第一例用乌帕替尼治疗的RA和LGL共存白血病的病例报告,并显示出临床改善。
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