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

Bernatsky, Sasha; Ramsey-Goldman, Rosalind; Joseph, Lawrence; Boivin, Jean-Francois; Costenbader, Karen H.; Urowitz, Murray B.; Gladman, Dafna D.; Fortin, Paul R.; Nived, Ola LU and Petri, Michelle A., et al. (2014) In Annals of the Rheumatic Diseases 73(1). p.138-142
Abstract
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... (More)
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. (Less)
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published
subject
keywords
Systemic Lupus Erythematosus, Epidemiology, Treatment, Disease Activity
in
Annals of the Rheumatic Diseases
volume
73
issue
1
pages
138 - 142
publisher
British Medical Association
external identifiers
  • wos:000327835100025
  • scopus:84889686638
ISSN
1468-2060
DOI
10.1136/annrheumdis-2012-202099
language
English
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yes
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97446c64-d19f-43f8-813a-4ddd7dabbbbb (old id 4272240)
date added to LUP
2014-02-10 12:18:32
date last changed
2017-10-22 04:12:42
@article{97446c64-d19f-43f8-813a-4ddd7dabbbbb,
  abstract     = {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.},
  author       = {Bernatsky, Sasha and Ramsey-Goldman, Rosalind and Joseph, Lawrence and Boivin, Jean-Francois and Costenbader, Karen H. and Urowitz, Murray B. and Gladman, Dafna D. and Fortin, Paul R. and Nived, Ola and Petri, Michelle A. and Jacobsen, Soren and Manzi, Susan and Ginzler, Ellen M. and Isenberg, David and Rahman, Anisur and Gordon, Caroline and Ruiz-Irastorza, Guillermo and Yelin, Edward and Bae, Sang-Cheol and Wallace, Daniel J. and Peschken, Christine A. and Dooley, Mary Anne and Edworthy, Steven M. and Aranow, Cynthia and Kamen, Diane L. and Romero-Diaz, Juanita and Askanase, Anca and Witte, Torsten and Barr, Susan G. and Criswell, Lindsey A. and Sturfelt, Gunnar and Blanco, Irene and Feldman, Candace H. and Dreyer, Lene and Patel, Neha M. and St Pierre, Yvan and Clarke, Ann E.},
  issn         = {1468-2060},
  keyword      = {Systemic Lupus Erythematosus,Epidemiology,Treatment,Disease Activity},
  language     = {eng},
  number       = {1},
  pages        = {138--142},
  publisher    = {British Medical Association},
  series       = {Annals of the Rheumatic Diseases},
  title        = {Lymphoma risk in systemic lupus: effects of disease activity versus treatment},
  url          = {http://dx.doi.org/10.1136/annrheumdis-2012-202099},
  volume       = {73},
  year         = {2014},
}