Lymphoma risk in systemic lupus: effects of disease activity versus treatment

医学 系统性狼疮 系统性红斑狼疮 淋巴瘤 全身性疾病 疾病 皮肤病科 内科学 痹症科 免疫学
作者
Sasha Bernatsky,Rosalind Ramsey‐Goldman,Lawrence Joseph,Jean-François Boivin,Karen H. Costenbader,Murray B. Urowitz,Dafna D. Gladman,Paul R. Fortin,Ola Nived,Michelle Petri,Søren Jacobsen,Susan Manzi,Ellen M. Ginzler,David Isenberg,Anisur Rahman,Caroline Gordon,Guillermo Ruiz‐Irastorza,Edward Yelin,Sang‐Cheol Bae,Daniel J. Wallace,Christine A. Peschken,Mary Anne Dooley,Steven M. Edworthy,Cynthia Aranow,Diane L. Kamen,Juanita Romero‐Díaz,Anca Askanase,Torsten Witte,Susan G. Barr,Lindsey A. Criswell,Gunnar Sturfelt,Irene Blanco,Candace H. Feldman,Lene Dreyer,Neha M. Patel,Yvan St. Pierre,Ann E. Clarke
出处
期刊:Annals of the Rheumatic Diseases [BMJ]
卷期号:73 (1): 138-142 被引量:132
标识
DOI:10.1136/annrheumdis-2012-202099
摘要

Objective

To examine disease activity versus treatment as lymphoma risk factors in systemic lupus erythematosus (SLE).

Methods

We performed case–cohort analyses within a multisite SLE cohort. Cancers were ascertained by regional registry linkages. Adjusted HRs for lymphoma were generated in regression models, for time-dependent exposures to immunomodulators (cyclophosphamide, azathioprine, methotrexate, mycophenolate, antimalarial drugs, glucocorticoids) demographics, calendar year, Sjogren9s syndrome, SLE duration and disease activity. We used adjusted mean SLE Disease Activity Index scores (SLEDAI-2K) over time, and drugs were treated both categorically (ever/never) and as estimated cumulative doses.

Results

We studied 75 patients with lymphoma (72 non-Hodgkin, three Hodgkin) and 4961 cancer-free controls. Most lymphomas were of B-cell origin. As is seen in the general population, lymphoma risk in SLE was higher in male than female patients and increased with age. Lymphomas occurred a mean of 12.4 years (median 10.9) after SLE diagnosis. Unadjusted and adjusted analyses failed to show a clear association of disease activity with lymphoma risk. There was a suggestion of greater exposure to cyclophosphamide and to higher cumulative steroids in lymphoma cases than the cancer-free controls.

Conclusions

In this large SLE sample, there was a suggestion of higher lymphoma risk with exposure to cyclophosphamide and high cumulative steroids. Disease activity itself was not clearly associated with lymphoma risk. Further work will focus on genetic profiles that might interact with medication exposure to influence lymphoma risk in SLE.

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