51
|
Fujimoto K, Hatanaka KC, Hatanaka Y, Kasahara I, Yamamoto S, Tsuji T, Nakata M, Takakuwa Y, Haseyama Y, Oyamada Y, Yonezumi M, Suzuki H, Sakai H, Noguchi H, Mori A, Nishihara H, Teshima T, Matsuno Y. Association of Epstein-Barr virus with regression after withdrawal of immunosuppressive drugs and subsequent progression of iatrogenic immunodeficiency-associated lymphoproliferative disorders in patients with autoimmune diseases. Hematol Oncol 2020; 38:799-807. [PMID: 32798315 DOI: 10.1002/hon.2790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/12/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022]
Abstract
Patients with autoimmune diseases (AIDs) may develop lymphoproliferative disorders (LPDs) during treatment with immunosuppressive agents (IS) such as methotrexate (MTX), biological agents, or tacrolimus. Some LPDs in patients with AIDs (AID-LPDs) regress after withdrawal of IS, and a high incidence of Epstein-Barr virus (EBV) positivity in such patients has been reported. To identify characteristics and factors predictive of the response to treatment and disease progression, we retrospectively analyzed clinical and histopathological data for 81 patients with AID-LPDs. Almost all of them (96%) had been treated with MTX. Diffuse large B cell lymphoma was the most common LPD type (61%) and seven patients (9%) had classical Hodgkin lymphoma (CHL). EBV was detected by in situ hybridization with an EBV-encoded small RNA (EBER) probe in 43% of the examined cases. In 59 patients, IS was discontinued as the initial treatment, resulting in regression of LPDs in 69% of them, and multivariate analysis showed that EBER positivity was an independent factor predictive of such regression (p = 0.022). Two-year progression-free survival (PFS) and overall survival for the patients overall were 63% and 83%, respectively. Poor PFS was associated with advanced stage (p = 0.024), worse performance status (PS, p = 0.031), CHL histology (p = 0.013), and reactivation of EBV-related antibodies (p = 0.029). In conclusion, EBV positivity demonstrated using an EBER probe is useful for prediction of successful regression after withdrawal of IS in patients with AID-LPDs. Patients with advanced stage disease, worse PS, CHL histology, or reactivation of EBV-related antibodies should be closely monitored after initial treatment.
Collapse
Affiliation(s)
- Katsuya Fujimoto
- Department of Hematology, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.,Department of Hematology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Kanako C Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yutaka Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Ikumi Kasahara
- Department of Hematology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Satoshi Yamamoto
- Department of Hematology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Takahiro Tsuji
- Department of Pathology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Masanobu Nakata
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Yasunari Takakuwa
- Department of Pathology, NTT Sapporo Medical Center, Sapporo, Hokkaido, Japan
| | | | - Yumiko Oyamada
- Department of Pathology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Masakatsu Yonezumi
- Department of Hematology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Hiroaki Suzuki
- Department of Pathology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Hajime Sakai
- Department of Hematology, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroko Noguchi
- Department of Pathology, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Nishihara
- Department of Translational Pathology, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takanori Teshima
- Department of Hematology, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| |
Collapse
|
52
|
Kane E, Painter D, Smith A, Lamb M, Oliver SE, Patmore R, Roman E. Risk of mature B-cell neoplasms and precursor conditions after joint replacement: A report from the Haematological Malignancy Research Network. Int J Cancer 2020; 147:702-708. [PMID: 31675431 PMCID: PMC7317514 DOI: 10.1002/ijc.32765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/02/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022]
Abstract
Associations between previous joint replacement and B-cell lymphoid malignancies have been reported, but despite numerous reports, associations with the disease subtypes have received little attention. Using a UK-based register of haematological malignancies and a matched general population-based cohort, joint replacements from linked hospital inpatient records were examined. Cases diagnosed 2009-2015 who were aged 50 years or more were included; 8,013 mature B-cell neoplasms comprising myeloma (n = 1,763), diffuse large B-cell lymphoma (DLBCL, n = 1,676), chronic lymphocytic leukaemia (CLL, n = 1,594), marginal zone lymphoma (MZL, n = 957), follicular lymphoma (FL, n = 725) and classical Hodgkin lymphoma (CHL, n = 255), together with monoclonal gammopathy of uncertain significance (MGUS, n = 2,138) and monoclonal B-cell lymphocytosis (MBL, n = 632). Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated relative to 10 age- and sex-matched controls using conditional logistic regression. Having had a joint replacement before diagnosis was associated with myeloma (OR = 1.3, 95% CI 1.1-1.5, p = 0.008) and MGUS (OR = 1.3, 95% CI 1.1-1.5, p < 0.001). Excluding replacements in the year before diagnosis, the MGUS risk remained, elevated where two or more joints were replaced (OR = 1.5, 95% CI 1.2-2.0, p = 0.001), with hip (OR = 1.2, 95% CI 1.0-1.5, p = 0.06) or knee replacements (OR = 1.5, 95% CI 1.2-1.8, p < 0.001). Associations with CHL and two or more replacements (OR = 2.7, 95% CI 1.3-5.6, p = 0.005) or hip replacements (OR = 1.9, 95% CI 1.0-3.4, p = 0.04); and between DLBCL and knee replacements (OR = 1.3, 95% CI 1.0-1.6, p = 0.04) were also observed. Our study reports for the first time a relationship between joint replacements and MGUS; while absolute risks of disease are low and not of major public health concern, these findings warrant further investigation.
Collapse
Affiliation(s)
- Eleanor Kane
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
| | - Maxine Lamb
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
| | - Steven E. Oliver
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
- Hull York Medical SchoolYorkUnited Kingdom
| | - Russell Patmore
- Queens Centre for Oncology, Castle Hill HospitalHullUnited Kingdom
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
| |
Collapse
|
53
|
Abstract
People living with rheumatic diseases frequently encounter cancer, either as a potential harm of antirheumatic therapies or as a comorbidity that alters the conversation about management. This article provides a general overview of the issues related to cancer and rheumatic disease and serves as a springboard for the remaining chapters in this issue. Several topics are reviewed, including epidemiology, bidirectional causal pathways, and issues related to medications. Although uncertainties remain, the issue of cancer is of great importance to patients with rheumatic diseases, and an individualized, person-centered approach to assessment and management is necessary.
Collapse
Affiliation(s)
- John Manley Davis
- Division of Rheumatology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
| |
Collapse
|
54
|
Khanmohammadi S, Shabani M, Tabary M, Rayzan E, Rezaei N. Lymphoma in the setting of autoimmune diseases: A review of association and mechanisms. Crit Rev Oncol Hematol 2020; 150:102945. [PMID: 32353704 DOI: 10.1016/j.critrevonc.2020.102945] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 03/11/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Autoimmune disorders are a spectrum of diseases caused by impaired self-tolerance of the immune system. Previous studies underscored the association between autoimmune disorders and lymphomas. However, only a few papers studied the exact mechanisms of this association. The effect of IL-2, IL-5, IL-6, IL-10 and TNF-α, contribution of NOTCH, FAS and MHC receptor families, the interplay of various immune cells, and the relation of immunosuppressive agents and development of autoimmune disorders are the proposed mechanisms for this association. Each individual autoimmune disorder associates with particular types of lymphomas and their common pathways are not necessarily similar to other pairs of autoimmune disorder-lymphomas. Thus, the lymphomas susceptibility in various autoimmune disorders could not be investigated through a single pathway. In this review, we demonstrate the association between each pair of autoimmune disorder-lymphoma and the underlying pathways. By clarifying these associations, follow-up plans could be made leading to early diagnosis of lymphomas.
Collapse
Affiliation(s)
- Shaghayegh Khanmohammadi
- International Hematology/Oncology of Pediatrics Experts (IHOPE), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsima Shabani
- International Hematology/Oncology of Pediatrics Experts (IHOPE), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Baltimore, MD, USA
| | - Mohammadreza Tabary
- International Hematology/Oncology of Pediatrics Experts (IHOPE), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Rayzan
- International Hematology/Oncology of Pediatrics Experts (IHOPE), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| |
Collapse
|
55
|
Reactivation of Epstein-Barr Virus Presenting as Massive Splenomegaly after Initiation of Golimumab Treatment. Case Rep Hematol 2020; 2020:3641813. [PMID: 32328321 PMCID: PMC7171624 DOI: 10.1155/2020/3641813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/13/2020] [Indexed: 02/06/2023] Open
Abstract
Epstein–Barr virus infection is most commonly asymptomatic in the acute setting, where the end result of infection is the adoption of a viral latency phenotype. The virus can reactivate later in life leading to the abnormal proliferation of the infected B, T, or NK cells. Hereby, we report a 71-year-old female with seronegative rheumatoid arthritis who presented with massive splenomegaly, pancytopenia, and positivization of antibodies against double-stranded deoxyribonucleic acid (dsDNA) after initiation of the anti-tumor necrosis factor (TNF) golimumab. The diagnosis of EBV-associated lymphoproliferative disorder (LPD) was demonstrated by elevation of the plasmatic EBV viral load. Withdrawal of the anti-TNF and treatment with the anti-CD20 antibody rituximab were able to revert the clinical abnormalities. EBV-associated LPDs are described after initiation of other anti-TNF agents, such as infliximab, but no reports of golimumab-associated EBV LPD are found in the literature. The mechanisms for this occurrence are not clear, but these are known to involve expression of a panel of viral proteins specific to the viral latency phenotypes.
Collapse
|
56
|
Vasaitis L, Nordmark G, Theander E, Backlin C, Smedby KE, Askling J, Rönnblom L, Sundström C, Baecklund E. Population-based study of patients with primary Sjögren's syndrome and lymphoma: lymphoma subtypes, clinical characteristics, and gender differences. Scand J Rheumatol 2020; 49:225-232. [PMID: 32153241 DOI: 10.1080/03009742.2019.1696403] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: To examine lymphoma subtypes, clinical characteristics, and gender differences in patients with primary Sjögren's syndrome (pSS) and lymphoma in a population-based setting.Method: Patients with Sjögren's syndrome and lymphoma diagnoses were identified by linkage of the Swedish Patient Register 1964-2007 with the Cancer Register 1990-2007. Clinical data were collected from medical records and lymphoma tissues were re-examined. The lymphoma subtype distribution was compared with the Swedish Lymphoma Register.Results: We identified 105 pSS patients with lymphoma. Diffuse large B-cell lymphoma (DLBCL) (32%) and marginal zone lymphoma [MZL including mucosa-associated lymphoid tissue (MALT) lymphoma] (31%) were the most common lymphoma subtypes. The proportion of DLBCL was not increased compared to the general population reference (32%, p = 1), in contrast to MZL (general population 5%, p < 0.0001). Compared to DLBCL, MALT lymphoma was diagnosed at a younger age (55 vs 67 years, p = 0.0001), and earlier after patient-reported sicca onset (7 vs 18 years, p = 0.0001) and pSS diagnosis (2 vs 9 years, p = 0.0005). Sixteen of the pSS-lymphoma cases were men (15%), twice the proportion in general pSS populations. Compared to women, men had a shorter median time from pSS diagnosis to lymphoma diagnosis (1 vs 8 years, p = 0.0003) and more often had lymphoma in the salivary glands (56% vs 29%, p = 0.04).Conclusion: DLBCL and MZL are common in pSS patients, but only MZL/MALT lymphoma occurs at an increased relative frequency in pSS compared to the general population. The study supports increased awareness of signs of lymphoma in men in the first years after pSS diagnosis.
Collapse
Affiliation(s)
- L Vasaitis
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| | - G Nordmark
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| | - E Theander
- Department of Rheumatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C Backlin
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| | - K E Smedby
- Department of Medical Sciences, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - J Askling
- Department of Medical Sciences, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - L Rönnblom
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| | - C Sundström
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - E Baecklund
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
57
|
Wang LH, Wang WM, Lin SH, Shieh CC. Bidirectional relationship between systemic lupus erythematosus and non-Hodgkin's lymphoma: a nationwide population-based study. Rheumatology (Oxford) 2020; 58:1245-1249. [PMID: 30726952 DOI: 10.1093/rheumatology/kez011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/03/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We conducted this nationwide population-based study in Taiwan to investigate whether there is a bidirectional relationship between SLE and non-Hodgkin's lymphoma (NHL). METHODS Using the National Health Insurance Research Database of Taiwan, we identified 16 417 patients with new-onset SLE without previous cancer and 25 069 patients with new-onset NHL without previous SLE as two non-overlapping cohorts from 1998-2012, and followed them until 2013. Standardized incidence ratio (SIR) for NHL in the patients with SLE and SIR for SLE in the patients with NHL were compared with the general population. RESULTS Among the 16 417 patients with SLE, 512 developed cancers, including 34 with NHL. The highest SIR was that for NHL (SIR 4.2, 95% CI 2.9, 5.9) in site-specific cancer risk analysis. Among the 25 069 patients with NHL, 14 developed SLE, and the SIR was also increased (SIR 2.0, 95% CI 1.1, 3.4). The SIRs of the patients with SLE to develop NHL and the patients with NHL to develop SLE were both highest within the first year after the diagnosis of each disease. CONCLUSION This nationwide population-based study is the first study to report a bidirectional relationship between SLE and NHL. This finding may suggest being alert for the patients with SLE or NHL who have early sings of the other disease in clinical care.
Collapse
Affiliation(s)
- Li-Hui Wang
- Division of Immunology, Department of Pediatrics, Kuo General Hospital, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei-Ming Wang
- Department of Statistics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Biostatistics Consulting Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chi-Chang Shieh
- Institute of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| |
Collapse
|
58
|
Wang LH, Wang WM, Lin CY, Lin SH, Shieh CC. Bidirectional Relationship Between Primary Sjögren Syndrome and Non-Hodgkin Lymphoma: A Nationwide Taiwanese Population-based Study. J Rheumatol 2020; 47:1374-1378. [PMID: 31941803 DOI: 10.3899/jrheum.191027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Bidirectional relationships between some autoimmune diseases and non-Hodgkin lymphoma (NHL) may exist. We conducted this nationwide population-based study in Taiwan to investigate whether there is a bidirectional relationship between primary Sjögren syndrome (pSS) and NHL. METHODS Using the National Health Insurance Research Database of Taiwan, we identified 15,636 patients with new-onset pSS without previous cancer and 25,074 patients with new-onset NHL without previous pSS as 2 non-overlapping cohorts from 1998 to 2012, and followed them until 2013. Standardized incidence ratios (SIR) for NHL in the patients with pSS and SIR for pSS in the patients with NHL were compared with the general population. RESULTS Among the 15,636 patients with pSS, 741 developed cancers, including 51 with NHL. The highest SIR of specific cancer risk in patients with pSS was that for NHL (SIR 4.6, 95% CI 3.4-6.0). Among the 25,074 patients with NHL, 49 developed pSS; the SIR was also increased (SIR 3.2, 95% CI 2.4-4.2). The risk was highest within 1 year after the diagnosis of each disease. CONCLUSION This nationwide population-based study is the first to report a bidirectional relationship between pSS and NHL. Our findings suggest being alert for patients with pSS or NHL who have early signs of the other disease in clinical care. The underlying mechanisms of the bidirectional relationship merit further investigation.
Collapse
Affiliation(s)
- Li-Hui Wang
- From the Division of Immunology, Department of Pediatrics, Kuo General Hospital; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University; Division of Allergy, Immunology and Rheumatology, and Department of Pediatrics, Department of Internal Medicine, and Department of Statistics, National Cheng Kung University Hospital, Tainan, Taiwan.,L.H. Wang, MD, MS, Immunologist, Division of Immunology, Department of Pediatrics, Kuo General Hospital; W.M. Wang, MS, Biostatistician, National Cheng Kung University, Department of Statistics; C.Y. Lin, MD, Rheumatologist, National Cheng Kung University Hospital, Department of Internal Medicine; S.H. Lin, PhD, Associate Professor of Biostatistics, National Cheng Kung University College of Medicine, Institute of Clinical Medicine; C.C. Shieh, MD, PhD, Professor of Immunology, Rheumatology, and Pediatrics, National Cheng Kung University College of Medicine, Institute of Clinical Medicine
| | - Wei-Ming Wang
- From the Division of Immunology, Department of Pediatrics, Kuo General Hospital; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University; Division of Allergy, Immunology and Rheumatology, and Department of Pediatrics, Department of Internal Medicine, and Department of Statistics, National Cheng Kung University Hospital, Tainan, Taiwan.,L.H. Wang, MD, MS, Immunologist, Division of Immunology, Department of Pediatrics, Kuo General Hospital; W.M. Wang, MS, Biostatistician, National Cheng Kung University, Department of Statistics; C.Y. Lin, MD, Rheumatologist, National Cheng Kung University Hospital, Department of Internal Medicine; S.H. Lin, PhD, Associate Professor of Biostatistics, National Cheng Kung University College of Medicine, Institute of Clinical Medicine; C.C. Shieh, MD, PhD, Professor of Immunology, Rheumatology, and Pediatrics, National Cheng Kung University College of Medicine, Institute of Clinical Medicine
| | - Chun-Yu Lin
- From the Division of Immunology, Department of Pediatrics, Kuo General Hospital; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University; Division of Allergy, Immunology and Rheumatology, and Department of Pediatrics, Department of Internal Medicine, and Department of Statistics, National Cheng Kung University Hospital, Tainan, Taiwan.,L.H. Wang, MD, MS, Immunologist, Division of Immunology, Department of Pediatrics, Kuo General Hospital; W.M. Wang, MS, Biostatistician, National Cheng Kung University, Department of Statistics; C.Y. Lin, MD, Rheumatologist, National Cheng Kung University Hospital, Department of Internal Medicine; S.H. Lin, PhD, Associate Professor of Biostatistics, National Cheng Kung University College of Medicine, Institute of Clinical Medicine; C.C. Shieh, MD, PhD, Professor of Immunology, Rheumatology, and Pediatrics, National Cheng Kung University College of Medicine, Institute of Clinical Medicine
| | - Sheng-Hsiang Lin
- From the Division of Immunology, Department of Pediatrics, Kuo General Hospital; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University; Division of Allergy, Immunology and Rheumatology, and Department of Pediatrics, Department of Internal Medicine, and Department of Statistics, National Cheng Kung University Hospital, Tainan, Taiwan.,L.H. Wang, MD, MS, Immunologist, Division of Immunology, Department of Pediatrics, Kuo General Hospital; W.M. Wang, MS, Biostatistician, National Cheng Kung University, Department of Statistics; C.Y. Lin, MD, Rheumatologist, National Cheng Kung University Hospital, Department of Internal Medicine; S.H. Lin, PhD, Associate Professor of Biostatistics, National Cheng Kung University College of Medicine, Institute of Clinical Medicine; C.C. Shieh, MD, PhD, Professor of Immunology, Rheumatology, and Pediatrics, National Cheng Kung University College of Medicine, Institute of Clinical Medicine
| | - Chi-Chang Shieh
- From the Division of Immunology, Department of Pediatrics, Kuo General Hospital; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University; Division of Allergy, Immunology and Rheumatology, and Department of Pediatrics, Department of Internal Medicine, and Department of Statistics, National Cheng Kung University Hospital, Tainan, Taiwan. .,L.H. Wang, MD, MS, Immunologist, Division of Immunology, Department of Pediatrics, Kuo General Hospital; W.M. Wang, MS, Biostatistician, National Cheng Kung University, Department of Statistics; C.Y. Lin, MD, Rheumatologist, National Cheng Kung University Hospital, Department of Internal Medicine; S.H. Lin, PhD, Associate Professor of Biostatistics, National Cheng Kung University College of Medicine, Institute of Clinical Medicine; C.C. Shieh, MD, PhD, Professor of Immunology, Rheumatology, and Pediatrics, National Cheng Kung University College of Medicine, Institute of Clinical Medicine.
| |
Collapse
|
59
|
Marques-Piubelli ML, Salas YI, Pachas C, Becker-Hecker R, Vega F, Miranda RN. Epstein-Barr virus-associated B-cell lymphoproliferative disorders and lymphomas: a review. Pathology 2019; 52:40-52. [PMID: 31706670 DOI: 10.1016/j.pathol.2019.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/12/2022]
Abstract
In this review, we focus on B-cell lymphoproliferative disorders (LPDs) and lymphomas associated with Epstein-Barr virus (EBV). In some of these diseases-such as EBV-positive diffuse large B-cell lymphoma (DLBCL), not otherwise specified-virus detection is required for the diagnosis, while in others its detection is not necessary for diagnosis. EBV infection has three main latency patterns (types III, II, and I). Different latency patterns are found in different LPD types and are related to the host immune system status. For each of the LPDs/lymphomas, we discuss the clinical presentation, epidemiology, pathology, immunophenotype, and genetic or molecular basis. We provide data for a better understanding of the relationships among the discussed diseases and other information that can be useful in differential diagnosis. Not included in this review are classic Hodgkin lymphoma and some specific variants of DLBCL, as these entities are discussed in separate reviews in this issue.
Collapse
Affiliation(s)
- Mario L Marques-Piubelli
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yessenia I Salas
- Departamento de Patologia, Hospital Cayetano Heredia, Lima, Peru
| | - Carlos Pachas
- Departamento de Patologia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | | | - Francisco Vega
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| |
Collapse
|
60
|
Abstract
BACKGROUND Several studies have reported the association of Behcet disease (BD) with the risk of diverse kinds of cancers. However, its association is controversial. Therefore, we conducted a bioinformatics-analysis to explore any possible association. METHODS We obtained relevant findings published before October 2018 through literature survey of the PubMed, EMBASE, and Web of Science databases. STATA 12.0 software was used for statistical analysis. RESULTS After screening, the meta-analysis comprised 5 studies. We observed a significant positive association between BD and enhanced malignancy risk (pooled relative risk [RR], 1.19; 95% confidence interval [CI]: 1.09-1.30), especially for hematological cancer (pooled RR, 2.58; 95% CI: 1.61-3.55) and thyroid cancer (pooled RR, 1.25; 95% CI: 1.04-1.47). However, high heterogeneity was also observed in the results (I = 81.3%). Subgroup analysis indicated that female BD patients from Korean population are at highest predisposition to overall malignancy. Besides, publication bias was not observed with our choice of surveys. CONCLUSION We conclude that patients suffering from BD have an overall increased risk for malignancy. Greater numbers of exhaustive temporal studies are essential for definitive inferences.
Collapse
Affiliation(s)
| | - Yu Peng
- Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1, Dong Cheng District, Beijing 100730, China
| | | | | | | |
Collapse
|
61
|
Tsang L, Banerjee N, Tabibian JH. Bloody Diarrhea and Weight Loss in a Patient in Remission From Ulcerative Colitis. Gastroenterology 2019; 157:1207-1209. [PMID: 30831082 DOI: 10.1053/j.gastro.2019.01.272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/18/2019] [Accepted: 01/31/2019] [Indexed: 12/02/2022]
Affiliation(s)
- Lisa Tsang
- UCLA-Olive View Internal Medicine Residency Program, Sylmar, California
| | - Natasha Banerjee
- Division of Hematology and Oncology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California
| |
Collapse
|
62
|
Hellbacher E, Hjorton K, Backlin C, Enblad G, Sundström C, Baecklund E, Knight A. Malignant lymphoma in granulomatosis with polyangiitis: subtypes, clinical characteristics and prognosis. Acta Oncol 2019; 58:1655-1659. [PMID: 31407922 DOI: 10.1080/0284186x.2019.1634833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Erik Hellbacher
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| | - Karin Hjorton
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| | - Carin Backlin
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Christer Sundström
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Eva Baecklund
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| | - Ann Knight
- Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
63
|
Din L, Sheikh M, Kosaraju N, Smedby KE, Bernatsky S, Berndt S, Skibola CF, Nieters A, Wang S, McKay JD, Cocco P, Maynadié M, Foretová L, Staines A, Mack TM, de Sanjosé S, Vyse TJ, Padyukov L, Taub Z, Din M, Monnereau A, Arslan AA, Moore A, Brooks-Wilson AR, Novak AJ, Glimelius B, Birmann BM, Link BK, Stewart C, Vajdic CM, Haioun C, Magnani C, Conti D, Cox DG, Casabonne D, Albanes D, Kane E, Roman E, Muzi G, Salles G, Giles GG, Adami HO, Ghesquières H, Vivo ID, Clavel J, Cerhan JR, Spinelli JJ, Hofmann JN, Vijai J, Curtin K, Costenbader KH, Onel K, Offit K, Teras LR, Morton LM, Conde L, Miligi L, Melbye M, Ennas MG, Liebow M, Purdue MP, Glenn M, Southey MC, Rothman N, Camp NJ, Doo NW, Becker N, Pradhan N, Bracci PM, Boffetta P, Vineis P, Brennan P, Kraft P, Lan Q, Severson RK, Vermeulen RCH, Milne RL, Kaaks R, Travis RC, Weinstein S, Chanock SJ, Ansell SM, Slager SL, Zheng T, Zhang Y, Benavente Y, Madireddy L, Gourraud PA, Oksenberg JR, Cozen W, Hjalgrim H, Khankhanian P. Genetic overlap between autoimmune diseases and non-Hodgkin lymphoma subtypes. Genet Epidemiol 2019; 43:844-863. [PMID: 31407831 PMCID: PMC6763347 DOI: 10.1002/gepi.22242] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 01/07/2023]
Abstract
Epidemiologic studies show an increased risk of non-Hodgkin lymphoma (NHL) in patients with autoimmune disease (AD), due to a combination of shared environmental factors and/or genetic factors, or a causative cascade: chronic inflammation/antigen-stimulation in one disease leads to another. Here we assess shared genetic risk in genome-wide-association-studies (GWAS). Secondary analysis of GWAS of NHL subtypes (chronic lymphocytic leukemia, diffuse large B-cell lymphoma, follicular lymphoma, and marginal zone lymphoma) and ADs (rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis). Shared genetic risk was assessed by (a) description of regional genetic of overlap, (b) polygenic risk score (PRS), (c)"diseasome", (d)meta-analysis. Descriptive analysis revealed few shared genetic factors between each AD and each NHL subtype. The PRS of ADs were not increased in NHL patients (nor vice versa). In the diseasome, NHLs shared more genetic etiology with ADs than solid cancers (p = .0041). A meta-analysis (combing AD with NHL) implicated genes of apoptosis and telomere length. This GWAS-based analysis four NHL subtypes and three ADs revealed few weakly-associated shared loci, explaining little total risk. This suggests common genetic variation, as assessed by GWAS in these sample sizes, may not be the primary explanation for the link between these ADs and NHLs.
Collapse
Affiliation(s)
- Lennox Din
- California Northstate University, Medicine
| | | | | | - Karin E Smedby
- Karolinska Institutet, Karolinska University Hospital, Division of Clinical Epidemiology, Dept of Medicine
| | - Sasha Bernatsky
- McGill University, Medicine
- Research Institute, McGill University Health Centre, Clinical Epidemiology
| | - Sonja Berndt
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | | | - Alexandra Nieters
- University Medical Centre Freiburg, Centre of Chronic Immunodeficiency
| | - Sophia Wang
- City of Hope and the Beckman Research Institute, Department of Population Sciences
| | | | - Pierluigi Cocco
- University of Caligari, Department of Medical Sciences and Public Health
| | - Marc Maynadié
- University of Burgundy-Franche-Comté and CHU Dijon Bourgogne, Registre des Hémopathies Malignes de Côte d’Or, INSERM U1231
| | - Lenka Foretová
- Masaryk Memorial Cancer Institute, Department of Cancer Epidemiology and Genetics
| | | | - Thomas M Mack
- University of Southern California, Norris Comprehensive Cancer Center and Hospital
| | | | | | | | | | | | - Alain Monnereau
- Center of Research in Epidemiology and Statistics, Sorbonne (CRESS), Epidemiology of childhood and adolescent cancer group, INSERM
- Institut Bergonie, Registre des Hémopathies Malignes de la Gironde
| | | | - Amy Moore
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | - Angela R Brooks-Wilson
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Agency
- Simon Fraser University, Department of Biomedical Physiology and Kinesiology
| | | | - Bengt Glimelius
- Uppsala Universitet, Department of Immunology, Genetics, and Pathology
| | - Brenda M Birmann
- Brigham and Women’s Hospital and Harvard Medical School, Channing Division of Network Medicine
| | - Brian K Link
- University of Iowa Hospitals and Clinics, Internal Medicine
| | | | - Claire M Vajdic
- University of New South Wales, Centre for Big Data Research in Health
| | - Corinne Haioun
- University Paris-Est Créteil (UPEC), Lymphoid Malignancies Unit, Henri Mondor Hospital
| | | | - David Conti
- University of Southern California, Preventive Med. Dept., Biostat
| | | | - Delphine Casabonne
- Catalan Institute of Oncology, Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL
- CIBER Epidemiología y Salud Pública
| | - Demetrius Albanes
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | - Eleanor Kane
- University of York, Department of Health Sciences
| | - Eve Roman
- University of York, Department of Health Sciences
| | - Giacomo Muzi
- Universita degli Studi di Perugia, Department of Occupational Medicine
| | - Gilles Salles
- Centre Hospitalier Universitaire de Lyon, Hematology
| | - Graham G Giles
- Cancer Council Victoria, Cancer Epidemiology & Intelligence
- University of Melbourne, Centre for Epidemiology and Biostatistics
| | - Hans-Olov Adami
- Karolinska Institutet, Department of Medical Epidmiology and Biostatistics
| | | | - Immaculata De Vivo
- Brigham and Women’s Hospital, Channing Division of Network Medicine
- Brigham Women’s Hospital and Harvard Medical School
| | | | - James R Cerhan
- Mayo Clinic, Health Sciences Research and Clinical Epidemiology
| | | | | | | | | | - Karen H Costenbader
- Brigham and Women’s Hospital, Medicine, Rheumatology, Immunology and Allergy
| | | | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, Department of Medicine
- Memorial Sloan Kettering Cancer Center, Department of Cancer Biology and Genetics
| | | | - Lindsay M Morton
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | | | | | - Mads Melbye
- Statens Serum Institut, Epidemiology Research
- Stanford University, Medicine
| | | | | | - Mark P Purdue
- National Cancer Institute, Division of Cancer Biology
| | | | - Melissa C Southey
- University of Melbourne, Department of Clinical Pathology, Genetic Epidemiology Laboratory
- Monash University, Precision Medicine, School of Clinical Sciences at Monash Health
| | - Nathaniel Rothman
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | - Nicola J Camp
- Huntsman Cancer Institute
- University of Utah, Internal Medicine and Biomedical Informatics
| | - Nicole Wong Doo
- University of Sydney, Concord Hospital Clinical School
- Cancer Council Australia, Centre for Epidemiology and Intelligence
| | | | | | - Paige M Bracci
- University of California San Francisco, Department of Epidemiology and Biostatistics
| | - Paolo Boffetta
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute
| | - Paolo Vineis
- Imperial College London, Environmental Epidemiology and Public Health
| | - Paul Brennan
- International Agency for Research on Cancer (IARC)
| | - Peter Kraft
- Harvard School of Public Health, Departments of Epidemiology and Biostatistics
| | - Qing Lan
- National Cancer Institute, Division of Cancer Epidemiology and Genetics
| | - Richard K Severson
- Wayne State University, Karmanos Cancer Institute, Department of Family Medicine and Public Health Sciences
| | | | - Roger L Milne
- University of Melbourne, Centre for Epidemiology and Biostatistics
- Cancer Council Australia, Epidemiology and Intelligence
| | - Rudolph Kaaks
- German Cancer Research Center, Division of Cancer Epidemiology
| | | | - Stephanie Weinstein
- National Cancer Institute, NIH, Division of Cancer Epidemiology and Genetics
| | - Stephen J Chanock
- National Cancer Research Institute, Division of Cancer Epidemiology and Genetics
| | | | | | | | - Yawei Zhang
- Yale University School of Public Health, Environmental Health Sciences
| | - Yolanda Benavente
- Institut Catala d’ Oncologia, Unit of Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, CIBER Epidemiología y Salud Pública
| | | | - Pierre-Antoine Gourraud
- Université de Nantes, Inserm, Centre de Recherche en Transplantation et Immunologie
- Centre Hospitalier Universitaire de Nantes, Institut de Transplantation Urologie Néphrologie (ITUN)
| | | | - Wendy Cozen
- University of Southern California - Norris Comprehensive Cancer Center and Hospital, Departments of Preventive Medicine and Pathology
| | | | | |
Collapse
|
64
|
Kim H, Sung YK, Choi S, Im SG, Jung SY, Jang EJ, Yoo DH, Cho SK. Increased risk of malignancy in patients aged over 50 with idiopathic inflammatory myositis compared to patients with osteoarthritis of the knee. Mod Rheumatol 2019; 30:870-877. [PMID: 31442092 DOI: 10.1080/14397595.2019.1660041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To estimate risk of malignancy in patients with idiopathic inflammatory myositis (IIM) compared to patients with knee osteoarthritis (OA).Methods: Patients with IIM and knee OA aged over 50, who had no history of malignancy, were identified using Korean National claims database from January 2012 to December 2014. They had been observed until a malignancy was diagnosed or up to the end of the study, December 2015. The incidence rate (IR) of malignancy in IIM patients was calculated and compared with knee OA patients using standardized incidence ratio (SIR).Results: A total of 634 polymyositis (PM) and 556 dermatomyositis (DM) patients were included. Overall, 100 solid (IR 270.4/10,000 person-years (PY), 95% confidence interval (CI) 217.4-323.4) and 12 hematologic malignancies (IR 32.4/10,000 PY, 95% CI 14.1-50.8) occurred. Compared with knee OA, risk of overall (SIR 1.5, 95% CI 1.2-1.8), solid (SIR 1.4, 95% CI 1.1-1.6), and hematologic malignancy (SIR 5.7, 95% CI 2.5-9.0) were increased in IIM patients. This was due to increased incidence of malignancy in DM (hematologic malignancy, SIR 8.7, 95% CI 2.7-14.7, solid malignancy, SIR 1.5, 95% CI 1.1-1.9).Conclusion: Patients with IIM, especially DM, have an increased risk of malignancy compared to patients with knee OA.
Collapse
Affiliation(s)
- Hyoungyoung Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Seongmi Choi
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Republic of Korea
| | - Seul Gi Im
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Republic of Korea.,Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, Republic of Korea
| | - Dae Hyun Yoo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| |
Collapse
|
65
|
Abstract
Although about 90% of the world's population is infected by EBV only a small subset of the related infections result in neoplastic transformation. EBV is a versatile oncogenic agent involved in a multitude of hematopoietic, epithelial, and mesenchymal neoplasms, but the precise role of EBV in the pathogenesis of many of the associated lymphoid/histiocytic proliferations remains hypothetical or not completely understood. Additional studies and use of evolving technologies such as high-throughput next-generation sequencing may help address this knowledge gap and may lead to enhanced diagnostic assessment and the development of potential therapeutic interventions.
Collapse
|
66
|
Brandefors L, Lindh J, Preuss KD, Fadle N, Pfreundschuh M, Kimby E. Incidence and inheritance of hyperphosphorylated paratarg-7 in patients with Waldenstrom's macroglobulinaemia in Sweden. Acta Oncol 2019; 58:824-827. [PMID: 30888245 DOI: 10.1080/0284186x.2019.1582798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lena Brandefors
- Department of Radiation Sciences, Oncology, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Jack Lindh
- Department of Radiation Sciences, Oncology, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Klaus-Dieter Preuss
- José-Carreras-Center for Immuno- and Gene Therapy, Department of Internal Medicine I, Saarland University Medical School, Homburg, Germany
| | - Natalie Fadle
- José-Carreras-Center for Immuno- and Gene Therapy, Department of Internal Medicine I, Saarland University Medical School, Homburg, Germany
| | - Michael Pfreundschuh
- José-Carreras-Center for Immuno- and Gene Therapy, Department of Internal Medicine I, Saarland University Medical School, Homburg, Germany
| | - Eva Kimby
- Department of Hematology, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
67
|
Wang Y, Tan J, Wu H, Yi C. High Glucose Promotes Epithelial-Mesenchymal Transition, Migration and Invasion in A20 Murine Diffuse Large B-Cell Lymphoma Cells Through Increased Expression of High Mobility Group AT-Hook 2 (HMGA2). Med Sci Monit 2019; 25:3860-3868. [PMID: 31124542 PMCID: PMC6545067 DOI: 10.12659/msm.916195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Patients with type 2 diabetes mellitus have been reported to be at increased risk of developing non-Hodgkin’s lymphoma (NHL). Diffuse large B-cell lymphoma (DLBCL) is the most common type of high-grade NHL. This study aimed to investigate the effects of high glucose on cell migration, invasion and epithelial-mesenchymal transition (EMT), and the expression of high mobility group AT-hook 2 (HMGA2) in A20 murine DLBCL cells. Material/Methods Quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot were used to analyze the expression of HMGA2 at the gene and protein level and EMT markers in the A20 murine DLBCL cell line. A transwell assay evaluated cell migration and invasion of A20 cells. Short-interfering RNA (siRNA) was used to knockdown HMGA2 expression. Results High glucose levels upregulated the expression of HMGA2, induced phenotypic changes of EMT, and increased cell migration and invasion in A20 cells. Knockdown of HMGA2 by siRNA effectively inhibited EMT induced by high glucose in A20 cells by directly regulating the Wnt/β-catenin signaling pathway. Conclusions In the A20 murine DLBCL cell line, high glucose upregulated the expression of HMGA2 to induce EMT and promote cell migration and invasion through the Wnt/β-catenin signaling pathway.
Collapse
Affiliation(s)
- Ya Wang
- Department of Endocrinology, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China (mainland)
| | - Jie Tan
- Department of Hematology, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China (mainland)
| | - Hongyan Wu
- Department of Endocrinology, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China (mainland)
| | - Cunjian Yi
- Department of Obstetrics and Gynecology, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China (mainland)
| |
Collapse
|
68
|
Riva F, Ponzoni M, Supino D, Bertilaccio MTS, Polentarutti N, Massara M, Pasqualini F, Carriero R, Innocenzi A, Anselmo A, Veliz-Rodriguez T, Simonetti G, Anders HJ, Caligaris-Cappio F, Mantovani A, Muzio M, Garlanda C. IL1R8 Deficiency Drives Autoimmunity-Associated Lymphoma Development. Cancer Immunol Res 2019; 7:874-885. [PMID: 31018956 DOI: 10.1158/2326-6066.cir-18-0698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/28/2019] [Accepted: 04/17/2019] [Indexed: 12/15/2022]
Abstract
Chronic inflammation, including that driven by autoimmunity, is associated with the development of B-cell lymphomas. IL1R8 is a regulatory receptor belonging to the IL1R family, which negatively regulates NF-κB activation following stimulation of IL1R or Toll-like receptor family members. IL1R8 deficiency is associated with the development of severe autoimmune lupus-like disease in lpr mice. We herein investigated whether concomitant exacerbated inflammation and autoimmunity caused by the deficiency of IL1R8 could recapitulate autoimmunity-associated lymphomagenesis. We thus monitored B-cell lymphoma development during the aging of IL1R8-deficient lpr mice, observing an increased lymphoid cell expansion that evolved to diffuse large B-cell lymphoma (DLBCL). Molecular and gene-expression analyses showed that the NF-κB pathway was constitutively activated in Il1r8 -/-/lpr B splenocytes. In human DLBCL, IL1R8 had reduced expression compared with normal B cells, and higher IL1R8 expression was associated with a better outcome. Thus, IL1R8 silencing is associated with increased lymphoproliferation and transformation in the pathogenesis of B-cell lymphomas associated with autoimmunity.
Collapse
Affiliation(s)
- Federica Riva
- Department of Veterinary Medicine, University of Milan, Milan, Italy.,Humanitas Research Hospital, Rozzano, Italy
| | - Maurilio Ponzoni
- Ateneo Vita-Salute and Unit of Lymphoid Malignancies, IRCCS San Raffaele Scientific Institute; Pathology Unit, San Raffaele Scientific Institute, Milano, Italy
| | | | | | | | | | | | | | - Anna Innocenzi
- Ateneo Vita-Salute and Unit of Lymphoid Malignancies, IRCCS San Raffaele Scientific Institute; Pathology Unit, San Raffaele Scientific Institute, Milano, Italy
| | | | - Tania Veliz-Rodriguez
- Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Giorgia Simonetti
- Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Hans-Joachim Anders
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Germany
| | | | - Alberto Mantovani
- Humanitas Research Hospital, Rozzano, Italy.,Humanitas University, Pieve Emanuele, Italy.,The William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Marta Muzio
- Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milano, Italy.
| | - Cecilia Garlanda
- Humanitas Research Hospital, Rozzano, Italy. .,Humanitas University, Pieve Emanuele, Italy
| |
Collapse
|
69
|
Kane E, Painter D, Smith A, Crouch S, Oliver S, Patmore R, Roman E. The impact of rheumatological disorders on lymphomas and myeloma: a report on risk and survival from the UK's population-based Haematological Malignancy Research Network. Cancer Epidemiol 2019; 59:236-243. [PMID: 30844679 PMCID: PMC6452783 DOI: 10.1016/j.canep.2019.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Autoimmune inflammatory disease increases the risk of diffuse large B-cell lymphoma (DLBCL) and marginal zone lymphoma (MZL), but findings for other mature B-cell malignancies are equivocal. Furthermore, it has been suggested that the increase in DLBCL is due to the activated B-cell (ABC) subtype; but data on this, and the impact of inflammatory co-morbidities on survival, are sparse and contradictory. METHODS Data are from an established UK population-based cohort. Patients (n = 6834) diagnosed between 01/2009 and 08/2015 are included; DLBCL (n = 1771), myeloma (n = 1760), chronic lymphocytic leukaemia (CLL, n = 1580), MZL (n = 936), and follicular lymphoma (FL, n = 787). Information on rheumatological disorders and deaths was obtained by record-linkage to nationally compiled Hospital Episode Statistics, with age-and sex-matched individuals (n = 68,340) from the same catchment population (˜4 million people) providing the comparator. RESULTS Significantly increased risks for DLBCL (OR = 2.3, 95% CI 1.8-2.8) and MZL (OR = 2.0, 95% CI 1.5-2.7) were found for those with rheumatological disorders; the site distribution of those with/without rheumatological conditions differing for DLBCL (p = 0.007) and MZL (p = 0.002). No increases in risk were observed for the remaining mature B-cell malignancies, and no associations with survival were detected for DLBCL (age-adjusted HR = 1.2, 95% CI 0.9-1.6) or MZL (age-adjusted HR = 1.0, 95% CI 0.6-1.9). Furthermore, whilst our findings provide evidence for an association with rheumatological disease severity for DLBCL, they offer little support for the notion that the association is driven by an increase in the incidence of the ABC subtype. CONCLUSION Our findings support the hypothesis that the chronic activation and proliferation of specific B-cell populations which characterize autoimmune disease increase the potential for the lymphomagenic events that lead to DLBCL and MZL in both males and females; but have no impact on the development of CLL, FL or MM, or on survival.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell
- Lymphoma/epidemiology
- Lymphoma/mortality
- Lymphoma/pathology
- Lymphoma, B-Cell, Marginal Zone/epidemiology
- Lymphoma, B-Cell, Marginal Zone/mortality
- Lymphoma, Follicular/epidemiology
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Multiple Myeloma/epidemiology
- Multiple Myeloma/mortality
- Multiple Myeloma/pathology
- Rheumatic Diseases/epidemiology
- Rheumatic Diseases/mortality
- Rheumatic Diseases/pathology
- United Kingdom/epidemiology
Collapse
Affiliation(s)
- Eleanor Kane
- Department of Health Sciences, University of York, York, UK.
| | - Daniel Painter
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Crouch
- Department of Health Sciences, University of York, York, UK
| | - Steven Oliver
- Department of Health Sciences, University of York, York, UK; Hull York Medical School, York, UK
| | | | - Eve Roman
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
70
|
Schmalzing M. The relationship of lymphoma and lupus—at least bidirectional. Rheumatology (Oxford) 2019; 58:1131-1132. [DOI: 10.1093/rheumatology/kez088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 02/13/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marc Schmalzing
- Department of Internal Medicine, Rheumatology and Clinical Immunology, University Clinic of Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
71
|
Ferraro S, Leonardi L, Convertino I, Blandizzi C, Tuccori M. Is There a Risk of Lymphoma Associated With Anti-tumor Necrosis Factor Drugs in Patients With Inflammatory Bowel Disease? A Systematic Review of Observational Studies. Front Pharmacol 2019; 10:247. [PMID: 30941038 PMCID: PMC6433961 DOI: 10.3389/fphar.2019.00247] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/26/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Inflammatory bowel diseases (IBDs) are generally not considered a risk factor for the development of lymphoma. When considering IBD treatments, there is good evidence supporting thiopurines (azathioprine, 6-mercaptopurine) as a risk factor for lymphoma. Conversely, the association between the use of anti-TNF agents and the development of lymphoma remains undetermined. In this systematic review, we analyzed the evidence coming from observational studies supporting an association between the use of anti-TNF drugs and lymphoma in patients with IBDs. Methods: This systematic review was performed according with MOOSE and PRISMA statements. We searched observational studies conducted on IBD patients, using MEDLINE, EMBASE, and Google Scholar, published in English language, within the period ranging from January 1st, 1999 to June 30th, 2018. An assessment of the methodologic shortcomings of selected studies was performed as well. Results: Fourteen studies met the eligibility criteria and were included in the review. Only four studies found a significant association of anti-TNF drug with lymphoma or groups of cancers including lymphoma. However, the methodologic shortcomings of all the included studies made their results unreliable, irrespectively of whether their findings supported an association or not. Conclusions: Current evidence from observational studies does not allow excluding or confirming an association of the exposure to anti-TNF treatments with lymphoma in IBD patients.
Collapse
Affiliation(s)
- Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Leonardi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Corrado Blandizzi
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
| |
Collapse
|
72
|
Zhong H, Chen J, Cheng S, Chen S, Shen R, Shi Q, Xu P, Huang H, Zhang M, Wang L, Wu D, Zhao W. Prognostic nomogram incorporating inflammatory cytokines for overall survival in patients with aggressive non-Hodgkin's lymphoma. EBioMedicine 2019; 41:167-174. [PMID: 30827933 PMCID: PMC6443577 DOI: 10.1016/j.ebiom.2019.02.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study aimed to investigate the association of pre-treatment inflammatory status with survival time and to develop a prognostic nomogram incorporating inflammatory cytokines in non-Hodgkin's lymphoma. METHODS A total of 228 patients with diffuse large B-cell lymphoma (DLBCL) received R-CHOP-based regimens from a prospective randomized study (NCT01852435) were included as a training cohort. Other cohorts of 886 lymphoma patients were served as validation cohorts. Lymphocyte-monocyte ratio (LMR), serum levels of soluble interleukin s(IL)-2R, IL-6, IL-8, IL-10 and tumor necrosis factor-α (TNF-α), were assessed before treatment. Least absolute shrinkage and selection operator (LASSO) regression were used to select variables for nomogram of overall survival (OS). The predictive accuracy of the nomogram was determined by concordance index (C-index). FINDINGS The nomogram included lactate dehydrogenase (LDH), sIL-2R, TNF-α and decreased LMR. The C-index of the nomogram for OS prediction were range from 0.61 to 0.86 for training cohort of DLBCL and validation cohorts of DLBCL, PTCL, NKTCL and ASCT, which were superior to the predictive power of International Prognostic Index (IPI, 0.67 to 0.84) or NCCN-IPI (0.59 to 0.78), but not in those of indolent lymphoma like FL and MALT. INTERPRETATIONS The nomogram incorporating inflammatory cytokines provides a useful tool for risk stratification in aggressive non-Hodgkin's lymphomas. FUND: National Natural Science Foundation of China, the Shanghai Commission of Science and Technology, Multicenter Clinical Research Project by Shanghai Jiao Tong University School of Medicine, Clinical Research Plan of SHDC, and Chang Jiang Scholars Program.
Collapse
Affiliation(s)
- Huijuan Zhong
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China
| | - Jia Chen
- Jiangsu Institute of Hematology, Institute of Blood and Marrow Transplantation, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Shu Cheng
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China
| | - Suning Chen
- Jiangsu Institute of Hematology, Institute of Blood and Marrow Transplantation, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Rong Shen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China
| | - Qing Shi
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China
| | - Pengpeng Xu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China
| | - Hengye Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, China
| | - Muchen Zhang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China
| | - Li Wang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China; Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai, China
| | - Depei Wu
- Jiangsu Institute of Hematology, Institute of Blood and Marrow Transplantation, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
| | - Weili Zhao
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, China; Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai, China.
| |
Collapse
|
73
|
Ghosh S, Lalani R, Patel V, Bardoliwala D, Maiti K, Banerjee S, Bhowmick S, Misra A. Combinatorial nanocarriers against drug resistance in hematological cancers: Opportunities and emerging strategies. J Control Release 2019; 296:114-139. [DOI: 10.1016/j.jconrel.2019.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 12/16/2022]
|
74
|
Shared Medical and Environmental Risk Factors in Dry Eye Syndrome, Sjogren's Syndrome, and B-Cell Non-Hodgkin Lymphoma: A Case-Control Study. J Immunol Res 2019; 2019:9060842. [PMID: 30805374 PMCID: PMC6360537 DOI: 10.1155/2019/9060842] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/10/2018] [Accepted: 12/16/2018] [Indexed: 12/13/2022] Open
Abstract
Objectives To assess whether there are shared exposures associated with Sjogren's syndrome (SS), dry eye syndrome (DES), and B-cell non-Hodgkin lymphoma (B-NHL), in order to determine whether they are etiologically related. Methods In a clinic-based case-control study, 702 participants (91 SS, 120 DES, 211 (age and sex frequency-matched) controls, and 280 B-NHL cases) were recruited and interviewed regarding exposures, medical history, and family history. Results Female predominance was noted in SS (ratio 9.2 : 1). Eye dryness was severest in SS compared to DES and controls (P < 0.001). Compared to controls, alcohol consumption was inversely associated with NHL, DES, and SS (odds ratio (OR) = 0.47, 95% confidence interval (CI): 0.31-0.71; OR = 0.54, 95% CI: 0.33-0.88; and OR = 0.26, 95% CI: 0.14-0.49, respectively), while a previous history of infection requiring hospitalization was positively associated with all three conditions: NHL (OR = 1.92; 95% CI: 1.23-2.99), DES (OR = 3.29; 95% CI: 1.97-5.47), and SS (OR = 4.74; 95% CI: 2.66-8.44). NHL patients were more likely to report first-degree relatives with hematologic cancer, while having first-degree relatives with an autoimmune disease (AID) was associated with SS (OR = 5.25; 95% CI: 2.59-10.63) and DES (OR = 3.55; 95% CI: 1.83-6.91) compared to controls. Conclusions Some exposures are associated with all three conditions (such as an inverse association with alcohol consumption and a positive association with serious past infection), while a family history of AID appears to be shared by DES and SS, but not NHL subjects. Shared risk factors for all three conditions indicate possible mutual etiological pathways.
Collapse
|
75
|
Han M, Jung YS, Kim WH, Cheon JH, Park S. Cancer Risk in Patients with Intestinal Behçet's Disease: A Nationwide Population-Based Study. Gut Liver 2018; 12:433-439. [PMID: 29429154 PMCID: PMC6027828 DOI: 10.5009/gnl17324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/12/2017] [Accepted: 10/30/2017] [Indexed: 12/27/2022] Open
Abstract
Background/Aims The relationship between intestinal Behçet’s disease (BD) and cancer remains unclear. We conducted a nationwide, population-based study to determine the risk of cancer in patients with intestinal BD. Methods Using the National Health Insurance claims records, we collected data on 365 patients who had been diagnosed with intestinal BD between 2011 and 2014. Standardized incidence ratios (SIRs) of overall and site-specific cancers in patients with intestinal BD in comparison with the general population were calculated. Results Among 167 men with intestinal BD, four cases of cancer were observed; among 191 women with BD, eight cases of cancer were observed. The risk of all cancers was significantly higher in women with intestinal BD than in women of the general population (SIR, 4.27; 95% confidence interval [CI], 1.84 to 8.41). However, in men with intestinal BD, the risk of all cancers was not significantly higher than that in men of the general population (SIR, 2.08; 95% CI, 0.57 to 5.33). The risk of hematologic cancer was significantly higher in both men and women with intestinal BD than in their counterparts in the general population (SIR, 23.90; 95% CI, 2.89 to 86.32 in men; SIR, 34.47; 95% CI, 4.17 to 124.51 in women). In particular, patients with intestinal BD showed a higher risk of leukemia and myelodysplastic syndrome than the general population. Conclusions Patients with intestinal BD demonstrated a higher risk of hematologic cancer, especially leukemia, than the general population. Furthermore, women with intestinal BD showed a higher risk of all cancers.
Collapse
Affiliation(s)
- Minkyung Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
| | - Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Ho Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
| |
Collapse
|
76
|
Autoimmune disease-associated non-Hodgkin’s lymphoma—a large retrospective study from China. Ann Hematol 2018; 98:445-455. [DOI: 10.1007/s00277-018-3515-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022]
|
77
|
Kleinstern G, Maurer MJ, Liebow M, Habermann TM, Koff JL, Allmer C, Witzig TE, Nowakowski GS, Micallef IN, Johnston PB, Inwards DJ, Thompson CA, Feldman AL, Link BK, Flowers C, Slager SL, Cerhan JR. History of autoimmune conditions and lymphoma prognosis. Blood Cancer J 2018; 8:73. [PMID: 30069001 PMCID: PMC6070501 DOI: 10.1038/s41408-018-0105-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/05/2018] [Accepted: 06/15/2018] [Indexed: 02/08/2023] Open
Abstract
Autoimmune conditions are strong risk factors for developing lymphoma, but their role in lymphoma prognosis is less clear. In a prospective cohort study, we evaluated self-reported history of eight autoimmune conditions with outcomes in 736 diffuse large B-cell, 703 follicular, 302 marginal zone (MZL), 193 mantle cell (MCL), 297 Hodgkin lymphoma (HL), and 186 T-cell lymphomas. We calculated event-free survival (EFS) and overall survival (OS), and estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sex, prognostic score, and treatment. History of any of the eight autoimmune conditions ranged from 7.4% in HL to 18.2% in MZL, and was not associated with EFS or OS for any lymphoma subtype. However, there was a positive association of autoimmune conditions primarily mediated by B-cell responses with inferior EFS in MCL (HR = 2.23, CI: 1.15–4.34) and HL (HR = 2.63, CI: 1.04–6.63), which was largely driven by rheumatoid arthritis. Autoimmune conditions primarily mediated by T-cell responses were not found to be associated with EFS or OS in any lymphoma subtype, although there were few events for this exposure. Our results indicate that distinguishing autoimmune conditions primarily mediated by B-cell/T-cell responses may yield insight regarding the impact of this comorbid disease, affecting ~10% of lymphoma patients, on survival.
Collapse
Affiliation(s)
- Geffen Kleinstern
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mark Liebow
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Jean L Koff
- Division of Bone Marrow and Stem Cell Transplantation, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ivana N Micallef
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Brian K Link
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
78
|
Rezk SA, Zhao X, Weiss LM. Epstein-Barr virus (EBV)-associated lymphoid proliferations, a 2018 update. Hum Pathol 2018; 79:18-41. [PMID: 29885408 DOI: 10.1016/j.humpath.2018.05.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/14/2018] [Accepted: 05/29/2018] [Indexed: 12/12/2022]
Abstract
Epstein-Barr virus (EBV) has been linked to many human neoplasms including hematopoietic, epithelial, and mesenchymal tumors. Since our original review of EBV-associated lymphoproliferative disorders in 2007, many advances and developments have been reported. In this review, we will examine the recent advances in EBV-associated lymphoid/histiocytic proliferations, dividing them into reactive, B cell, T/NK cell, immunodeficiency-related, and histiocytic/dendritic cell proliferations.
Collapse
Affiliation(s)
- Sherif A Rezk
- Department of Pathology & Laboratory Medicine, University of California Irvine (UCI) Medical Center, Orange, 92868, CA.
| | - Xiaohui Zhao
- Department of Pathology & Laboratory Medicine, University of California Irvine (UCI) Medical Center, Orange, 92868, CA
| | - Lawrence M Weiss
- Department of Pathology & Laboratory Medicine, University of California Irvine (UCI) Medical Center, Orange, 92868, CA; NeoGenomics Laboratories, Aliso Viejo, 92656, CA
| |
Collapse
|
79
|
Javier R, Shaikh N, Lesniak MS, Sonabend A, Stupp R, Behdad A, Horbinski C. B cell-rich non-neoplastic sentinel lesion preceding primary central nervous system lymphoma. Diagn Pathol 2018; 13:37. [PMID: 29871654 PMCID: PMC5989478 DOI: 10.1186/s13000-018-0717-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is an uncommon tumor in the brain. Although most PCNSL are readily diagnosed as diffuse large B cell lymphoma (DLBCL) on the first biopsy, very rare cases have been described in which the first detected intracerebral lesions are non-neoplastic, and are composed mostly of perivascular T cells, not B cells. This phenomenon is known as “sentinel lesions.”
Collapse
Affiliation(s)
- Rodrigo Javier
- Departments of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA
| | - Nawal Shaikh
- Departments of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Maciej S Lesniak
- Departments of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA
| | - Adam Sonabend
- Departments of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA
| | - Roger Stupp
- Departments of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA
| | - Amir Behdad
- Departments of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Craig Horbinski
- Departments of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA. .,Departments of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
| |
Collapse
|
80
|
Imgenberg-Kreuz J, Sandling JK, Björk A, Nordlund J, Kvarnström M, Eloranta ML, Rönnblom L, Wahren-Herlenius M, Syvänen AC, Nordmark G. Transcription profiling of peripheral B cells in antibody-positive primary Sjögren's syndrome reveals upregulated expression of CX3CR1 and a type I and type II interferon signature. Scand J Immunol 2018; 87:e12662. [PMID: 29655283 DOI: 10.1111/sji.12662] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/16/2018] [Indexed: 12/19/2022]
Abstract
B cells play a key role in the pathogenesis of primary Sjögren's syndrome (pSS). The aim of this study was to analyse the transcriptome of CD19+ B cells from patients with pSS and healthy controls to decipher the B cell-specific contribution to pSS. RNA from purified CD19+ B cells from 12 anti-SSA antibody-positive untreated female patients with pSS and 20 healthy blood donors was subjected to whole transcriptome sequencing. A false discovery rate corrected significance threshold of α < 0.05 was applied to define differential gene expression. As validation, gene expression in B cells from 17 patients with pSS and 16 healthy controls was analysed using a targeted gene panel. RNA-sequencing identified 4047 differentially expressed autosomal genes in pSS B cells. Upregulated expression of type I and type II interferon (IFN)-induced genes was observed, establishing an IFN signature in pSS B cells. Among the top upregulated and validated genes were CX3CR1, encoding the fractalkine receptor involved in regulation of B-cell malignancies, CCL5/RANTES and CCR1. Increased expression of several members of the TNF superfamily was also identified; TNFSF4/Ox40L, TNFSF10/TRAIL, TNFSF13B/BAFF, TNFRSF17/BCMA as well as S100A8 and -A9/calprotectin, TLR7, STAT1 and STAT2. Among genes with downregulated expression in pSS B cells were SOCS1 and SOCS3, CD70 and TNFAIP3/A20. We conclude that B cells from patients with anti-SSA antibody-positive pSS display immune activation with upregulated expression of chemokines, chemokine receptors and a prominent type I and type II IFN signature, while suppressors of cytokine signalling are downregulated. This adds insight into the autoimmune process and suggests potential targets for future functional studies.
Collapse
Affiliation(s)
- J Imgenberg-Kreuz
- Department of Medical Sciences, Molecular Medicine and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Rheumatology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - J K Sandling
- Department of Medical Sciences, Rheumatology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - A Björk
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Nordlund
- Department of Medical Sciences, Molecular Medicine and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - M Kvarnström
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M-L Eloranta
- Department of Medical Sciences, Rheumatology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - L Rönnblom
- Department of Medical Sciences, Rheumatology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - M Wahren-Herlenius
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A-C Syvänen
- Department of Medical Sciences, Molecular Medicine and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - G Nordmark
- Department of Medical Sciences, Rheumatology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| |
Collapse
|
81
|
Na SJ, Kang MJ, Yu DS, Han KD, Lee JH, Park YG, Lee YB. Cancer risk in patients with Behçet disease: A nationwide population-based dynamic cohort study from Korea. J Am Acad Dermatol 2018; 78:464-470.e2. [DOI: 10.1016/j.jaad.2017.09.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/05/2017] [Accepted: 09/16/2017] [Indexed: 12/11/2022]
|
82
|
Mottok A, Rosenwald A. Methotrexate-induced lymphoproliferative disorders: regression matters. Leuk Lymphoma 2018; 59:1027-1029. [PMID: 29468914 DOI: 10.1080/10428194.2018.1437270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anja Mottok
- a Institute of Pathology , University of Würzburg , Würzburg , Germany.,b Comprehensive Cancer Centre Mainfranken , University of Würzburg , Würzburg , Germany
| | - Andreas Rosenwald
- a Institute of Pathology , University of Würzburg , Würzburg , Germany.,b Comprehensive Cancer Centre Mainfranken , University of Würzburg , Würzburg , Germany
| |
Collapse
|
83
|
Byers JT, Kurtz JL, Mendoza AS, Oster CD, Sun NCJ, Qing X, Cornford ME. An unusual presentation of primary pulmonary extranodal marginal zone lymphoma of mucosal associated lymphoid tissue: An autopsy case report. Exp Mol Pathol 2018; 104:155-157. [PMID: 29452080 DOI: 10.1016/j.yexmp.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/12/2018] [Indexed: 11/16/2022]
Abstract
A 40 year old female with no documented medical history presented to the Emergency Department with several days of lethargy and altered mental status. She was found to be anemic, thrombocytopenic, and hypotensive. The patient was found to be in severe metabolic acidosis, became bradycardic, and quickly deteriorated. Clinicians suspected thrombotic thrombocytopenic purpura, and the diagnosis was supported by ADAMTS13 testing. The clinicians attempted to place a Quinton catheter for emergent plasmapheresis, but the patient expired before definitive treatment could be initiated. Autopsy was obtained and revealed a right middle lobe consolidation grossly consistent with lymphoid tissue or tumor.
Collapse
Affiliation(s)
- Joshua T Byers
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W. Carson St., Torrance, CA, United States.
| | - Justin L Kurtz
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W. Carson St., Torrance, CA, United States
| | - Alejandro S Mendoza
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W. Carson St., Torrance, CA, United States
| | - Cyrus D Oster
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W. Carson St., Torrance, CA, United States
| | - Nora C J Sun
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W. Carson St., Torrance, CA, United States
| | - Xin Qing
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W. Carson St., Torrance, CA, United States
| | - Marcia E Cornford
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W. Carson St., Torrance, CA, United States
| |
Collapse
|
84
|
Baecklund E, Backlin C, Rönnelid J, Toes R, Huizinga T, Åhlin E, Askling J, Hochberg FH, Klareskog L, Kay J, Smedby KE. Anti-cyclic citrullinated peptide antibodies, other common autoantibodies, and smoking as risk factors for lymphoma in patients with rheumatoid arthritis. Scand J Rheumatol 2018; 47:270-275. [PMID: 29336646 DOI: 10.1080/03009742.2017.1376108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) are at increased risk of lymphoma. There is no biomarker to indicate future lymphoma risk in RA and it is not known whether factors associated with an increased risk of RA also confer an increased risk of lymphoma. We investigated whether anti-cyclic citrullinated peptide (CCP) antibodies, other autoantibodies, and smoking, are associated with lymphoma development in RA. METHOD From two population-based case-control studies, the Scandinavian Lymphoma Etiology (SCALE) study and the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) I study, we identified lymphoma cases with a validated RA diagnosis (n = 50), to whom we matched study participants with RA but no lymphoma (n = 261), lymphoma but no RA (n = 257), and neither RA nor lymphoma (n = 233). Lymphomas were classified according to the WHO classification. Blood samples were analysed for immunoglobulin G (IgG), IgM, and IgA isotypes and IgG1-4 subclasses of anti-CCP antibodies and for 15 antinuclear antibody (ANA)-associated specific autoantibodies. Relative risks were estimated as crude and adjusted odds ratios (adjOR) with 95% confidence intervals (CIs) using logistic regression. RESULTS We found no association between anti-CCP IgG ≥ 25 units/mL (adjOR 1.4, 95% CI 0.7-2.7), anti-CCP IgG ≥ 500 units/mL (adjOR 1.4, 95% CI 0.7-3.0), anti-CCP Ig of other isotypes, other autoantibodies (adjOR any vs none 0.6, 95% CI 0.3-1.2), or cigarette smoking (adjOR ever vs never 1.1, 95% CI 0.5-2.2) and lymphoma risk among patients with RA. CONCLUSION In this study, neither anti-CCP antibodies (IgG, IgG1-4, IgM, or IgA), nor other common autoantibodies, nor smoking predicted lymphoma risk in RA.
Collapse
Affiliation(s)
- E Baecklund
- a Department of Medical Sciences, Unit of Rheumatology , Uppsala University , Uppsala , Sweden
| | - C Backlin
- a Department of Medical Sciences, Unit of Rheumatology , Uppsala University , Uppsala , Sweden
| | - J Rönnelid
- b Department of Immunology, Genetics and Pathology , Uppsala University , Uppsala , Sweden
| | - R Toes
- c Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Twj Huizinga
- c Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - E Åhlin
- b Department of Immunology, Genetics and Pathology , Uppsala University , Uppsala , Sweden
| | - J Askling
- d Department of Medicine, Unit of Clinical Epidemiology , Karolinska Institutet , Stockholm , Sweden.,e Center of Hematology , Karolinska University Hospital , Stockholm , Sweden
| | - F H Hochberg
- f Division of Rheumatology, Department of Medicine , University of Massachusetts Medical School , Worcester , MA , USA
| | - L Klareskog
- g Rheumatology Unit, Department of Medicine, Karolinska Institutet , Karolinska University Hospital , Stockholm , Sweden
| | - J Kay
- f Division of Rheumatology, Department of Medicine , University of Massachusetts Medical School , Worcester , MA , USA
| | - K E Smedby
- d Department of Medicine, Unit of Clinical Epidemiology , Karolinska Institutet , Stockholm , Sweden.,e Center of Hematology , Karolinska University Hospital , Stockholm , Sweden
| |
Collapse
|
85
|
Kleinert S, La Rosée P, Krüger K. [Rheumatoid symptoms in patients with hematologic neoplasms]. Z Rheumatol 2018; 76:38-45. [PMID: 29330756 DOI: 10.1007/s00393-017-0338-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Paraneoplastic syndromes in lymphatic or myeloid neoplasms can present with musculoskeletal symptoms, vasculitis-like or febrile symptoms. Hematologic diseases are also associated with rheumatic diseases whereas inflammatory rheumatic diseases are often associated with an increased risk for lymphoproliferative disease. Atypical disease characteristics, lack of disease-specific antibodies or therapeutic response are red flags for diagnosing paraneoplastic or coexistent malignant diseases. New onset of systemic symptoms, worsening of general condition, night sweats or weight loss need to be considered during follow-up and differential diagnostics. This article focuses on musculoskeletal, vasculitis-like and systemic signs of lymphatic or myeloid neoplasms either because of coexistency, tumor association or paraneoplastic disease.
Collapse
Affiliation(s)
- S Kleinert
- Rheumatologische Schwerpunktpraxis, Praxisgemeinschaft Rheumatologie - Nephrologie, Möhrendorfer Str. 1c, 91056, Erlangen, Deutschland.
| | - P La Rosée
- Klinik für Innere Medizin II, Onkologie, Hämatologie, Immunologie, Infektiologie und Palliativmedizin, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Deutschland
| | - K Krüger
- Praxiszentrum St Bonifatius, München, Deutschland
| |
Collapse
|
86
|
EBV-induced lymphoproliferative disorders in rheumatic patients: A systematic review of the literature. Joint Bone Spine 2018; 85:35-40. [DOI: 10.1016/j.jbspin.2017.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/02/2017] [Indexed: 11/22/2022]
|
87
|
Cancer risk in Korean patients with Behçet's disease: A nationwide population-based study. PLoS One 2017; 12:e0190182. [PMID: 29287101 PMCID: PMC5747440 DOI: 10.1371/journal.pone.0190182] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/08/2017] [Indexed: 11/19/2022] Open
Abstract
Background Various immune-mediated diseases are associated with increased malignancy risks. However, the relationship between Behçet’s disease (BD) and cancer remains unclear. We conducted a nationwide, population-based study to determine the risk of cancer in patients with BD. Methods Using National Health Insurance claims records, we collected data from 2402 patients diagnosed with BD between 2013 and 2014. Standardized incidence ratios (SIRs) of overall and site-specific cancers in patients with BD in comparison with the general population were calculated. Results The risks of overall cancer (SIR, 3.54; 95% confidence interval, 2.35–5.11 in men and 2.17; 1.58–2.92 in women) and solid cancer (3.10; 1.94–4.69 in men and 2.13; 1.52–2.90 in women) were greater in patients with BD than in the general population. There were significantly increased risks for these solid cancers: colorectal (4.26; 1.38–9.94), liver (4.00; 1.09–10.25), bone/articular cartilage (55.66; 1.41–310.14), prostate (7.05; 1.45–20.60), and brain/central nervous system (28.32; 3.43–102.31) in men; and the lips/oral cavity/pharynx (13.97, 1.69–50.47), liver (12.78; 5.14–26.33), lungs (4.35; 1.18–11.13), other female genital organs (53.57; 1.36–298.49), and eyes (128.26; 3.24–714.59) in women. Patients with BD had a greater risk of myelodysplastic syndrome (MDS) than the general population did (65.72; 7.96–237.41 in men and 53.86; 11.11–157.40 in women), but not of hematological cancer. Conclusions Compared to the general population, Korean patients with BD had greater risks of overall cancer, some solid cancers, and MDS, but not of hematological cancer.
Collapse
|
88
|
Shih YH, Yang Y, Chang KH, Chen YH, Teng CLJ. Clinical features and outcome of lymphoma patients with pre-existing autoimmune diseases. Int J Rheum Dis 2017; 21:93-101. [DOI: 10.1111/1756-185x.13231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Yu-Hsuan Shih
- Division of Hematology/Medical Oncology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
| | - Youngsen Yang
- Division of Hematology/Medical Oncology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
- Internal Medicine; China Medical University; Taichung Taiwan
| | - Kuang-Hsi Chang
- Graduate Institute of Biomedical Sciences; China Medical University; Taichung Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
- Department of Life Science; Tunghai University; Taichung Taiwan
- Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Chieh-Lin Jerry Teng
- Division of Hematology/Medical Oncology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
- Department of Life Science; Tunghai University; Taichung Taiwan
- Faculty of Medicine; Chung Shan Medical University; Taichung Taiwan
| |
Collapse
|
89
|
Smedby KE, Ponzoni M. The aetiology of B-cell lymphoid malignancies with a focus on chronic inflammation and infections. J Intern Med 2017; 282:360-370. [PMID: 28875507 DOI: 10.1111/joim.12684] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
B-cell malignancies are a heterogeneous group of lymphoproliferative disorders with different molecular characteristics and clinical course. It is increasingly recognized that the group displays considerable heterogeneity also regarding aetiologic factors. Here, we summarize the latest developments in the aetiology of B-cell lymphoid malignancy subtypes focusing on immune perturbation. Severe immune suppression constitutes a strong and well-established risk factor for aggressive subtypes (e.g. diffuse large B-cell and Burkitt lymphoma), but appears unrelated to risk of common low-grade subtypes (e.g. follicular and mantle cell lymphoma). Inflammation and infections are known co-factors amongst the immunosuppressed; however, immune stimulation is now recognized as a crucial determinant of lymphomagenesis also amongst immunocompetent individuals. This is best exemplified in marginal zone lymphomas where local chronic inflammation and infection in the stomach, ocular adnexa and salivary glands have been directly linked with the development of oligoclonal and monoclonal malignant B-cell populations. Aggressive subtypes (e.g. diffuse large B-cell lymphoma) are increasingly linked with features of systemic immune stimulation including autoimmune/inflammatory disease and subclinical cytokine elevations. Lifestyle factors (e.g. high body mass index, cigarette smoking) are associated with risk of diffuse large B-cell and follicular lymphoma, respectively, possibly mediated through inflammation. Recent genome-wide association studies further underline the importance of immune function by linking several subtypes to variations in the human leucocyte antigen (HLA) class genes. In the future, improved knowledge of mechanistic pathways of inflammation/infections in lymphoma development may translate to active measures of prevention or treatment, as is already the case for some low-grade lymphoma subtypes.
Collapse
Affiliation(s)
- K E Smedby
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - M Ponzoni
- Ateneo Vita-Salute, Pathology and Lymphoid Malignancies Unit, San Raffaele H. Scientific Institute, Milan, Italy
| |
Collapse
|
90
|
Jachiet V, Mekinian A, Carrat F, Grignano E, Retbi A, Boffa JJ, Ronco P, Rondeau E, Sellam J, Berenbaum F, Chazouillères O, Capron J, Alamowitch S, Chasset F, Frances C, Coppo P, Fain O. Autoimmune manifestations associated with lymphoma: characteristics and outcome in a multicenter retrospective cohort study. Leuk Lymphoma 2017; 59:1399-1405. [DOI: 10.1080/10428194.2017.1379075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Vincent Jachiet
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
| | - Arsène Mekinian
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
| | - Fabrice Carrat
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Unité de Santé Publique, Paris, France
| | - Eric Grignano
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
| | - Aurelia Retbi
- Département d’Information médicale, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Jean-Jacques Boffa
- Service de Néphrologie et Dialyses, Hôpital Tenon, APHP, Université Paris 06, Paris France
| | - Pierre Ronco
- Service de Néphrologie et Dialyses, Hôpital Tenon, APHP, Université Paris 06, Paris France
| | - Eric Rondeau
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Université Paris 06, Paris, France
| | - Jérémie Sellam
- Service de Rhumatologie-(DHU i2B), Hôpital Saint Antoine, APHP, Université Paris 06, Inserm UMRS_938, Paris, France
| | - Francis Berenbaum
- Service de Rhumatologie-(DHU i2B), Hôpital Saint Antoine, APHP, Université Paris 06, Inserm UMRS_938, Paris, France
| | - Olivier Chazouillères
- Service d’Hépatologie, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Jean Capron
- Service de Neurologie, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Sonia Alamowitch
- Service de Neurologie, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Francois Chasset
- Service de Dermatologie, Hôpital Tenon, APHP, Université Paris 06, Paris, France
| | - Camille Frances
- Service de Dermatologie, Hôpital Tenon, APHP, Université Paris 06, Paris, France
| | - Paul Coppo
- Service d'Hématologie, Centre de référence des Microangiopathies Thrombotiques, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Olivier Fain
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
| | | |
Collapse
|
91
|
Jung YS, Han M, Park S, Kim WH, Cheon JH. Cancer Risk in the Early Stages of Inflammatory Bowel Disease in Korean Patients: A Nationwide Population-based Study. J Crohns Colitis 2017; 11:954-962. [PMID: 28333358 DOI: 10.1093/ecco-jcc/jjx040] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/15/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The association between inflammatory bowel disease [IBD] and cancer remains poorly defined in Asian populations. Therefore, we conducted a nationwide population-based study to determine the cancer risk in Korean patients with IBD. METHODS Using the National Health Insurance claims data, we collected data on patients diagnosed with IBD (5595 Crohn's disease [CD] and 10 049 ulcerative colitis [UC]) from 2011 to 2014. Standardized incidence ratios [SIRs] of overall and site-specific cancers in IBD patients in comparison with the general population were calculated. RESULTS The overall cancer risk was higher in CD patients [SIR, 2.2; 95% confidence interval, 1.5-3.0 in men and 3.3; 2.4-4.5 in women] and UC patients [1.9; 1.6-2.3 in men and 1.9; 1.5-2.4 in women]. There were significantly increased risks for the following cancers: small bowel cancer [31.2; 3.8-112.8], colorectal cancer [CRC] [3.7; 1.6-7.2] and haematological cancer [4.0; 1.1-10.3] in men with CD; small bowel cancer [61.1; 7.4-220.6], CRC [4.7; 1.5-10.9], liver cancer [15.3; 5.6-33.2], pancreatic cancer [8.6; 1.0-31.0] and haematological cancer [11.0; 3.6-25.7] in women with CD; CRC [2.1; 1.3-3.3] and cancer of the prostate [3.5; 2.1-5.5], brain/central nervous system [6.1; 1.3-17.9] and thyroid [2.2; 1.1-3.9] in men with UC; and CRC [3.0; 1.5-5.3], cancer of the liver [4.4; 1.6-9.7] and cervix uteri [5.7; 2.4-11.1], and haematological cancer [3.5; 1.1-8.1] in women with UC. Women with CD had an increased risk of non-Hodgkin lymphoma [NHL] and leukaemia. Women with UC had an increased risk of NHL. CONCLUSIONS Korean patients with IBD are at increased risk for overall, intestinal and haematological cancer.
Collapse
Affiliation(s)
- Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minkyung Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Sohee Park
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Won Ho Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
92
|
Adult T-type lymphoblastic lymphoma: Treatment advances and prognostic indicators. Exp Hematol 2017; 51:7-16. [DOI: 10.1016/j.exphem.2017.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 12/19/2022]
|
93
|
Malignancy Incidence, Management, and Prevention in Patients with Rheumatoid Arthritis. Rheumatol Ther 2017; 4:333-347. [PMID: 28508282 PMCID: PMC5696277 DOI: 10.1007/s40744-017-0064-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Indexed: 12/17/2022] Open
Abstract
Traditional and biologic disease-modifying antirheumatic drugs (DMARDs) are effective medications for the management of rheumatoid arthritis (RA). However, the effects of these medications on immune function raises concern that they may increase long-term cancer risk. The baseline risk for some cancers appears to differ in patients with RA compared to the general population, with the former having an increased risk of lymphoma, lung cancer and renal cancer, but a decreased risk of colorectal and breast cancer. Some DMARDs appear to increase the rate of specific cancer types (such as bladder cancer with cyclophosphamide), but few appear to increase the overall cancer risk. Studying the link between lymphoma and disease severity in RA is complicated because patients with persistently active disease are at increased risk for lymphoma, and disease severity correlates with more intense use of immunosuppressive medications. Overall, cancer risk in patients with RA is slightly above that of the general population, with the increased risk likely secondary to an increased risk of lymphomas in those with high disease activity. Risk mitigation includes management of RA disease activity as well as age- and sex-appropriate cancer screening.
Collapse
|
94
|
Balandraud N, Roudier J. Epstein-Barr virus and rheumatoid arthritis. Joint Bone Spine 2017; 85:165-170. [PMID: 28499895 DOI: 10.1016/j.jbspin.2017.04.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/20/2017] [Indexed: 12/12/2022]
Abstract
Rheumatoid arthritis (RA) is one of the most common autoimmune diseases, with a 0.5% worldwide prevalence. The cause of RA remains unknown, however both genetic and environmental factors may contribute to its development. Among these is the Epstein-Barr virus (EBV). Here, we discuss several aspects of the close relationship between EBV and RA. Patients with RA have impaired control of EBV infection. Indeed, they have high titres of antibodies against EBV antigens. Their peripheral blood T lymphocytes are less efficient at controlling the outgrowth of EBV-infected B cells. RA patients have more EBV-infected B cells than normal controls, leading to a 10-fold systemic EBV overload. Post-transplant lymphoproliferative disorder (PTLPD) is a polyclonal EBV-positive B lymphocyte proliferation, which can evolve into an EBV-positive B cell lymphoma. RA patients also have an increased risk of developing EBV-associated lymphoproliferative disorder (LPD). Hence the need to monitor EBV load when treating RA patients with immunosuppressors. EBV, a widespread virus, highly recognized by antibodies but never eliminated, is an ideal candidate to trigger chronic immune complex disease. Anti-EBV antibody responses should be considered as one of the chronic autoantibody responses linked to the development of RA, in the same way as anti-citrullinated protein antibodies.
Collapse
Affiliation(s)
- Nathalie Balandraud
- Rheumatology 1, IML, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; Inserm UMRs 1097, Aix-Marseille University, 163, avenue de Luminy, 13288 Marseille, France.
| | - Jean Roudier
- Rheumatology 1, IML, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; Inserm UMRs 1097, Aix-Marseille University, 163, avenue de Luminy, 13288 Marseille, France
| |
Collapse
|
95
|
Enblad G, Martinsson G, Baecklund E, Hesselager G, Sundström C, Amini RM, Hagberg H. Population-based experience on primary central nervous system lymphoma 2000-2012: the incidence is increasing. Acta Oncol 2017; 56:599-607. [PMID: 28084866 DOI: 10.1080/0284186x.2016.1270465] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Primary central nervous system lymphomas (PCNSL) are rare lymphomas with a poor prognosis. Recently, an increased incidence has been reported. The present study is a population-based study of all patients with PCNSL in the Uppsala/Örebro region of middle Sweden. PATIENTS AND METHODS All patients diagnosed with a PCNSL at Uppsala University Hospital 2000-2012 were identified. Altogether, 96 patients (50 women and 46 men) were included. The median age at diagnosis was 66 years (17-95). RESULTS There was a statistically significant increase in age-standardized incidence during the study period, 30 patients were diagnosed in the first half and 66 in the second half of the period. No patient had an HIV-infection. Two patients had undergone kidney transplantation and were treated with immunosuppressive drugs. A high proportion of the patients, 29%, had a history of an autoimmune or inflammatory disease. The prognosis was poor with a median survival of only four months. In the 70 (73%) patients treated with curative intention the median survival was 12 months. Patients treated with high-dose methotrexate, radiotherapy and/or temozolomide appeared to have a better survival. There was no improvement in survival during the study period or after the introduction of rituximab. There also was no difference in any of the analyzed variables that could explain the increased incidence. CONCLUSION In this population-based study we could confirm the previously described increased incidence of PCNSL. The prognosis remains poor despite the inclusion of treatment with rituximab during the study period. A high proportion of the patients had a history of an autoimmune or inflammatory disease not previously described but there was no increase during the study period.
Collapse
Affiliation(s)
- Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Sweden
| | - Gustaf Martinsson
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Sweden
| | - Eva Baecklund
- Department of Medical Sciences, Uppsala University, Sweden
| | | | - Christer Sundström
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Rosie-Marie Amini
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Hans Hagberg
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Sweden
| |
Collapse
|
96
|
Hellgren K, Baecklund E, Backlin C, Sundstrom C, Smedby KE, Askling J. Rheumatoid Arthritis and Risk of Malignant Lymphoma: Is the Risk Still Increased? Arthritis Rheumatol 2017; 69:700-708. [DOI: 10.1002/art.40017] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 12/06/2016] [Indexed: 12/19/2022]
Affiliation(s)
- K. Hellgren
- Karolinska Institutet at Karolinska University HospitalStockholm Sweden
| | | | | | | | - K. E. Smedby
- Karolinska Institutet at Karolinska University HospitalStockholm Sweden
| | - J. Askling
- Karolinska Institutet at Karolinska University HospitalStockholm Sweden
| |
Collapse
|
97
|
Stübgen JP. Juvenile dermatomyositis/polymyositis and lymphoma. J Neurol Sci 2017; 377:19-24. [PMID: 28477693 DOI: 10.1016/j.jns.2017.03.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/18/2017] [Accepted: 03/21/2017] [Indexed: 12/12/2022]
Abstract
In patients with juvenile dermatomyositis/polymyositis (JDM/PM), malignancy is a rare phenomenon. An extensive workup for neoplastic disease is not routinely indicated, but should be considered if unusual physical findings are noted at JDM/PM diagnosis or during follow-up period. The objective of this literature review was to assess for any association between, and disease profile of, JDM/PM and lymphoma in childhood. Risk determinants of the possible development of lymphoma in the pediatric population with JDM/PM appear to be the degree and duration of inflammatory activity with chronic B-cell activation and/or antigen stimulation; a paraneoplastic relationship is unlikely.
Collapse
Affiliation(s)
- Joerg-Patrick Stübgen
- Department of Neurology, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065-4885, USA.
| |
Collapse
|
98
|
Marginal zone lymphoma: Associated autoimmunity and auto-immune disorders. Best Pract Res Clin Haematol 2017; 30:65-76. [DOI: 10.1016/j.beha.2016.07.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 07/09/2016] [Indexed: 12/20/2022]
|
99
|
Nocturne G, Boudaoud S, Ly B, Pascaud J, Paoletti A, Mariette X. Impact of anti-TNF therapy on NK cells function and on immunosurveillance against B-cell lymphomas. J Autoimmun 2017; 80:56-64. [PMID: 28214146 DOI: 10.1016/j.jaut.2017.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/03/2017] [Accepted: 02/07/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is associated with an increased risk of lymphoma linked to activity of the disease. Immunosuppressive drugs have been suspected to induce an additional risk. Since, NK cells have been recently shown to participate to anti-lymphoma immunosurveillance, we aimed to assess if anti-TNF might impact their anti-lymphoma activity. METHODS NK cells have been assessed ex vivo in patients with RA treated with methotrexate (MTX) with or without anti-TNF. Phenotype has been studied by flow cytometry and function has been assessed after NKp30-cross linking. NK have been cultured 6 days in presence of anti-TNF, TNF-R inhibitors or controls and phenotype has been studied. Then cytotoxicity against 2 B non-Hodgkin lymphoma cell lines [Farage (EBV+) and SU-DHL4 (EBV-)] was assessed. RESULTS Exposure to anti-TNF was associated with a decreased activation of NK cells. NK cells exhibited an impaired function in patients treated with anti-TNF compared to patients treated with MTX alone as assessed by the percentage of degranulation (20.9% [18.5-32.9] vs 31.3% [21.5-49.1], p = 0.04) and a decreased IFN-γ secretion ((17.4% [8.9-25.9] vs to 29.7% [22.5-43.1], p = 0.007). In vitro, exposure to anti-TNF impaired NK cells function and impacted negatively anti-lymphoma activity. These effects may be the consequence of inhibition of TNFR1 signaling. CONCLUSIONS Thus, even if meta-analysis of randomized controlled trials and of registries have not demonstrated to date an increased risk of lymphoma with anti-TNF, cautious must be pursued concerning this possible side effect in patients with long-term anti-TNF exposure.
Collapse
Affiliation(s)
- Gaetane Nocturne
- INSERM U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud, Le Kremlin-Bicêtre, France; Department of Rheumatology, AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France.
| | - Saida Boudaoud
- INSERM U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Bineta Ly
- INSERM U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Juliette Pascaud
- INSERM U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Audrey Paoletti
- INSERM U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Xavier Mariette
- INSERM U1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud, Le Kremlin-Bicêtre, France; Department of Rheumatology, AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| |
Collapse
|
100
|
Lan JL, Tseng CH, Chen JH, Cheng CF, Liang WM, Tsay GJ. Reduced risk of all-cancer and solid cancer in Taiwanese patients with rheumatoid arthritis treated with etanercept, a TNF-α inhibitor. Medicine (Baltimore) 2017; 96:e6055. [PMID: 28207513 PMCID: PMC5319502 DOI: 10.1097/md.0000000000006055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Biologics has been widely used in the treatment of rheumatoid arthritis. We aimed to determine whether etanercept, a TNF-α inhibitor (TNFi) that is used to treat patients with rheumatoid arthritis (RA), affects cancer risk.This retrospective matched cohort study used data in the Registry of Catastrophic Illness Database in Taiwan from January 1, 1996 to December 31, 2010. RA, all-cancer, and solid cancer were defined using International Classification of Disease codes (ICD-9-CM 714.X, 140-208, and 140-199, respectively). Cox proportional hazard modeling was used to estimate the hazard ratio (HR) of cancer in all TNFi-treated RA patients, with a focus on the risk in the etanercept-treated patients, after adjusting for comorbidities and concomitant medication.In this Taiwanese dataset, there were 1111 TNFi-treated RA patients and 16,812 RA patients who were naive to all biologics identified. Among the 1002 pairs of etanercept-treated and biologic-naive patients who were matched 1-to-1 for age, gender, RA duration, methotrexate-use, and index date of TNFi prescription, the mean age was 48.9 ± 15.0 years. The highest proportion of patients was in the age subgroup of 30 to 60 years (63.8%). Most patients (77.2%) were women. The mean RA duration before etanercept treatment was 2.0 ± 1.5 years. During a mean 2.1 years of observation, etanercept was associated with significant risk reduction for all-cancer (HR 0.59, 0.36-0.98) and solid cancer (HR 0.46, 0.27-0.79) relative to the matched biologic-naive patients.The current study explored the safety profile of TNFi and identified a potential benefit of etanercept on the incidence of all-cancer and solid cancer in RA patients.
Collapse
Affiliation(s)
- Joung-Liang Lan
- School of Medicine, China Medical University
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital
- Rheumatology Research Laboratory, China Medical University
| | - Chun-Hung Tseng
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital
- Department of Neurology, China Medical University Hospital
| | - Jiunn-Horng Chen
- School of Medicine, China Medical University
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital
- Rheumatology Research Laboratory, China Medical University
| | - Chi-Fung Cheng
- Graduate Institute of Biostatistics, Biostatistics Center
| | - Wen-Miin Liang
- Graduate Institute of Biostatistics, Biostatistics Center
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Gregory J. Tsay
- School of Medicine, China Medical University
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital
- Rheumatology Research Laboratory, China Medical University
| |
Collapse
|