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 12.4 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.
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 12.4 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.
Authors: Eva Baecklund; Anastasia Iliadou; Johan Askling; Anders Ekbom; Carin Backlin; Fredrik Granath; Anca Irinel Catrina; Richard Rosenquist; Nils Feltelius; Christer Sundström; Lars Klareskog Journal: Arthritis Rheum Date: 2006-03
Authors: S Bernatsky; R Ramsey-Goldman; R Rajan; J-F Boivin; L Joseph; S Lachance; D Cournoyer; A Zoma; S Manzi; E Ginzler; M Urowitz; D Gladman; P R Fortin; S Edworthy; S Barr; C Gordon; S-C Bae; J Sibley; K Steinsson; O Nived; G Sturfelt; Y St Pierre; A Clarke Journal: Ann Rheum Dis Date: 2005-10 Impact factor: 19.103
Authors: S Bernatsky; L Joseph; J-F Boivin; C Gordon; M Urowitz; D Gladman; P R Fortin; E Ginzler; S-C Bae; S Barr; S Edworthy; D Isenberg; A Rahman; M Petri; G S Alarcón; C Aranow; M-A Dooley; R Rajan; J-L Sénécal; M Zummer; S Manzi; R Ramsey-Goldman; A E Clarke Journal: Ann Rheum Dis Date: 2007-06-01 Impact factor: 19.103
Authors: Ryan M Young; Tianyi Wu; Roland Schmitz; Moez Dawood; Wenming Xiao; James D Phelan; Weihong Xu; Laurence Menard; Eric Meffre; Wing-Chung C Chan; Elaine S Jaffe; Randy D Gascoyne; Elías Campo; Andreas Rosenwald; German Ott; Jan Delabie; Lisa M Rimsza; Louis M Staudt Journal: Proc Natl Acad Sci U S A Date: 2015-10-19 Impact factor: 11.205
Authors: Sonya VanPatten; Shan Sun; Mingzhu He; Kai Fan Cheng; Ahmad Altiti; Angelos Papatheodorou; Czeslawa Kowal; Venkatesh Jeganathan; James M Crawford; Ona Bloom; Bruce T Volpe; Christian Grant; Nathalie Meurice; Thomas R Coleman; Betty Diamond; Yousef Al-Abed Journal: J Med Chem Date: 2016-09-20 Impact factor: 7.446
Authors: May Y Choi; Kelsey Flood; Sasha Bernatsky; Rosalind Ramsey-Goldman; Ann E Clarke Journal: Best Pract Res Clin Rheumatol Date: 2017-11-10 Impact factor: 4.098