Low-Dose Methotrexate May Decrease Symptom Burden in Myeloproliferative Neoplasms

Low-dose methotrexate may improve the hematologic and constitutional symptoms of myeloproliferative neoplasms (MPNs), according to results from a study published recently in the British Journal of Haematology.

Results from this retrospective service evaluation of patients with MPNs treated with low-dose methotrexate for comorbidities not related to MPN showed in 3 case studies that patients experienced hematologic changes following the initiation and/or interruption of methotrexate.

In one patient with polycythemia vera (PV), a type of MPN, dose interruption of methotrexate due to renal impairment correlated with complaints from the patient of pruritis. Restarting methotrexate correlated with the cessation of pruritis.

Another patient with essential thrombocythemia (ET), another type of MPN, was receiving hydroxycarbamide and began receiving methotrexate upon diagnosis of rheumatoid arthritis. The researchers noted that the combination of hydroxycarbamide and methotrexate decreased the patient’s platelet count to less than 400×10⁹/L with no apparent toxicity.

The third case study patient had long-term psoriasis when ET was diagnosed. When the psoriasis flared, this patient received low-dose methotrexate. During treatment with methotrexate, the patient’s platelet count continued to rise, but at a slower rate.

Three patients with PV and 8 patients with ET were treated with methotrexate for comorbidities not related to MPN. Researchers assessed the burden of symptoms via MPN-10 in these patients compared with historic controls. Symptoms included fatigue, early satiety, abdominal discomfort, inactivity, concentration problems, night sweats, pruritis, bone pain, fever, and weight loss. Night sweats and fever were significantly improved in patients with PV and ET who received methotrexate, and abdominal discomfort, pruritis, and bone pain were significantly improved in patients with ET who received methotrexate.

The researchers caution that the number of patients in this study is small and interpretation of results are therefore limited; however, they did not detect any toxicities for low-dose methotrexate in patients with MPNs.

In conclusion, the authors suggest that prospective studies assessing methotrexate for controlling the constitutional symptoms of MPNs are warranted.

Reference

Francis S, Thomas S, Luben R, et al. Low-dose methotrexate: potential clinical impact on haematological and constitutional symptoms in myeloproliferative neoplasms [published online September 16, 2019]. Br J Haematol. doi:10.1111/bjh.16193