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Späth F, Wibom C, Krop EJM, Johansson AS, Bergdahl IA, Vermeulen R, Melin B. Biomarker Dynamics in B-cell Lymphoma: A Longitudinal Prospective Study of Plasma Samples Up to 25 Years before Diagnosis. Cancer Res 2017; 77:1408-1415. [PMID: 28108506 DOI: 10.1158/0008-5472.can-16-2345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/16/2016] [Accepted: 12/05/2016] [Indexed: 11/16/2022]
Abstract
The B-cell activation markers CXCL13, sCD23, sCD27, and sCD30 are associated with future lymphoma risk. However, a lack of information about the individual dynamics of marker-disease association hampers interpretation. In this study, we identified 170 individuals who had donated two prediagnostic blood samples before B-cell lymphoma diagnosis, along with 170 matched cancer-free controls from the Northern Sweden Health and Disease Study. Lymphoma risk associations were investigated by subtype and marker levels measured at baseline, at the time of the repeated sample, and with the rate of change in the marker level. Notably, we observed strong associations between CXCL13, sCD23, sCD27, and sCD30 and lymphoma risk in blood samples collected 15 to 25 years before diagnosis. B-cell activation marker levels increased among future lymphoma cases over time, while remaining stable among controls. Associations between slope and risk were strongest for indolent lymphoma subtypes. We noted a marked association of sCD23 with chronic lymphocytic leukemia (ORSlope = 28, Ptrend = 7.279 × 10-10). Among aggressive lymphomas, the association between diffuse large B-cell lymphoma risk and slope was restricted to CXCL13. B-cell activation seemed to play a role in B-cell lymphoma development at early stages across different subtypes. Furthermore, B-cell activation presented differential trajectories in future lymphoma patients, mainly driven by indolent subtypes. Our results suggest a utility of these markers in predicting the presence of early occult disease and/or the screening and monitoring of indolent lymphoma in individual patients. Cancer Res; 77(6); 1408-15. ©2017 AACR.
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Affiliation(s)
- Florentin Späth
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
| | - Carl Wibom
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Esmeralda J M Krop
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | | | | | - Roel Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
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102
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Sriskandarajah P, Dearden CE. Epidemiology and environmental aspects of marginal zone lymphomas. Best Pract Res Clin Haematol 2016; 30:84-91. [PMID: 28288721 DOI: 10.1016/j.beha.2016.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 02/09/2023]
Abstract
Marginal zone lymphomas (MZLs) account for between 5% and 17% of all non-Hodgkin's lymphomas. MZLs consist of 3 different subtypes with extranodal being the most commonly reported, representing 50-70% of MZL, followed by splenic (20%) and nodal (10%). Median age at presentation varies between these lymphoma sub-types, ranging between 50 and 69 years, with an overall greater incidence noted in males compared to females. Given the rarity of these lymphomas, epidemiologic data has been sparse, although it has been suggested the aetiology is multi-factorial including ethnicity and geographical factors. Other reported associations include autoimmune disease and infection, with Helicobacter pylori and Campylobacter psittaci, being the most commonly reported pathogens. Larger population studies are required to investigate the role of these environmental factors further as these can direct the future management of these lymphomas, through the use of more effective targeted treatments.
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Affiliation(s)
- Priya Sriskandarajah
- Department of Haemato-Oncology, Royal Marsden Hospital NHS Foundation Trust, Downs Road, Sutton, UK; Division of Molecular Pathology, Institute of Cancer Research, 15 Cotswold Road, Sutton, UK.
| | - Claire E Dearden
- Department of Haemato-Oncology, Royal Marsden Hospital NHS Foundation Trust, Downs Road, Sutton, UK.
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Moling O, Piccin A, Tauber M, Marinello P, Canova M, Casini M, Negri G, Raffeiner B, Binazzi R, Gandini L, Vecchiato C, Rimenti G, Billio A. Intravascular large B-cell lymphoma associated with silicone breast implant, HLA-DRB1*11:01, and HLA-DQB1*03:01 manifesting as macrophage activation syndrome and with severe neurological symptoms: a case report. J Med Case Rep 2016; 10:254. [PMID: 27634631 PMCID: PMC5025582 DOI: 10.1186/s13256-016-0993-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 07/05/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Silicone implants have been successfully used for breast augmentation and reconstruction in millions of women worldwide. The reaction to the silicone implant is highly variable; it can lead to local inflammatory symptoms, and sometimes to systemic symptoms and disease. Over 80 cases of anaplastic lymphoma kinase-negative anaplastic large cell lymphoma have been reported in patients with silicone breast implants and have been accepted as a new clinical entity. To the best of our knowledge, an intravascular large B-cell lymphoma associated with a silicone breast implant has not been reported previously. CASE PRESENTATION A 48-year-old Caucasian woman who presented with high fever was found to have splenomegaly on physical examination. A laboratory diagnosis revealed pancytopenia, hypertriglyceridemia, and hyperferritinemia. She developed signs of altered sensorium, hemiparesis, aphasia, and cauda equina syndrome. On further evaluation, she fulfilled the necessary five out of eight criteria for diagnosis of macrophage activation syndrome/hemophagocytic lymphohistiocytosis. Dexamethasone administration was followed by prompt improvement; however, 3 days later she again manifested high fever, which persisted despite administration of immunoglobulin and cyclosporine A. Her silicone breast implant was considered a possible contributor to her macrophage activation syndrome and was therefore removed. A histological examination of the capsule tissue showed an extensive lymphohistiocytic/giant cell foreign body reaction suggestive of autoimmune/inflammatory syndrome induced by adjuvants. However, the histological examination unexpectedly also revealed an intravascular large B-cell lymphoma. CONCLUSIONS The genetic background of our patient with silicone breast implants might have predisposed her to three rare and difficult to diagnose syndromes/diseases: macrophage activation syndrome/hemophagocytic lymphohistiocytosis, autoimmune/inflammatory syndrome induced by adjuvants, and intravascular large B-cell lymphoma. The simultaneous manifestation of all three syndromes suggests causal interrelationships. Human leukocyte antigen testing in all women who undergo silicon breast implantation could in the future enable us to better evaluate the risk of potential side effects.
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Affiliation(s)
- Oswald Moling
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy.
| | - Andrea Piccin
- Department of Hematology, Ospedale Generale, 39100, Bolzano, Italy
| | - Martina Tauber
- Department of Pathology, Ospedale Generale, 39100, Bolzano, Italy
| | - Peter Marinello
- Department of General Surgery, Ospedale Generale, 39100, Bolzano, Italy
| | - Mariagrazia Canova
- Rheumatology Unit, Department of Medicine, Ospedale Generale, 39100, Bolzano, Italy
| | - Marco Casini
- Department of Hematology, Ospedale Generale, 39100, Bolzano, Italy
| | - Giovanni Negri
- Department of Pathology, Ospedale Generale, 39100, Bolzano, Italy
| | - Bernd Raffeiner
- Rheumatology Unit, Department of Medicine, Ospedale Generale, 39100, Bolzano, Italy
| | - Raffaella Binazzi
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy
| | - Latha Gandini
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy
| | - Cinzia Vecchiato
- Laboratory of Immunogenetics, Transfusion Medicine Service, Ospedale Generale, 39100, Bolzano, Italy
| | - Giovanni Rimenti
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy
| | - Atto Billio
- Department of Hematology, Ospedale Generale, 39100, Bolzano, Italy
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Wang J, Zhou M, Xu JY, Yang YG, Zhang QG, Zhou RF, Chen B, Ouyang J. Prognostic role of pretreatment neutrophil-lymphocyte ratio in patients with diffuse large B-cell lymphoma treated with RCHOP. Medicine (Baltimore) 2016; 95:e4893. [PMID: 27661033 PMCID: PMC5044903 DOI: 10.1097/md.0000000000004893] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study aims to investigate whether neutrophil to lymphocyte ratio (NLR) is an independent predictor in newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients in the rituximab era. Data from newly diagnosed DLBCL patients at Nanjing Drum Tower Hospital from 2006 to 2015 were retrospectively reviewed. We used the receiver operating characteristic (ROC) curve analysis to generate the optimal cutoff value for NLR. Among those 156 patients enrolled, the NLR was < 3.0 in 46.8% (73/156) of the patients, and the remaining 53.2% (83/156) had an NLR ≥ 3.0. Patients with higher pretreatment NLR were found to correlate with poorer OS and PFS than these with lower NLR (hazard ratio [HR] = 2.66, 95% confidence interval [CI] = 1.43-4.97, P = 0.002 and HR = 1.79, 95% CI = 1.05-3.07, P = 0.034, respectively). The multivariate Cox proportional hazard model analysis further showed that high NLR was found independently predictive of poor OS (HR = 0.40; CI = 0.19-0.84, P = 0.015) and PFS (HR = 0.57; CI = 0.33-0.98, P = 0.042). Consequently, pretreatment NLR was an independent prognostic predictor in patients with DLBCL in the rituximab era.
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Affiliation(s)
| | | | | | | | | | | | - Bing Chen
- Department of Hematology, the Affiliated DrumTower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, PR China
- Correspondence: Bing Chen, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, Jiangsu China (e-mail: )
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105
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Higher Risk for Hematological Malignancies in Inflammatory Bowel Disease: A Nationwide Population-based Study in Taiwan. Am J Gastroenterol 2016; 111:1313-9. [PMID: 27296944 DOI: 10.1038/ajg.2016.239] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/15/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The relationship between inflammatory bowel disease (IBD) and cancer remains unclear especially in Asian populations. Therefore, we conducted a nationwide population-based study in Taiwan to reveal the cancer risk in patients with IBD. METHODS Using the national health database of Taiwan, we identified 3,348 IBD patients without previous cancer, including 685 with Crohn's disease (CD) and 2,663 with ulcerative colitis (UC), as a cohort from 1998 to 2012 and followed them up until 2013. Standardized incidence ratios (SIRs) of overall and site-specific cancers in CD and UC patients in comparison with the general population were analyzed. RESULTS Regarding overall cancer risk analysis, both CD (SIR 1.4, 95% confidence interval (CI) 0.9-2.1) and UC (SIR 0.93, 95% CI 0.7-1.1) patients did not have a higher risk. In site-specific cancer risk analysis, CD (SIR 14.08, P<0.01) and UC (SIR 2.51, P=0.02) patients had a higher risk of hematological malignancies. The risk of colorectal cancer (CRC) did not increase significantly in either CD (SIR 0.96, P=0.7) or UC (SIR 1.39, P=0.22) patients. CONCLUSIONS This first nationwide population-based study in Asia reveals a significantly higher risk for hematological malignancies in IBD patients. This finding may highlight the importance of screening for hematological malignancies in patients with IBD in the future.
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106
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Inflammatory myopathies and lymphoma. J Neurol Sci 2016; 369:377-389. [PMID: 27653927 DOI: 10.1016/j.jns.2016.08.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 12/18/2022]
Abstract
The inflammatory myopathies comprise a group of immune-mediated muscle diseases. Lymphoma is a term for a variety of lymphatic system malignancies. Autoimmune diseases and lymphoproliferative malignancies share a complex bidirectional relationship. A causal relationship between inflammatory mypathies and lymphoma has not been established. The diagnosis/treatment of inflammatory myopathy usually precedes the detection/diagnosis of lymphoma. Immune system dysregulation presumably underlies the evolution of lymphoma in patients with inflammatory myopathies. Inflammatory activity with chronic B-cell activation and/or antigen stimulation is deemed the major risk factor for lymphoma in patients with autoimmunity. A "paraneoplastic" phenomenon or the effects of immunosuppressive therapy may be alternative immune-based mechanisms. In chronic lymphocytic leukemia immune system disturbance rarely results in non-hematological autoimmune disease, including inflammatory myopathies.
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107
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Serum BAFF and APRIL Levels, T-Lymphocyte Subsets, and Immunoglobulins after B-Cell Depletion Using the Monoclonal Anti-CD20 Antibody Rituximab in Myalgic Encephalopathy/Chronic Fatigue Syndrome. PLoS One 2016; 11:e0161226. [PMID: 27536947 PMCID: PMC4990178 DOI: 10.1371/journal.pone.0161226] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 05/01/2016] [Indexed: 12/19/2022] Open
Abstract
Myalgic Encephalopathy/Chronic Fatigue Syndrome (ME/CFS) is a disease of unknown etiology. We have previously suggested clinical benefit from B-cell depletion using the monoclonal anti-CD20 antibody rituximab in a randomized and placebo-controlled study. Prolonged responses were then demonstrated in an open-label phase-II study with maintenance rituximab treatment. Using blood samples from patients in the previous two clinical trials, we investigated quantitative changes in T-lymphocyte subsets, in immunoglobulins, and in serum levels of two B-cell regulating cytokines during follow-up. B-lymphocyte activating factor of the tumor necrosis family (BAFF) in baseline serum samples was elevated in 70 ME/CFS patients as compared to 56 healthy controls (p = 0.011). There were no significant differences in baseline serum BAFF levels between patients with mild, moderate, or severe ME/CFS, or between responders and non-responders to rituximab. A proliferation-inducing ligand (APRIL) serum levels were not significantly different in ME/CFS patients compared to healthy controls at baseline, and no changes in serum levels were seen during follow-up. Immunophenotyping of peripheral blood T-lymphocyte subsets and T-cell activation markers at multiple time points during follow-up showed no significant differences over time, between rituximab and placebo groups, or between responders and non-responders to rituximab. Baseline serum IgG levels were significantly lower in patients with subsequent response after rituximab therapy compared to non-responders (p = 0.03). In the maintenance study, slight but significant reductions in mean serum immunoglobulin levels were observed at 24 months compared to baseline; IgG 10.6–9.5 g/L, IgA 1.8–1.5 g/L, and IgM 0.97–0.70 g/L. Although no functional assays were performed, the lack of significant associations of T- and NK-cell subset numbers with B-cell depletion, as well as the lack of associations to clinical responses, suggest that B-cell regulatory effects on T-cell or NK-cell subsets are not the main mechanisms for the observed improvements in ME/CFS symptoms observed in the two previous trials. The modest increase in serum BAFF levels at baseline may indicate an activated B-lymphocyte system in a subgroup of ME/CFS patients.
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108
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Johnsen SJ, Gudlaugsson E, Skaland I, Janssen EAM, Jonsson MV, Helgeland L, Berget E, Jonsson R, Omdal R. Low Protein A20 in Minor Salivary Glands is Associated with Lymphoma in Primary Sjögren's Syndrome. Scand J Immunol 2016; 83:181-7. [PMID: 26679293 DOI: 10.1111/sji.12405] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 12/10/2015] [Indexed: 02/06/2023]
Abstract
Patients with primary Sjögren's syndrome (pSS) have an increased risk of developing lymphomas, particularly the subtype mucosa-associated lymphoid tissue (MALT) lymphoma. Chronic antigen stimulation and increased activation of nuclear factor-κB (NF-κB) are important factors for the pathogenesis of MALT lymphomas. Protein A20 is an inhibitor of NF-κB. A recent study of pSS-associated MALT lymphomas identified potential functional abnormalities in the TNFAIP3 gene, which encodes protein A20. The present study aimed to assess protein A20 by immunohistochemistry (IHC) in minor salivary glands (MSGs) and lymphoma tissue sections of patients with pSS and investigate a potential association with lymphoma development. Protein A20 staining in lymphocytes was scored in four categories (0 = negative, 1 = weak, 2 = moderate and 3 = strong). For statistical purposes, these scores were simplified into negative (scores 0-1) and positive (scores 2-3). We investigated associations between protein A20-staining, focus scores, germinal centre (GC)-like structures and monoclonal B-cell infiltration in MSGs. MSG protein A20 staining was weaker in pSS patients with lymphomas than in those without lymphomas (P = 0.01). Weak protein A20 staining was also highly associated with a lack of GC formation (P < 0.01). Finally, weaker A20 staining was observed in the majority of pSS-associated MALT lymphoma tissues. In conclusion, we found absent or weak protein A20 immunoreactivity in MSGs of patients with pSS with lymphomas. This finding indicates that protein A20 downregulation in lymphocytes might be a mechanism underlying lymphoma genesis in patients with pSS.
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Affiliation(s)
- S J Johnsen
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - E Gudlaugsson
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - I Skaland
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - E A M Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - M V Jonsson
- Section for Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - L Helgeland
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - E Berget
- The Gade Laboratory for Pathology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - R Omdal
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
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109
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Lack of association between cytotoxic T-lymphocyte antigen-4 gene polymorphisms and lymphoid malignancy risk: evidence from a meta-analysis. Ann Hematol 2016; 95:1685-94. [PMID: 27498821 DOI: 10.1007/s00277-016-2753-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/01/2016] [Indexed: 02/02/2023]
Abstract
Cytotoxic T-lymphocyte antigen-4 (CTLA-4) polymorphisms have been associated with susceptibility to lymphoid malignancies. However, results from the published single studies are inconsistent. Therefore, the present meta-analysis was conducted to get a more accurate estimation of the relationship between CTLA-4 gene polymorphisms and the lymphoid malignancy risk. We identified nine independent studies accounting for 3090 subjects up to January 30, 2016. Summary odds ratios (OR) and 95 % confidence intervals (CI) were used to evaluate the risk of lymphoid malignancies. Overall, no significant association was found between +49A/G (rs231775), -318C/T (rs5742909), and +6230A/G (rs3087243) CTLA-4 gene polymorphisms and lymphoid malignancies. Furthermore, ethnicity (Asian and Caucasian) and histopathology subgroup analyses (non-Hodgkin's lymphoma) also failed to detect an association between the studied polymorphisms and lymphoid malignancy risk. Our study shows that common CTLA-4 gene polymorphisms may not contribute to lymphoid malignancy susceptibility based on the current evidence.
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110
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Roriz M, Lopes A, Jarrin I, Lechtman S, Polivka M, Bergmann JF, Sène D, Mouly S. [Central nervous system lymphoma revealed by lymphocytic meningitis in a patient with systemic lupus erythematosus: An unusual association]. Rev Med Interne 2016; 38:269-273. [PMID: 27363932 DOI: 10.1016/j.revmed.2016.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/16/2016] [Accepted: 05/28/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We report an unusual observation of central nervous system (CNS) lymphoma in a 60-year-old woman with systemic lupus erythematosus and fatal outcome. OBSERVATION The patient had systemic erythematosus lupus for 7 years, treated with mycophenolate mofetil and developed lymphocytic meningitis in 2015 associated to the presence of EBV in the cerebrospinal fluid and a necrotic vermis' lesion. Diagnosis of large B-cell lymphoma was histologically confirmed from stereotaxic biopsy, shortly before she died from neurological complications. CONCLUSION Even though the current association is unusual, lymphocytic meningitis with hypoglycorrachia in patients with systemic lupus erythematosus may reveal CNS lymphoma and diagnosis confirmation requires stereotaxic biopsy in order not to delay specific therapeutic management.
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Affiliation(s)
- M Roriz
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France.
| | - A Lopes
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - I Jarrin
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - S Lechtman
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - M Polivka
- Service d'anatomopathologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J-F Bergmann
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - D Sène
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - S Mouly
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
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111
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Khankhanian P, Cozen W, Himmelstein DS, Madireddy L, Din L, van den Berg A, Matsushita T, Glaser SL, Moré JM, Smedby KE, Baranzini SE, Mack TM, Lizée A, de Sanjosé S, Gourraud PA, Nieters A, Hauser SL, Cocco P, Maynadié M, Foretová L, Staines A, Delahaye-Sourdeix M, Li D, Bhatia S, Melbye M, Onel K, Jarrett R, McKay JD, Oksenberg JR, Hjalgrim H. Meta-analysis of genome-wide association studies reveals genetic overlap between Hodgkin lymphoma and multiple sclerosis. Int J Epidemiol 2016; 45:728-40. [PMID: 26971321 PMCID: PMC5005944 DOI: 10.1093/ije/dyv364] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Based on epidemiological commonalities, multiple sclerosis (MS) and Hodgkin lymphoma (HL), two clinically distinct conditions, have long been suspected to be aetiologically related. MS and HL occur in roughly the same age groups, both are associated with Epstein-Barr virus infection and ultraviolet (UV) light exposure, and they cluster mutually in families (though not in individuals). We speculated if in addition to sharing environmental risk factors, MS and HL were also genetically related. Using data from genome-wide association studies (GWAS) of 1816 HL patients, 9772 MS patients and 25 255 controls, we therefore investigated the genetic overlap between the two diseases. METHODS From among a common denominator of 404 K single nucleotide polymorphisms (SNPs) studied, we identified SNPs and human leukocyte antigen (HLA) alleles independently associated with both diseases. Next, we assessed the cumulative genome-wide effect of MS-associated SNPs on HL and of HL-associated SNPs on MS. To provide an interpretational frame of reference, we used data from published GWAS to create a genetic network of diseases within which we analysed proximity of HL and MS to autoimmune diseases and haematological and non-haematological malignancies. RESULTS SNP analyses revealed genome-wide overlap between HL and MS, most prominently in the HLA region. Polygenic HL risk scores explained 4.44% of HL risk (Nagelkerke R(2)), but also 2.36% of MS risk. Conversely, polygenic MS risk scores explained 8.08% of MS risk and 1.94% of HL risk. In the genetic disease network, HL was closer to autoimmune diseases than to solid cancers. CONCLUSIONS HL displays considerable genetic overlap with MS and other autoimmune diseases.
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Affiliation(s)
- Pouya Khankhanian
- Center for Neuroengineering and Thereapeutics at the University of Pennsylvania, Philadelphia, PA, USA University of California, San Francisco, CA, USA
| | - Wendy Cozen
- University of Southern California, Los Angeles, CA, USA
| | | | | | - Lennox Din
- University of California, San Francisco, CA, USA
| | | | | | - Sally L Glaser
- Cancer Prevention Institute of California, Fremont, CA, USA
| | | | | | | | - Thomas M Mack
- University of Southern California, Los Angeles, CA, USA
| | | | - Silvia de Sanjosé
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Catalonia, Spain
| | | | | | | | | | - Marc Maynadié
- Centre Hospitalier Universitaire de Dijon, Dijon, France
| | | | | | | | - Dalin Li
- University of Southern California, Los Angeles, CA, USA
| | - Smita Bhatia
- City of Hope National Medical Center, Duarte, CA, USA
| | - Mads Melbye
- Statens Serum Institut, Copenhagen S, Denmark
| | | | - Ruth Jarrett
- MRC, University of Glasgow Centre for Virus Research, Glasgow, UK
| | - James D McKay
- International Agency for Research on Cancer, Lyon, France
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112
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Gunnarsson N, Höglund M, Stenke L, Wållberg-Jonsson S, Sandin F, Björkholm M, Dreimane A, Lambe M, Markevärn B, Olsson-Strömberg U, Wadenvik H, Richter J, Själander A. Increased prevalence of prior malignancies and autoimmune diseases in patients diagnosed with chronic myeloid leukemia. Leukemia 2016; 30:1562-7. [PMID: 27080811 DOI: 10.1038/leu.2016.59] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/11/2016] [Accepted: 02/19/2016] [Indexed: 02/03/2023]
Abstract
We recently reported an increased incidence of second malignancies in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKI). To elucidate whether this increase may be linked, not to TKI but rather to a hereditary or acquired susceptibility to develop cancer, we estimated the prevalence of malignancies, autoimmune disease (AD) and chronic inflammatory disease (CID) in CML patients prior to their CML diagnosis. Nationwide population-based registers were used to identify patients diagnosed with CML in Sweden 2002-2012 and to estimate the prevalence of other malignancies, AD and CID prior to their CML diagnosis. For each patient with CML, five matched controls were selected from the general population. Conditional logistic regression was used to calculate odds ratios (OR). Nine hundred and eighty-four CML patients were assessed, representing more than 45 000 person-years of follow-up. Compared with matched controls, the prevalence of prior malignancies and AD was elevated in CML patients: OR 1.47 (95% confidence interval (CI) 1.20-1.82) and 1.55 (95% CI 1.21-1.98), respectively. No associations were detected between CML and previous CID. An increased prevalence of other malignancies and AD prior to the diagnosis of CML suggest that a hereditary or acquired predisposition to cancer and/or autoimmunity is involved in the pathogenesis of CML.
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Affiliation(s)
- N Gunnarsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - M Höglund
- Department of Medical Science and Division of Hematology, University Hospital, Uppsala, Sweden
| | - L Stenke
- Department of Hematology, Karolinska University Hospital and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - S Wållberg-Jonsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - F Sandin
- Regional Cancer Centre, Uppsala-Örebro, Sweden
| | - M Björkholm
- Department of Hematology, Karolinska University Hospital and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Dreimane
- Department of Hematology, University Hospital, Linköping, Sweden
| | - M Lambe
- Regional Cancer Centre, Uppsala-Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - B Markevärn
- Department of Hematology, University Hospital, Umeå, Sweden
| | - U Olsson-Strömberg
- Department of Medical Science and Division of Hematology, University Hospital, Uppsala, Sweden
| | - H Wadenvik
- Department of Hematology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - J Richter
- Department of Hematology and Vascular Disorders, Skåne University Hospital, Lund, Sweden
| | - A Själander
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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113
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Cordtz R, Mellemkjær L, Glintborg B, Hetland ML, Madsen OR, Jensen Hansen IM, Dreyer L. Risk of virus-associated cancer in female arthritis patients treated with biological DMARDs—a cohort study. Rheumatology (Oxford) 2016; 55:1017-22. [DOI: 10.1093/rheumatology/kew012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Indexed: 11/13/2022] Open
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114
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Atzeni F, Gianturco L, Talotta R, Varisco V, Ditto MC, Turiel M, Sarzi-Puttini P. Investigating the potential side effects of anti-TNF therapy for rheumatoid arthritis: cause for concern? Immunotherapy 2016; 7:353-61. [PMID: 25917627 DOI: 10.2217/imt.15.4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
There are now five anti-TNF drugs available for clinical use, and it will not be long before they are joined by biosimilar drugs. Some patients treated with selective TNF drugs may develop adverse events such as infections, malignancies, acute infusion and injection reactions, autoimmunity and cardiovascular effects. Registry data consistently show that, particularly during the first 6 months, anti-TNF drugs slightly increase the risk of serious infections of the skin, soft tissues and joints, but it does not seem to increase the risk of cancer other than nonmelanoma skin cancers. A number of studies have shown that the administration of biological agents can lead to the formation of neutralizing and nonneutralizing antibodies. Lipid levels increase, but the atherogenic index remains stable and qualitative changes to lipid particles may reduce the risk of cardiovascular diseases. Patients treated with anti-TNF drugs therefore need to be monitored regularly.
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115
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Imgenberg-Kreuz J, Sandling JK, Almlöf JC, Nordlund J, Signér L, Norheim KB, Omdal R, Rönnblom L, Eloranta ML, Syvänen AC, Nordmark G. Genome-wide DNA methylation analysis in multiple tissues in primary Sjögren's syndrome reveals regulatory effects at interferon-induced genes. Ann Rheum Dis 2016; 75:2029-2036. [PMID: 26857698 PMCID: PMC5099203 DOI: 10.1136/annrheumdis-2015-208659] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/16/2016] [Indexed: 01/08/2023]
Abstract
Objectives Increasing evidence suggests an epigenetic contribution to the pathogenesis of autoimmune diseases, including primary Sjögren's Syndrome (pSS). The aim of this study was to investigate the role of DNA methylation in pSS by analysing multiple tissues from patients and controls. Methods Genome-wide DNA methylation profiles were generated using HumanMethylation450K BeadChips for whole blood, CD19+ B cells and minor salivary gland biopsies. Gene expression was analysed in CD19+ B cells by RNA-sequencing. Analysis of genetic regulatory effects on DNA methylation at known pSS risk loci was performed. Results We identified prominent hypomethylation of interferon (IFN)-regulated genes in whole blood and CD19+ B cells, including at the genes MX1, IFI44L and PARP9, replicating previous reports in pSS, as well as identifying a large number of novel associations. Enrichment for genomic overlap with histone marks for enhancer and promoter regions was observed. We showed for the first time that hypomethylation of IFN-regulated genes in pSS B cells was associated with their increased expression. In minor salivary gland biopsies we observed hypomethylation of the IFN-induced gene OAS2. Pathway and disease analysis resulted in enrichment of antigen presentation, IFN signalling and lymphoproliferative disorders. Evidence for genetic control of methylation levels at known pSS risk loci was observed. Conclusions Our study highlights the role of epigenetic regulation of IFN-induced genes in pSS where replication is needed for novel findings. The association with altered gene expression suggests a functional mechanism for differentially methylated CpG sites in pSS aetiology.
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Affiliation(s)
- Juliana Imgenberg-Kreuz
- Molecular Medicine and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johanna K Sandling
- Molecular Medicine and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden Rheumatology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Carlsson Almlöf
- Molecular Medicine and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jessica Nordlund
- Molecular Medicine and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Linnea Signér
- Rheumatology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Katrine Braekke Norheim
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Roald Omdal
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Lars Rönnblom
- Rheumatology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Maija-Leena Eloranta
- Rheumatology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ann-Christine Syvänen
- Molecular Medicine and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnel Nordmark
- Rheumatology and Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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116
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Waldner MJ, Strangfeld A, Aringer M. [Influence of therapy on risk of cancer in rheumatoid arthritis. Pathophysiological principles]. Z Rheumatol 2016; 75:13-21. [PMID: 26786169 DOI: 10.1007/s00393-015-0033-7] [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: 11/25/2022]
Abstract
The increased incidence of certain tumor entities in chronic inflammation and infections as well as the increased tumor risk under immunosuppression, illustrate the multiple and complex influences of the immune system on tumor pathogenesis. It is therefore conceivable that immunomodulatory therapy for rheumatoid arthritis (RA) could also influence the risk of malignancies, apart from treating the underlying disease. Basic scientific research studies have identified various signal transduction pathways that are relevant for tumorigenesis and tumor defense mechanisms. This review presents the current knowledge on the effects of the immune system on the occurrence of cancer and tries, where possible, to relate it to specific treatment options.
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Affiliation(s)
- M J Waldner
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Strangfeld
- Deutsches Rheumaforschungszentrum, Berlin, Deutschland
| | - M Aringer
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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117
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Kim HW, Sung YM, Baik JS, Yang SW. A Case of Lacrimal Gland MALT Lymphoma in a Patient with Primary Sjögren's Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.7.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyo Won Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Mi Sung
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Sun Baik
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk-Woo Yang
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lam GY, Halloran BP, Peters AC, Fedorak RN. Lymphoproliferative disorders in inflammatory bowel disease patients on immunosuppression: Lessons from other inflammatory disorders. World J Gastrointest Pathophysiol 2015; 6:181-192. [PMID: 26600976 PMCID: PMC4644882 DOI: 10.4291/wjgp.v6.i4.181] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Immunosuppressive agents, such as thiopurines, methotrexate, and biologics, have revolutionized the treatment of inflammatory bowel disease (IBD). However, a number of case reports, case control studies and retrospective studies over the last decade have identified a concerning link between immunosuppression and lymphoproliferative disorders (LPDs), the oncological phenomenon whereby lymphocytes divide uncontrollably. These LPDs have been associated with Epstein-Barr virus (EBV) infection in which the virus provides the impetus for malignant transformation while immunosuppression hampers the immune system’s ability to detect and clear these malignant cells. As such, the use of immunosuppressive agents may come at the cost of increased risk of developing LPD. While little is known about the LPD risk in IBD, more is known about immunosuppression in the post-transplantation setting and the development of EBV associated post-transplantation lymphoproliferative disorders (PTLD). In review of the PTLD literature, evidence is available to demonstrate that certain immune suppressants such as cyclosporine and T-lymphocyte modulators in particular are associated with an increased risk of PTLD development. As well, high doses of immunosuppressive agents and multiple immunosuppressive agent use are also linked to increased PTLD development. Here, we discuss these findings in context of IBD and what future studies can be taken to understand and reduce the risk of EBV-associated LPD development from immunosuppression use in IBD.
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119
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Temporal protein expression pattern in intracellular signalling cascade during T-cell activation: a computational study. J Biosci 2015; 40:769-89. [PMID: 26564978 DOI: 10.1007/s12038-015-9561-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Various T-cell co-receptor molecules and calcium channel CRAC play a pivotal role in the maintenance of cell's functional responses by regulating the production of effector molecules (mostly cytokines) that aids in immune clearance and also maintaining the cell in a functionally active state. Any defect in these co-receptor signalling pathways may lead to an altered expression pattern of the effector molecules. To study the propagation of such defects with time and their effect on the intracellular protein expression patterns, a comprehensive and largest pathway map of T-cell activation network is reconstructed manually. The entire pathway reactions are then translated using logical equations and simulated using the published time series microarray expression data as inputs. After validating the model, the effect of in silico knock down of co-receptor molecules on the expression patterns of their downstream proteins is studied and simultaneously the changes in the phenotypic behaviours of the T-cell population are predicted, which shows significant variations among the proteins expression and the signalling routes through which the response is propagated in the cytoplasm. This integrative computational approach serves as a valuable technique to study the changes in protein expression patterns and helps to predict variations in the cellular behaviour.
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120
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Brandefors L, Kimby E, Lundqvist K, Melin B, Lindh J. Familial Waldenstrom's macroglobulinemia and relation to immune defects, autoimmune diseases, and haematological malignancies--A population-based study from northern Sweden. Acta Oncol 2015; 55:91-8. [PMID: 26559865 DOI: 10.3109/0284186x.2015.1096019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Waldenstrom's macroglobulinemia (WM) is a rare lymphoprolipherative disorder with geographic and ethnic disparities in incidence. The cause of WM remains mostly unknown although a role for genetic, immune-related, and environmental factors has been suggested. Most cases of WM are sporadic although familial cases occur. AIM This study estimated the incidence of WM in northern Sweden and identified and described patients with familial WM in this area. PATIENTS AND METHODS The Swedish and Northern Lymphoma Registry, the Swedish Cancer Registry (1997-2011), and medical records were used to identify patients with WM in two counties (Norrbotten and Västerbotten) in northern Sweden and to calculate the overall age-adjusted incidence (2000-2012). We identified 12 families with a family history of WM, IgM monoclonal gammophathy (MGUS), and/or multiple myeloma (MM). RESULTS In Norrbotten and Västerbotten, the age-adjusted incidence of WM/LPL is 1.75 and 1.48 per 100,000 persons per year, respectively (2000-2012), rates that are higher than the overall incidence of WM/LPL in Sweden (1.05 per 100,000 persons per year; 2000-2012). Autoimmune diseases and other haematological malignancies in the medical history (their own or in relatives) were reported in 9/12 and 5/12 families, respectively. A high proportion of abnormal serum protein electrophoresis was found in the relatives; 12/56 (21%) had a MGUS and 13/56 (25%) showed abnormalities in the immunoglobulin levels (i.e. subnormal levels and poly/oligoclonality). CONCLUSION The incidence of WM in Norrbotten and Västerbotten counties was higher than expected. We found a strong correlation between autoimmune/inflammatory diseases, other haematological malignancies, and familial WM and a high frequency of serum immunoglobulin abnormalities in the relatives of the WM patients, findings that strengthen the hypothesis that the aetiology of WM depends on both immune-related and genetic factors.
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Affiliation(s)
| | - Eva Kimby
- Department of Hematology, Karolinska University Hospital Stockholm, Sweden
| | - Kristina Lundqvist
- Department of Radiation Science, Oncology, Umeå University, Umeå, Sweden
| | - Beatrice Melin
- Department of Radiation Science, Oncology, Umeå University, Umeå, Sweden
| | - Jack Lindh
- Department of Radiation Science, Oncology, Umeå University, Umeå, Sweden
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Abstract
The emerging epidemic of Hodgkin and non-Hodgkin lymphomas worldwide continues to defy our understanding and forces the search for the causative factors. Adjuvants are known to act as triggers of immune and inflammatory responses. Animal experiments have demonstrated that long-term inflammation is related to aggravation of the immune network resulting in cellular and humoral responses leading to autoimmunity and lymphoma development. Chronic stimulation of the immune system is thought to be the key mechanism through which infectious diseases as well as autoimmune diseases can lead to lymphomagenesis. Many adjuvants can act similarly perturbing immune system's function, inducing a state of prolonged immune activation related to chronic lymphatic drainage. Several mechanisms were proposed by which adjuvants induce inflammation, and they are discussed herein. Some of them are triggering inflammasome; others bind DNA, lipid moieties in cells, induce uric acid production or act as lipophilic and/or hydrophobic substances. The sustained inflammation increases the risk of genetic aberrations, where the initial polyclonal activation ends in monoclonality. The latter is the hallmark of malignant lymphoma. Thus, chronic adjuvant stimulation may lead to lymphoma.
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122
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Hollander P, Rostgaard K, Smedby KE, Chang ET, Amini RM, de Nully Brown P, Glimelius B, Adami HO, Melbye M, Glimelius I, Hjalgrim H. Autoimmune and Atopic Disorders and Risk of Classical Hodgkin Lymphoma. Am J Epidemiol 2015; 182:624-32. [PMID: 26346543 DOI: 10.1093/aje/kwv081] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/26/2015] [Indexed: 12/22/2022] Open
Abstract
Results from previous investigations have shown associations between the risk of Hodgkin lymphoma (HL) and a history of autoimmune and atopic diseases, but it remains unknown whether these associations apply to all types of HL or only to specific subtypes. We investigated immune diseases and the risk of classical HL in a population-based case-control study that included 585 patients and 3,187 controls recruited from October 1999 through August 2002. We collected information on immune diseases through telephone interviews and performed serological analyses of specific immunoglobulin E reactivity. Tumor Epstein-Barr virus (EBV) status was determined for 498 patients. Odds ratios with 95% confidence intervals were calculated using logistic regression analysis. Rheumatoid arthritis was associated with a higher risk of HL (odds ratio (OR) = 2.63; 95% confidence interval (CI): 1.47, 4.70), especially EBV-positive HL (OR = 3.18; 95% CI: 1.23, 8.17), and with mixed-cellularity HL (OR = 4.25; 95% CI: 1.66, 10.90). HL risk was higher when we used proxies of severe rheumatoid arthritis, such as ever having received daily rheumatoid arthritis medication (OR = 3.98; 95% CI: 2.08, 7.62), rheumatoid arthritis duration of 6-20 years (OR = 3.80; 95% CI: 1.72, 8.41), or ever having been hospitalized for rheumatoid arthritis (OR = 7.36; 95% CI: 2.95, 18.38). Atopic diseases were not associated with the risk of HL. EBV replication induced by chronic inflammation in patients with autoimmune diseases might explain the higher risk of EBV-positive HL.
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123
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Papageorgiou A, Mavragani CP, Nezos A, Zintzaras E, Quartuccio L, De Vita S, Koutsilieris M, Tzioufas AG, Moutsopoulos HM, Voulgarelis M. A BAFF Receptor His159Tyr Mutation in Sjögren's Syndrome-Related Lymphoproliferation. Arthritis Rheumatol 2015; 67:2732-41. [DOI: 10.1002/art.39231] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 06/04/2015] [Indexed: 01/05/2023]
Affiliation(s)
| | | | | | - Elias Zintzaras
- University of Thessaly School of Medicine, Larissa, Greece, and The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts University School of Medicine; Boston Massachusetts
| | - Luca Quartuccio
- University Hospital Santa Maria della Misericordia; Udine Italy
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124
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Chui MH, Kukreti V, Wei C, Delabie J. Primary Marginal Zone Lymphoma of the Subcutis Associated With Panniculitis and Fat Necrosis. Am J Clin Pathol 2015; 144:341-6. [PMID: 26185321 DOI: 10.1309/ajcpqh8k5tnuadlv] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Lymphocytic infiltrates in the subcutaneous adipose tissue, often accompanied by fat necrosis, are typically seen in benign panniculitis. Diagnostic considerations include subcutaneous panniculitis-like T-cell lymphoma and cutaneous γδ T-cell lymphoma, whereas a primary subcutaneous B-cell lymphoma in this setting has not been previously described. METHODS We report the case of a 72-year-old woman with multiple deep cutaneous nodules on the trunk and upper extremities. RESULTS During 3 years of clinical follow-up, new skin nodules developed, while existing lesions remained stable or regressed. No other organ involvement was detected. Sequential biopsy specimens of the subcutaneous lesions revealed patchy, predominantly septal, lymphocytic infiltrates associated with extensive hyaline fat necrosis. The histologic and immunophenotypic features were consistent with marginal zone lymphoma. Genotyping revealed an identical monoclonal immunoglobulin gene rearrangement across all biopsy specimens. CONCLUSIONS This case represents, to our knowledge, the first reported case of primary subcutaneous B-cell lymphoma closely associated with panniculitis.
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Affiliation(s)
- M. Herman Chui
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pathology, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Vishal Kukreti
- Department of Medical Oncology, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Cuihong Wei
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pathology, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Jan Delabie
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pathology, Toronto General Hospital, University Health Network, Toronto, Canada
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Abstract
The therapeutic potential of the immune system in the context of hematologic malignancies has long been appreciated particularly due to the curative impact of allogeneic hematopoietic stem cell transplantation (SCT). The role of immune system in shaping the biology and evolution of these tumors is now well recognized. While the contribution of the immune system in anti-tumor effects of certain therapies such as immune-modulatory drugs and monoclonal antibodies active in hematologic malignancies is quite evident, the immune system has also been implicated in anti-tumor effects of other targeted therapies. The horizon of immune-based therapies in hematologic malignancies is rapidly expanding with promising results from immune-modulatory drugs, immune-checkpoint blockade, and adoptive cellular therapies, including genetically-modified T cells. Hematologic malignancies present distinct issues (relative to solid tumors) for the application of immune therapies due to differences in cell of origin/developmental niche of tumor cells, and patterns of involvement such as common systemic involvement of secondary lymphoid tissues. This article discusses the rapidly changing landscape of immune modulation in hematologic malignancies and emphasizes areas wherein hematologic malignancies present distinct opportunities for immunologic approaches to prevent or treat cancer.
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Affiliation(s)
- Madhav V Dhodapkar
- Departments of Internal Medicine (Hematology); Immunobiology, Yale University, New Haven, CT; Yale Cancer Center, Yale University, New Haven, CT.
| | - Kavita M Dhodapkar
- Pediatrics (Hematology-Oncology); Yale Cancer Center, Yale University, New Haven, CT
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126
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Chan WPW, Leow WQ. Ulcerative Colitis Diagnosed in a Patient after Primary Rectal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT) Treated. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/201010581502400210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A 39-year-old woman presented with loose stool and rectal bleeding for 1 year. A colonoscopy was performed and revealed proctitis. Rectal biopsy revealed a diagnosis of rectal marginal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). She was treated with a course of chemotherapy rituximab. However, her symptoms persisted and a repeat colonoscopy showed features consistent with ulcerative colitis. She received topical mesalazine and her symptoms resolved. Another repeat colonoscopy showed evidence of inactive chronic colitis only. This is a rare report of ulcerative colitis being diagnosed after rectal MALT was treated. It is possible that she might have long-standing ulcerative colitis that was undiagnosed, with the rectal MALT lymphoma masking the features of ulcerative colitis. A few treatment modalities are available, and the prognosis in general is good.
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Affiliation(s)
- Webber Pak Wo Chan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Wei Qiang Leow
- Department of Pathology, Singapore General Hospital, Singapore
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127
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Chaigne B, Lasfargues G, Marie I, Hüttenberger B, Lavigne C, Marchand-Adam S, Maillot F, Diot E. Primary Sjögren's syndrome and occupational risk factors: A case-control study. J Autoimmun 2015; 60:80-5. [PMID: 25963068 DOI: 10.1016/j.jaut.2015.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/10/2015] [Accepted: 04/15/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVES A case-control study was carried out to investigate the relation between primary Sjögren's syndrome (pSS) and occupational exposure. METHODS One hundred seventy five cases of pSS followed up into the internal medicine departments of three French university hospitals from 2010 to 2013 were included. For each case, two age and gender matched controls were selected during the same period in the same departments. Occupational exposure was assessed retrospectively by industrial hygienists and occupational practitioners. Exposure to occupational factors such as organic solvents or silica was investigated using semiquantitative estimates of exposure. An exposure score was calculated for each subject based on probability, intensity, daily frequency, and duration of exposure for each period of employment. The final cumulative exposure score was obtained, taking into account all periods of employment. RESULTS Significant associations with pSS were observed for dichloromethane (OR 9.28, 95%CI 2.60-33.03), perchlorethylene (OR 2.64, 95%CI 1.20-5.77) chlorinated solvents (OR 2.95, 95%CI 1.77-4.93), benzene (OR 3.30, 95%CI 1.07-10.26), toluene (OR 4.18 95%CI 1.41-12.43), white spirit (OR 3.60, 95%CI 1.39-9.33), aromatic solvents (OR 3.03, 95%CI 1.41-6.50) and any types of solvents (OR 2.76, 95%CI 1.70-4.47). Risk of pSS was significantly associated with a high cumulative exposure score of occupational exposure to toluene (OR 4.69, 95%CI 1.42-15.45), white spirit (OR 3.30, 95%CI 1.07-10.26), aromatic solvents (OR 2.50, 95%CI 1.06-5.91) and any types of solvents (OR 2.25, 95%CI 1.20-4.22). CONCLUSION This work suggests the influence of occupational risk factors in the occurrence of pSS.
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Affiliation(s)
- Benjamin Chaigne
- CHRU de Tours, Service de Médecine Interne, Université François-Rabelais de Tours, France.
| | - Gérard Lasfargues
- Institut de Santé au travail de Paris-Est, Université Paris-Est Créteil, France
| | - Isabelle Marie
- CHRU de Rouen, Service de Médecine Interne, Rouen, France
| | - Brigitte Hüttenberger
- CHRU de Tours, Service de Stomatologie et de Chirurgie Maxillo-Faciale, Tours, France
| | | | - Sylvain Marchand-Adam
- CHRU de Tours, Service de Pneumologie, Université François-Rabelais de Tours, France
| | - François Maillot
- CHRU de Tours, Service de Médecine Interne, Université François-Rabelais de Tours, France
| | - Elisabeth Diot
- CHRU de Tours, Service de Médecine Interne, Université François-Rabelais de Tours, France
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Wang LH, Wang WM, Hsu SM, Lin SH, Shieh CC. Risk of Overall and Site-specific Cancers in Behçet Disease: A Nationwide Population-based Study in Taiwan. J Rheumatol 2015; 42:879-84. [DOI: 10.3899/jrheum.140770] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 01/21/2023]
Abstract
Objective.The relationship between autoimmune disease and cancer is complex while large-scale epidemiological studies of cancer risk in Behçet disease (BD) have not been reported. Therefore, we conducted a nationwide population-based cohort study.Methods.By using the National Health Insurance Research Database of 23 million people in Taiwan, we identified 1314 new patients with BD without previous cancer from 2000–2009 as a cohort. Standardized incidence ratios (SIR) of overall and site-specific cancers in patients with BD in comparison with the general population were calculated from 2000–2011.Results.Among the 1314 patients with BD, 30 developed cancers (9 men and 21 women). In overall cancer risk analysis, patients with BD had a higher risk (SIR 1.5, 95% CI 1.03–2.11). Among them, female patients with BD (SIR 1.8, 95% CI 1.14–2.7), but not male patients with BD (SIR 1.08, 95% CI 0.53–1.98), have a higher risk of overall cancer. In site-specific cancer risk analysis, patients with BD had a higher risk of non-Hodgkin lymphoma (SIR 8.3, 95% CI 2.1–22.7), hematological malignancy (SIR 4.2, 95% CI 1.3–10.2), and female breast cancer (SIR 2.2, 95% CI 1.004–4.1). The cancer risk was highest within the first-year followup (SIR 2.7, 95% CI 1.3–5.1), with 75% of the hematological malignancies found within the first year.Conclusion.This nationwide cohort study of cancer risk in patients with BD provides important information about the relationship between BD and malignancies. The results can be useful for cancer surveys in the future.
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Wang SS, Vajdic CM, Linet MS, Slager SL, Voutsinas J, Nieters A, de Sanjose S, Cozen W, Alarcón GS, Martinez-Maza O, Brown EE, Bracci PM, Lightfoot T, Turner J, Hjalgrim H, Spinelli JJ, Zheng T, Morton LM, Birmann BM, Flowers CR, Paltiel O, Becker N, Holly EA, Kane E, Weisenburger D, Maynadie M, Cocco P, Foretova L, Staines A, Davis S, Severson R, Cerhan JR, Breen EC, Lan Q, Brooks-Wilson A, De Roos AJ, Smith MT, Roman E, Boffetta P, Kricker A, Zhang Y, Skibola C, Chanock SJ, Rothman N, Benavente Y, Hartge P, Smedby KE. Associations of non-Hodgkin Lymphoma (NHL) risk with autoimmune conditions according to putative NHL loci. Am J Epidemiol 2015; 181:406-21. [PMID: 25713336 DOI: 10.1093/aje/kwu290] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Autoimmune conditions and immune system-related genetic variations are associated with risk of non-Hodgkin lymphoma (NHL). In a pooled analysis of 8,692 NHL cases and 9,260 controls from 14 studies (1988-2007) within the International Lymphoma Epidemiology Consortium, we evaluated the interaction between immune system genetic variants and autoimmune conditions in NHL risk. We evaluated the immunity-related single nucleotide polymorphisms rs1800629 (tumor necrosis factor gene (TNF) G308A), rs1800890 (interleukin-10 gene (IL10) T3575A), rs6457327 (human leukocyte antigen gene (HLA) class I), rs10484561 (HLA class II), and rs2647012 (HLA class II)) and categorized autoimmune conditions as primarily mediated by B-cell or T-cell responses. We constructed unconditional logistic regression models to measure associations between autoimmune conditions and NHL with stratification by genotype. Autoimmune conditions mediated by B-cell responses were associated with increased NHL risk, specifically diffuse large B-cell lymphoma (odds ratio (OR) = 3.11, 95% confidence interval (CI): 2.25, 4.30) and marginal zone lymphoma (OR = 5.80, 95% CI: 3.82, 8.80); those mediated by T-cell responses were associated with peripheral T-cell lymphoma (OR = 2.14, 95% CI: 1.35, 3.38). In the presence of the rs1800629 AG/AA genotype, B-cell-mediated autoimmune conditions increased NHL risk (OR = 3.27, 95% CI: 2.07, 5.16; P-interaction = 0.03) in comparison with the GG genotype (OR = 1.82, 95% CI: 1.31, 2.53). This interaction was consistent across major B-cell NHL subtypes, including marginal zone lymphoma (P-interaction = 0.02) and follicular lymphoma (P-interaction = 0.04).
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Kuksin CA, Minter LM. The Link between Autoimmunity and Lymphoma: Does NOTCH Signaling Play a Contributing Role? Front Oncol 2015; 5:51. [PMID: 25759795 PMCID: PMC4338678 DOI: 10.3389/fonc.2015.00051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 02/11/2015] [Indexed: 12/17/2022] Open
Abstract
An association between certain autoimmune conditions and increased risk of developing lymphoma is well documented. Recent evidence points to NOTCH signaling as a strong driver of autoimmunity. Furthermore, a role for NOTCH in various lymphomas, including classical Hodgkin lymphoma, non-Hodgkin lymphoma, and T cell lymphoma has also been described. In this mini-review, we will outline what is known about involvement of NOTCH signaling in those autoimmune conditions, such as rheumatoid arthritis and primary Sjörgren’s syndrome, which show an increased risk for subsequent diagnosis of lymphoma. Furthermore, we will detail what is known about the lymphomas associated with these autoimmune conditions and how aberrant or sustained NOTCH signaling in the immune cells that mediate these diseases may contribute to lymphoma.
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Affiliation(s)
- Christina Arieta Kuksin
- Department of Veterinary and Animal Sciences, University of Massachusetts Amherst , Amherst, MA , USA
| | - Lisa M Minter
- Department of Veterinary and Animal Sciences, University of Massachusetts Amherst , Amherst, MA , USA ; Program in Molecular and Cellular Biology, University of Massachusetts Amherst , Amherst, MA , USA
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Van den Bergh M, Alvarez-Argote J, Panwala AH, Dasanu CA. Autoimmune disorders in patients with T-cell lymphoma: a comprehensive review. Curr Med Res Opin 2015. [PMID: 26211818 DOI: 10.1185/03007995.2015.1074066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Increased risk of B-cell lymphoma in patients with autoimmune diseases is well known. Medical literature also links various autoimmune conditions with T-cell lymphomas (TCLs), a rarer but very heterogeneous group of generally aggressive neoplasms. METHODS Herein, we provide a comprehensive analysis of the available peer-reviewed literature on epidemiology, clinico-laboratory features and management of autoimmune diseases in patients with TCL. Most relevant publications were identified through searching the PubMed/Medline database for articles published from inception to June 2014. FINDINGS Prevalence of various hematologic and non-hematologic autoimmune conditions in patients with TCL appears to be increased. Due to the rarity of TCL, scientific literature on autoimmune conditions in these patients consists mainly of case series and isolated reports. CONCLUSIONS Autoimmune disorders can develop prior to, during or after the onset of TCL. The diagnosis of TCL should prompt early recognition of certain autoimmune disorders if clinical suspicion exists. A dysfunctional immune response in these patients may be responsible for the occurrence of autoimmunity. Conversely, autoimmune conditions might create a favorable milieu for T-cell lymphoma pathogenesis. Therefore, their presence should increase the suspicion of TCL in an appropriate clinico-laboratory context. There is need for larger studies to assess further the TCL-autoimmunity relationship as prognosis and management of these patients can be considerably affected.
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Affiliation(s)
| | | | - Amruta H Panwala
- a a University of Connecticut , Internal Medicine, Farmington, CT , USA
| | - Constantin A Dasanu
- b b Lucy Curci Cancer Center, Eisenhower Medical Center, Rancho Mirage , CA , USA
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132
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Ahn CJ, Kim NJ. A Case of Orbital MALT Lymphoma in a Patient with Rheumatoid Arthritis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.5.780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chan Joo Ahn
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Ju Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Sokol EV, Vasilyev VI, Kovrigina AM, Safonova TN, Nasonov EL. [IgG4-related disease and clonal B-cell lymphoid proliferation: Description of two clinical cases and a review of literature]. TERAPEVT ARKH 2015; 87:77-84. [PMID: 26978423 DOI: 10.17116/terarkh2015871277-84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IgG4-related disease (IgG4-RD) is a systemic immune-related disease that may involve the pancreas, liver, retroperitoneal space, biliary tract, salivary and lacrimal glands, eye socket, lung, and kidney. In term of pathomorphogenesis, it is a fibroinflammatory disease manifesting as a tumor-like lesion of organs, elevated serum IgG4 levels, and a morphofunctional substrate - the development of marked fibrosis and lymphoplasmacytic infiltration in the tissues with the high content of IgG4-positive plasma cells. The detection of a tumor-like nodule frequently leads to that the patients with IgG4-RD undergo major traumatic surgery for presumed cancer. At the same time, a number of investigations show the association of IgG4-RD with the development of cancer and lymphoproliferative diseases. The paper describes two clinical cases: Russia's first diagnosis of MALT lymphoma of the lacrimal gland, IgG4-positive and IgG4-RD with a rare onset with a destruction focus in the cervical vertebrae, multiple organ dysfunction, B-cell clonality in salivary gland tissue and PIgMκ secretion. It also reviews world literature on the development of lymphoproliferative diseases in the presence of IgG4-RD.
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Affiliation(s)
- E V Sokol
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - V I Vasilyev
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - A M Kovrigina
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - T N Safonova
- Helmholtz Research Institute of Eye Diseases, Ministry of Health of Russia, Moscow, Russia
| | - E L Nasonov
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
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Mandal S, Pile K, Chacko RT, Danda D. Malignancy and autoimmunity: causally or casually related? Int J Rheum Dis 2014; 17:601-5. [DOI: 10.1111/1756-185x.12536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Santoshkumar Mandal
- Department of Clinical Immunology and Rheumatology; Christian Medical College and Hospital; Vellore India
| | - Kevin Pile
- Department of Medicine; University of Western Sydney; Sydney Australia
| | - Raju Titus Chacko
- Department of Medical Oncology; Christian Medical College and Hospital; Vellore India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology; Christian Medical College and Hospital; Vellore India
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135
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Maślińska M, Przygodzka M, Kwiatkowska B, Sikorska-Siudek K. Sjögren's syndrome: still not fully understood disease. Rheumatol Int 2014; 35:233-41. [PMID: 24985362 PMCID: PMC4308635 DOI: 10.1007/s00296-014-3072-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 06/09/2014] [Indexed: 12/13/2022]
Abstract
Primary Sjögren's syndrome is an autoimmune disorder with external exocrine glands dysfunction and multiorgan involvement. The pathogenesis of primary Sjogren’s syndrome is still unclear; however, our knowledge of the involvement of different cells (e.g., B and T cells, macrophages and dendritic cells) and pathways (BAFF/APRIL and interferons) leading to the development of autoimmunity is continually expanding. For clinicians, the most frequent symptoms are dryness of eyes and mouth, but often the patients have musculoskeletal symptoms and systemic manifestations. However, the increased risk of lymphoproliferative disorders in this group of patients, most commonly B-cell marginal zone lymphoma, is particularly important. Recent separation of IgG4-related diseases and attempts to create further diagnostic criteria for pSS testify to the difficulties, and at the same time a large interest, in understanding the disease so as to allow the effective treatment. This article draws attention to the problems faced by the clinician wishing to securely identify pSS by using accurate laboratory biomarkers and useful imaging tools and predict the development of complications associated with this, still not fully understood, autoimmune disease.
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Affiliation(s)
- Maria Maślińska
- Clinic of Early Arthritis, Institute of Rheumatology, Spartańska 1, 02-637, Warsaw, Poland,
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Andersen CL, Lindegaard H, Vestergaard H, Siersma VD, Hasselbalch HC, de Fine Olivarius N, Bjerrum OW, Junker P. Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting. PLoS One 2014; 9:e99388. [PMID: 24914777 PMCID: PMC4051682 DOI: 10.1371/journal.pone.0099388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/14/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Several studies have demonstrated an association between rheumatoid arthritis (RA) and lymphoproliferative malignancies, but pathogenic mechanisms remain unclear. We investigated 1) the risk of lymphoproliferative malignancies and solid tumors in adults with RA identified in primary care and 2) the possible mediating role of blood eosinophilia in the clonal evolution of cancer in these patients. METHODS From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count between 2000-2007. From these, one DIFF was randomly chosen (the index DIFF). By linking to the Danish National Patient Register, we categorized the selected individuals according to known longstanding (≥3 years) or recent onset (<3 years) RA prior to the index DIFF. In addition, the cohort was stratified according to management in primary or secondary care. From the Danish Cancer Registry we ascertained malignancies within four years following the index DIFF. Using multivariable logistic regression, odds ratios (OR) were calculated and adjusted for sex, age, year, month, eosinophilia, comorbid conditions and C-reactive protein (CRP). RESULTS 921 patients had recent onset RA and 2,578 had longer disease duration. Seventy three percent of RA patients were managed in primary care. After adjustment for sex, age, year, and month, neither recent onset nor long-standing RA was associated with incident lymphoproliferative malignancies or solid cancers. These risk estimates did not change when eosinophilia, CRP, and comorbidities were included in the models. CONCLUSIONS In this large cohort of patients with RA of short or long duration recruited from a primary care resource, RA was not associated with an increased risk of lymphoproliferative or solid cancers during 4 years of follow-up, when the models were adjusted for confounders. Blood eosinophilia could not be identified as a mediator of cancer development in the present setting.
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Affiliation(s)
- Christen Lykkegaard Andersen
- Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Hanne Lindegaard
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Hanne Vestergaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Volkert Dirk Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Junker
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
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