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

被引：102

作者：

Bernatsky, Sasha ^{[1
,2
]}

Ramsey-Goldman, Rosalind ^{[3
]}

Joseph, Lawrence ^{[1
,2
]}

Boivin, Jean-Francois ^{[2
]}

Costenbader, Karen H. ^{[4
]}

Urowitz, Murray B. ^{[5
]}

Gladman, Dafna D. ^{[5
]}

Fortin, Paul R. ^{[6
]}

Nived, Ola ^{[7
]}

Petri, Michelle A. ^{[8
]}

Jacobsen, Soren ^{[9
]}

Manzi, Susan ^{[10
]}

Ginzler, Ellen M. ^{[11
]}

Isenberg, David ^{[12
]}

Rahman, Anisur ^{[12
]}

Gordon, Caroline ^{[13
]}

Ruiz-Irastorza, Guillermo ^{[14
]}

Yelin, Edward ^{[15
]}

Bae, Sang-Cheol ^{[16
]}

Wallace, Daniel J. ^{[17
]}

Peschken, Christine A. ^{[18
]}

Dooley, Mary Anne ^{[19
]}

Edworthy, Steven M. ^{[20
]}

Aranow, Cynthia ^{[21
]}

Kamen, Diane L. ^{[22
]}

Romero-Diaz, Juanita ^{[23
]}

Askanase, Anca ^{[24
]}

Witte, Torsten ^{[25
]}

Barr, Susan G. ^{[20
]}

Criswell, Lindsey A. ^{[26
]}

Sturfelt, Gunnar K. ^{[7
]}

Blanco, Irene ^{[27
]}

Feldman, Candace H. ^{[4
]}

Dreyer, Lene ^{[28
,29
]}

Patel, Neha M. ^{[11
]}

St Pierre, Yvan ^{[1
]}

Clarke, Ann E. ^{[1
,2
]}

机构：

[1] McGill Univ, Ctr Hlth, Div Clin Epidemiol, Montreal, PQ H3A 1A1, Canada

[2] McGill Univ, Dept Med, Montreal, PQ H3A 1A1, Canada

[3] Northwestern Univ, Feinberg Sch Med, Dept Med Rheumatol, Chicago, IL 60611 USA

[4] Brigham & Womens Hosp, Div Rheumatol, Boston, MA 02115 USA

[5] Toronto Western Hosp, Dept Med, Toronto, ON M5T 2S8, Canada

[6] Univ Laval, Quebec City, PQ, Canada

[7] Univ Lund Hosp, Div Rheumatol, S-22185 Lund, Sweden

[8] Johns Hopkins Univ, Sch Med, Div Rheumatol, Baltimore, MD USA

[9] Copenhagen Univ Hosp, Rigshosp, Dept Rheumatol, Copenhagen, Denmark

[10] West Penn Allegheny Hlth Syst, Dept Med, Pittsburgh, PA USA

[11] Suny Downstate Med Ctr, Div Rheumatol, Brooklyn, NY 11203 USA

[12] UCL, Ctr Rheumatol Res, London, England

[13] Univ Birmingham, Rheumatol Res Grp, Birmingham, W Midlands, England

[14] Univ Basque Country, Hosp Univ Cruces, Autoimmune Dis Res Unit, Bizkaia, Spain

[15] Univ Calif San Francisco, Div Rheumatol, San Francisco, CA USA

[16] Hanyang Univ Hosp Rheumat Dis, Dept Rheumatol, Seoul, South Korea

[17] Univ Calif Los Angeles, David Geffen Sch Med, Cedars Sinai Med Ctr, Dept Med, Los Angeles, CA 90095 USA

[18] Univ Manitoba, Winnipeg, MB, Canada

[19] Univ N Carolina, Dept Med, Chapel Hill, NC USA

[20] Univ Calgary, Div Rheumatol, Calgary, AB, Canada

[21] Feinstein Inst Med Res, Ctr Autoimmune & Musculoskeletal, Manhasset, NY USA

[22] Med Univ S Carolina, Div Immunol & Rheumatol, Charleston, SC 29425 USA

[23] Inst Nacl Cs Med & Nutr, Div Rheumatol & Immunol, Mexico City, DF, Mexico

[24] NYU, Dept Med, Hosp Joint Dis, New York, NY 10016 USA

[25] Hannover Med Sch, Div Rheumatol & Immunol, Hannover, Germany

[26] Univ Calif San Francisco, Dept Med, Rosalind Russell Med Res Ctr Arthrit, San Francisco, CA USA

[27] Albert Einstein Coll Med, Div Rheumatol, Bronx, NY 10467 USA

[28] Rigshosp, Dept Rheumatol, DK-2100 Copenhagen, Denmark

[29] Copenhagen Univ Hosp, Gentofte Hosp, Copenhagen, Denmark

来源：

ANNALS OF THE RHEUMATIC DISEASES | 2014年 / 73卷 / 01期

关键词：

Systemic Lupus Erythematosus; Epidemiology; Treatment; Disease Activity; RHEUMATOID-ARTHRITIS; CANCER; ERYTHEMATOSUS; COHORT; INFLAMMATION; MALIGNANCY; EXPOSURE;

D O I：

10.1136/annrheumdis-2012-202099

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

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, Sjogren's 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 12.4years (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.

引用

页码：138 / 142

页数：5

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