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Mizushima M, Sugihara T, Matsui T, Urata Y, Tohma S, Kawahata K. Comparison between rheumatoid arthritis with malignant lymphoma and other malignancies: Analysis of a National Database of Rheumatic Disease in Japan. Semin Arthritis Rheum 2023; 63:152301. [PMID: 37939601 DOI: 10.1016/j.semarthrit.2023.152301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The background status and the current treatment options of patients with rheumatoid arthritis (RA) who develop malignant lymphoma (ML) and other malignancies are unclear. This study investigated the differences in background factors between ML and other malignancies that occur in RA patients and post-malignancy treatment. METHODS We identified 935 RA patients with new-onset malignancies among 110,571 person-years registered in the National Database of Rheumatic Disease in Japan from 2012 to 2018. Analysis cohorts 1 and 2 included 597 and 490 patients with available data for 1 year before and after the development of malignancies, respectively. Factors associated with the development of ML were longitudinally evaluated by multiple logistic regression analyses. RESULTS Of the 935 patients (mean age 70.5, standard deviation 9.9), 15.5% had ML; this was comparable to the rate of lung cancer (14.3%). In cohort 1, methotrexate (MTX), biological disease-modifying anti-rheumatic drugs (bDMARDs), and non-steroidal anti-inflammatory drugs (NSAIDs) were used in 74.4%, 23.4%, and 56.7% of ML and in 56.8%, 25.4%, and 35.3% of other malignancies 1 year before the occurrence of malignancies. Clinical disease activity index (CDAI) and C-reactive protein were similar between the two groups. Multivariable analysis showed that MTX use (odds ratio [OR]: 2.22, 95% CI [confidence interval]: 1.32-3.73, p=0.003) and NSAID use (OR: 2.51, 95% CI: 1.58-3.98, p <0.001) were significantly associated with the development of ML versus other malignancies. However, this association was not observed with bDMARDs. In cohort 2, one year after the development of malignancies, MTX was used in none of ML and 41.8% of patients who developed other malignancies. In both malignancy groups, approximately 15% of patients received bDMARDs and 50% received glucocorticoids. IL-6 inhibitors were preferentially prescribed in patients with ML versus those with other malignancies. At year 1, CDAI remission was achieved in 37.3% and 31.1% of patients in the ML and other malignancy groups, respectively. CONCLUSION Patients receiving long-term treatment with MTX and NSAIDs may be at a relatively high risk of developing ML. The treatment landscape after developing malignancies differed considerably between patients with ML and other malignancies, and different treatment strategies should be established.
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Affiliation(s)
- Machiko Mizushima
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takahiko Sugihara
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Toshihiro Matsui
- Department of Rheumatology Research, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yukitomo Urata
- Department of Rheumatology, Tsugaru General Hospital, Goshogawara, Japan
| | - Shigeto Tohma
- Department of Rheumatology, National Hospital Organization Tokyo Hospital
| | - Kimito Kawahata
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Japan
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Kolijn PM, Langerak AW. Immune dysregulation as a leading principle for lymphoma development in diverse immunological backgrounds. Immunol Lett 2023; 263:46-59. [PMID: 37774986 DOI: 10.1016/j.imlet.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 10/01/2023]
Abstract
Lymphoma is a heterogeneous group of malignancies arising from lymphocytes, which poses a significant challenge in terms of diagnosis and treatment due to its diverse subtypes and underlying mechanisms. This review aims to explore the shared and distinct features of various forms of lymphoma predisposing conditions, with a focus on genetic, immunological and molecular aspects. While diseases such as autoimmune disorders, inborn errors of immunity and iatrogenic immunodeficiencies are biologically and immunologically distinct, each of these diseases results in profound immune dysregulation and a predisposition to lymphoma development. Interestingly, the increased risk is often skewed towards a particular subtype of lymphoma. Patients with inborn errors of immunity in particular present with extreme forms of lymphoma predisposition, providing a unique opportunity to study the underlying mechanisms. External factors such as chronic infections and environmental exposures further modulate the risk of lymphoma development. Common features of conditions predisposing to lymphoma include: persistent inflammation, recurrent DNA damage or malfunctioning DNA repair, impaired tumor surveillance and viral clearance, and dysregulation of fundamental cellular processes such as activation, proliferation and apoptosis. Our growing understanding of the underlying mechanisms of lymphomagenesis provides opportunities for early detection, prevention and tailored treatment of lymphoma development.
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Affiliation(s)
- P Martijn Kolijn
- Laboratory Medical Immunology, Department of Immunology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anton W Langerak
- Laboratory Medical Immunology, Department of Immunology, Erasmus Medical Center, Rotterdam, the Netherlands.
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Li H, Yu L, Zhang X, Shang J, Duan X. Exploring the molecular mechanisms and shared gene signatures between rheumatoid arthritis and diffuse large B cell lymphoma. Front Immunol 2022; 13:1036239. [PMID: 36389761 PMCID: PMC9659608 DOI: 10.3389/fimmu.2022.1036239] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/17/2022] [Indexed: 07/25/2023] Open
Abstract
The relationship between rheumatoid arthritis (RA) and diffuse large B-cell lymphoma (DLBCL) is well characterized, but the molecular mechanisms underlying this association have not been clearly investigated. Our study aimed to identify shared gene signatures and molecular mechanisms between RA and DLBCL. We selected multiple Gene Expression Omnibus (GEO) datasets (GSE93272, GSE83632, GSE12453, GSE1919) to obtain gene expression levels and clinical information about patients with RA and DLBCL. Weighted gene co-expression network analysis (WGCNA) was used to research co-expression networks associated with RA and DLBCL. Subsequently, we performed enrichment analysis of shared genes and screened the most significant core genes. We observed expression of the screened target gene, galectin 2 (LGALS2), in DLBCL patients and its impact on patient prognosis. Finally, we analyzed the molecular functional mechanism of LGALS2 and observed its relationship with the immune response in DLBCL using single-sample Gene Set Enrichment Analysis (ssGSEA). WGCNA recognized two major modules for RA and DLBCL, respectively. Shared genes (551) were identified for RA and DLBCL by observing the intersection. In addition, a critical shared gene, LGALS2, was acquired in the validation tests. Next, we found that the expression level of LGALS2 gradually decreased with tumor progression in DLBCL and that increased expression of LGALS2 predicted a better prognosis for DLBCL patients. ssGSEA revealed that LGALS2 is involved in immune-related pathways and has a significant regulatory effect on human immune responses. Additionally, we observed that LGALS2 is closely related to the sensitivity of multiple chemotherapeutic drugs. There is extremely little research on the molecular mechanism of correlation between RA and DLBCL. Our study identified that LGALS2 is a potential therapeutic target and an immune-related biomarker for patients with RA and DLBCL.
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FDG-PET/CT imaging parameters for predicting spontaneous regression of methotrexate-associated lymphoproliferative disorder in patients with rheumatoid arthritis. Sci Rep 2022; 12:15367. [PMID: 36100660 PMCID: PMC9470546 DOI: 10.1038/s41598-022-19727-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
In this study, we investigated the usefulness of FDG-PET/CT for predicting spontaneous regression in methotrexate-associated lymphoproliferative disorder (MTX-LPD). Twenty patients with rheumatoid arthritis who were diagnosed with MTX-LPD were enrolled in the study. These patients were divided into those who showed spontaneous regression (SR group: ten patients) and those who received chemotherapy after discontinuation of MTX (CTx group: ten patients). Between-group differences in potential biomarkers were compared, including clinical markers at the onset of LPD [serum LDH and interleukin 2 receptor (sIL-2R)], change in absolute number of peripheral lymphocytes (ΔALC) over follow-up, and the FDG-PET/CT-derived parameters of maximum standardized uptake value (SUVmax), mean SUV (SUVmean), peak SUV (SUVpeak), sum of the metabolic tumor volume (MTVsum), and sum of total lesion glycolysis (TLGsum). The levels of sIL-2R, MTVsum, and TLGsum were significantly lower in the SR group than in the CTx group. In addition, ΔALC was higher in the SR group. In conclusion, MTV and TLG values measured by FDG-PET/CT may be suitable for use as predictors of SR in patients with MTX-LPD.
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Prevalence of Findings in Routine Abdominal Ultrasound in Patients with Systemic Autoimmune Rheumatic Diseases and Their Impact on Therapeutic Decision Making. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patients with systemic autoimmune rheumatic diseases (SARD) often receive abdominal ultrasound examinations to screen for organ involvement; yet, the spectrum of findings and their clinical relevance are poorly understood. We conducted a retrospective chart review of inpatients from a rheumatological referral centre with an abdominal ultrasound between 1 January2006 and 31 December 2015, examining 1092 SARD patients with a total of 1695 inpatient stays. The mean age was 55.1 years (range: 17–90 years, SD: 15.8), and the mean disease duration was 6.4 years (range: 0.0–52.8 years, SD: 9.1). A total of 87.5% of the patients were female. The most frequent ultrasound findings were hepatic steatosis (in 26.8% of all patients), splenomegaly (15.2% of all patients), pancreatic lipomatosis (14.3% of all patients) and aortic sclerosis (13.9% of all patients). Based on glucocorticoid and disease-modifying antirheumatic drug use, we identified cases where immuno-modulatory medication was escalated; there was an association between therapy escalation and the findings of hepatomegaly and pleural effusion (as tested via Fisher’s exact test). In patients with several examinations during the defined time span (n = 318), we found ultrasound findings to change, especially findings of hepatomegaly, pleural effusion and splenomegaly. When justifying decisions regarding the further treatment of a patient in the discharge letter, abdominal ultrasound results were rarely discussed. Abdominal ultrasound rarely yielded disease-specific or treatment-changing results.
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Hori Y, Yamamoto H, Kawatoko S, Nozaki Y, Torisu T, Kato K, Koga Y, Miyoshi H, Ohshima K, Tateishi Y, Nakamura S, Kitazono T, Oda Y. Lymphoid and myeloid proliferative disorders associated with inflammatory bowel disease: A clinicopathological study of 15 cases. Hum Pathol 2022; 120:88-98. [PMID: 34990621 DOI: 10.1016/j.humpath.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022]
Abstract
Lymphoproliferative disorder (LPD) can occur in patients with inflammatory bowel disease (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD). On rare occasion, patients with IBD develop myeloid neoplasms; however, the frequency and clinicopathological features of IBD-associated lymphoid and myeloid proliferative disorder (LMPD) in Japanese patients is still unclear. In this study, we reviewed 2474 Japanese patients with IBD, and found that LMPD occurred in 12 (0.5%) patients with UC (n=7) or CD (n=5). Together with an additional 3 cases, we analyzed a total of 15 cases of LMPD for clinicopathological and histological features. Based on the status of using immunosuppressants such as biologics and immunomodulators, Epstein-Barr virus (EBV) infection, and histopathology, the 15 cases were classified into the Group I (high-grade LPD; n=7), Group II (low-grade LPD; n=5), and Group III (myeloid neoplasms; n=3). Most patients in Group I were undergoing strong immunosuppressive therapy, and the LPD lesions corresponded to high-grade B-cell or T/NK-cell lymphoma often with EBV infection. Discontinuation of immunosuppressive drugs alone did not resolve these LPDs; Group I patients required chemotherapy, and eventually 4 of them (57%) died of the tumor. Most cases in Group II were low-grade B-cell lymphoma without EBV infection and had an indolent clinical course with excellent prognosis. All patients in Group III developed acute myeloid leukemia (AML) during the course of CD. Two (67%) of these patients died of AML. Our study suggests that IBD-associated LMPD is very rare, but can follow an aggressive clinical course.
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Affiliation(s)
- Yoshifumi Hori
- Department of Anatomic Pathology, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan.
| | - Shinichiro Kawatoko
- Department of Anatomic Pathology, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Yui Nozaki
- Department of Anatomic Pathology, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Koji Kato
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Yuhki Koga
- Department of Pediatrics, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, Kurume University School of Medicine, 830-0011, Kurume, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, 830-0011, Kurume, Japan
| | - Yuki Tateishi
- Department of Pathology, Japan Community Health Care Organization (JCHO), Kyushu Hospital, 806-8501, Kitakyushu, Japan
| | - Shotaro Nakamura
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 028-3695, Morioka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Kyushu University Graduate School of Medicine Sciences, 812-8582, Fukuoka, Japan
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Gorodetskiy V, Probatova N, Obukhova T, Vasilyev V. Analysis of prognostic factors in diffuse large B-cell lymphoma associated with rheumatic diseases. Lupus Sci Med 2021; 8:8/1/e000561. [PMID: 34785569 PMCID: PMC8596057 DOI: 10.1136/lupus-2021-000561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/22/2021] [Indexed: 12/23/2022]
Abstract
Objective The risk of developing diffuse large B-cell lymphoma (DLBCL) is increased in many rheumatic diseases (RDs). It is possible that RD-associated DLBCL is a distinct subset within the category of ‘DLBCL’, exhibiting characteristic biological features and clinical behaviour. However, information on RD-associated DLBCL is limited. Methods We searched the V.A. Nasonova Research Institute of Rheumatology (Russia) database from 1996 to 2021 for patients with RDs and coexisting DLBCL. Prognostic factors including the International Prognostic Index (IPI), bulk disease and c-MYC/8q24 gene rearrangements were analysed. Furthermore, we stratified DLBCLs as germinal centre B-cell (GCB) subtype and non-GCB subtype based on Hans’ immunohistochemical algorithm and also examined Epstein-Barr virus (EBV) status. Results Twenty-seven patients with RD-associated DLBCL were identified. Twenty patients had primary Sjogren’s syndrome, three had systemic lupus erythematosus, two had rheumatoid arthritis and two had systemic sclerosis. Secondary Sjogren’s syndrome was found in four patients. The median age at the time of diagnosis of DLBCL was 59 years with a female predominance (26:1). Based on IPI, 16 patients were assigned to the intermediate-high and high-risk groups. Bulk disease was detected in 29% of patients. Of the 20 examined cases, 4 (20%) were classified as the GCB subtype and 16 (80%) were classified as the non-GCB subtype. EBV was detected in 2 of the 21 tested cases (10%), and the c-MYC/8q24 gene rearrangement was not found in any of the 19 examined cases. After the lymphoma diagnosis, the median overall survival (OS) was 10 months (range: 0–238 months). Conclusions Except for the more common non-GCB subtype, we did not identify any other prognostic factor that could influence the prognosis of patients with RD-associated DLBCL. We believe that short OS in our patients was predominantly associated with decreased tolerance to lymphoma treatment.
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Affiliation(s)
- Vadim Gorodetskiy
- Department of Intensive Methods of Therapy, V A Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Natalya Probatova
- Department of Pathology, N N Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - Tatiana Obukhova
- Cytogenetic Laboratory, National Research Center for Hematology, Moscow, Russian Federation
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HGAL inhibits lymphoma dissemination by interacting with multiple Cytoskeletal proteins. Blood Adv 2021; 5:5072-5085. [PMID: 34543391 PMCID: PMC9153012 DOI: 10.1182/bloodadvances.2021004304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
In vivo experiments demonstrate that HGAL expression in lymphoma decreases tumor dissemination and prolongs animal survival. HGAL inhibits cell motility by interacting with multiple cytoskeletal proteins, thereby affecting cell motility by multiple mechanisms.
Human germinal center–associated lymphoma (HGAL) is an adaptor protein specifically expressed in germinal center lymphocytes. High expression of HGAL is a predictor of prolonged survival of diffuse large B-cell lymphoma (DLBCL) and classic Hodgkin lymphoma. Furthermore, HGAL expression is associated with early-stage DLBCL, thus potentially limiting lymphoma dissemination. In our previous studies, we demonstrated that HGAL regulates B-cell receptor signaling and cell motility in vitro and deciphered some molecular mechanisms underlying these effects. By using novel animal models for in vivo DLBCL dispersion, we demonstrate here that HGAL decreases lymphoma dissemination and prolongs survival. Furthermore, by using an unbiased proteomic approach, we demonstrate that HGAL may interact with multiple cytoskeletal proteins thereby implicating a multiplicity of effects in regulating lymphoma motility and spread. Specifically, we show that HGAL interacts with tubulin, and this interaction may also contribute to HGAL effects on cell motility. These findings recapitulate previous observations in humans, establish the role of HGAL in dissemination of lymphoma in vivo, and explain improved survival of patients with HGAL-expressing lymphomas.
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D'Arcy ME, Beachler DC, Pfeiffer RM, Curtis JR, Mariette X, Seror R, Mahale P, Rivera DR, Yanik EL, Engels EA. Tumor Necrosis Factor Inhibitors and the Risk of Cancer among Older Americans with Rheumatoid Arthritis. Cancer Epidemiol Biomarkers Prev 2021; 30:2059-2067. [PMID: 34426413 DOI: 10.1158/1055-9965.epi-21-0125] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/28/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND TNF inhibitors (TNFi) effectively treat rheumatoid arthritis but may increase patient risk of some malignancies, particularly lymphomas or skin cancers. METHODS We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data to conduct a case-control study in patients with rheumatoid arthritis (2007-2015). Cases were individuals with a first cancer diagnosed in SEER registries (ages 66-99, 22 cancer sites, N = 10,263). Skin cancer cases [nonmelanoma skin cancer (NMSC, N = 501), basal cell carcinoma (BCC, N = 161), squamous cell carcinoma (SCC, N = 150)] and cancer-free controls (N = 30,475) were selected from Medicare beneficiaries residing in SEER areas. Cases and controls had prior Medicare claims-based evidence for rheumatoid arthritis, and TNFi exposure was ascertained from part B and part D claims. Logistic regression was used to estimate adjusted odds ratios (aOR). RESULTS TNFi exposure was present in 16.2% of controls and 12.8% to 33.7% of cancer cases, varying by site. TNFi use was associated with increased risk of NMSC overall (aOR 1.32, 95% confidence interval 1.06-1.63), non-Hodgkin lymphoma (NHL) overall (1.28, 1.06-1.56) and, specifically, follicular lymphoma (2.63, 1.63-4.24). TNFi exposure was not associated with other SEER cancer sites, BCC or SCC specifically, or other common NHL subtypes. CONCLUSIONS Among older adults with rheumatoid arthritis, TNFi exposure was associated with elevated risk of NMSC and NHL, driven specifically by follicular lymphoma. Exposure was not associated with increased risk for other cancer sites. IMPACT Our results support a role for TNF in lymphomagenesis. Given the association with NMSC, patients initiating TNFi therapy may benefit from skin cancer screening and sun protection measures.
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Affiliation(s)
- Monica E D'Arcy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland. monica.d'
| | | | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | | | - Xavier Mariette
- Hôpital Bicêtre, Assistance Publique -Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin Bicêtre, Paris, France
| | - Raphaele Seror
- Hôpital Bicêtre, Assistance Publique -Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin Bicêtre, Paris, France
| | - Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Donna R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | | | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Patil AD, Kulkarni SL, Balikai G. Diffuse Large B-Cell Lymphoma Discovered following Total Knee Arthroplasty: A Case Report and Literature Review. CASE REPORTS IN ORTHOPEDIC RESEARCH 2021. [DOI: 10.1159/000514412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Total knee arthroplasty is performed routinely for osteoarthritis of the knee joint. We report a case of high-grade diffuse large B-cell lymphoma as an unexpected diagnosis after histopathological examination of unusual-looking synovium during total knee arthroplasty in a 68-year-old patient without any systemic symptoms.
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Lyapichev KA, Ivashkevich Y, Chernov Y, Chinenov D, Shpot E, Bessonov AA, Dabaja BS, Konoplev S. MALT Lymphoma of the Urinary Bladder Shows a Dramatic Female Predominance, Uneven Geographic Distribution, and Possible Infectious Etiology. Res Rep Urol 2021; 13:49-62. [PMID: 33575225 PMCID: PMC7873029 DOI: 10.2147/rru.s283366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/11/2021] [Indexed: 12/22/2022] Open
Abstract
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of the urinary bladder is an extremely rare entity accounting for 0.2% of all malignant urinary bladder neoplasms, and the diagnosis could be challenging. We present here a patient with urinary bladder MALT lymphoma and review of all published case reports in the literature. We summarized the reported immunophenotype of the neoplasm, ancillary studies, therapy, and follow-up for all 59 patients in the table. The median patients’ age was 57 years-old (range, 17 to 88), with female predominance in 50 of 59 patients representing a 1:5.6 ratio. Geographical distribution of the reported patients was as follows: 22 from Asia, of which more than a half (16) originated from Japan; 28 from Europe, of which 19 reported from the United Kingdom, and 3 patients were reported from the United States (including our patient). Twenty-three (77%) of 30 patients, for whom their clinical presentation was recorded, had symptoms of cystitis; Escherichia coli was the most common pathogen. We concluded that a prominent female predominance, uneven geographic distribution of urinary bladder MALT lymphoma, and a success of antibacterial therapy in selected cases suggest the link between urinary tract infection and urinary bladder MALT lymphoma.
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Affiliation(s)
- Kirill A Lyapichev
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Yana Ivashkevich
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Yaroslav Chernov
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Denis Chinenov
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Evgeniy Shpot
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander A Bessonov
- Breast Cancer Department, NMRC N.N. Petrov Research Institute of Oncology of the Ministry of Healthcare, St. Petersburg, Russia
| | - Bouthaina S Dabaja
- Radiation Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sergej Konoplev
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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Shiraiwa S, Kikuti YY, Carreras J, Hara R, Aoyama Y, Ogiya D, Suzuki R, Toyosaki M, Ohmachi K, Ogawa Y, Kawada H, Sato S, Nakamura N, Ando K. Clinicopathological evaluation of methotrexate-associated lymphoproliferative disorders with special focus on Epstein-Barr virus-positive mucocutaneous lesions. J Clin Exp Hematop 2020; 60:159-168. [PMID: 33148934 PMCID: PMC7810250 DOI: 10.3960/jslrt.20041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/09/2020] [Accepted: 09/12/2020] [Indexed: 11/25/2022] Open
Abstract
Some patients diagnosed with methotrexate-associated lymphoproliferative disorder (MTX-LPD) develop spontaneous regression upon the discontinuation of MTX, whereas others require chemotherapy. The mechanisms underlying this differential response and the capacity to spontaneously regress are not clearly understood. We evaluated numerous clinicopathological features in 63 patients diagnosed with MTX-LPD, with a special focus on those with Epstein-Barr virus (EBV)-positive mucocutaneous lesions (EBVMCL). The diagnosis of EBVMCL included cases of both EBV-positive mucocutaneous ulcers (EBVMCU) and diffuse gingival swelling associated with proliferation of EBV-positive large B-cells. Of the four subgroups of MTX-LPD, one-year treatment-free survival (TFS) after the discontinuation of MTX was achieved among those with EBVMCL (100%), diffuse large B-cell lymphoma (57%), Hodgkin-like lesions (60%), or classical Hodgkin lymphoma (29%); a significant difference in TFS was observed when comparing the responses of patients with EBVMCL to the those diagnosed with other subtypes. Multivariate analysis revealed predictive factors for prolonged TFS that included EBV-positive lesions and comparatively low levels of serum LDH. Taken together, our study suggests that a diagnosis of EBVMCL is related to the overall clinical outcome after the discontinuation of MTX.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Disease-Free Survival
- Epstein-Barr Virus Infections/chemically induced
- Epstein-Barr Virus Infections/metabolism
- Epstein-Barr Virus Infections/mortality
- Epstein-Barr Virus Infections/therapy
- Female
- Herpesvirus 4, Human/metabolism
- Hodgkin Disease/chemically induced
- Hodgkin Disease/metabolism
- Hodgkin Disease/mortality
- Hodgkin Disease/therapy
- Humans
- Lymphoma, Large B-Cell, Diffuse/chemically induced
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Methotrexate/administration & dosage
- Methotrexate/adverse effects
- Middle Aged
- Retrospective Studies
- Survival Rate
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Saito S, Takeuchi T. Immune response in LPD during methotrexate administration (MTX-LPD) in rheumatoid arthritis patients. J Clin Exp Hematop 2020; 59:145-155. [PMID: 31866617 PMCID: PMC6954173 DOI: 10.3960/jslrt.19028] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Methotrexate (MTX) is known as a first-line synthetic disease-modifying anti-rheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA). Although the risk of LPD development increases by RA inflammation itself, observation of spontaneous regression of LPD after MTX discontinuation lead to the theory of lymphomagenic role of MTX. In this review, we focused on the several immune response involved in LPD that developed under MTX administration in RA patients.
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14
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McFarlane IM, Bhamra MS, Amarnani A, Zhaz SY, Kolla S, Alvarez MR, Mo G, Srinivasan M, Hevroni G, Meisel T, Hasan A, Baguidy MS, Hadaddin M, Melamed A, Koci K, Taklalsingh N, Pathiparampil J, Freeman L, Kaplan I, Kabani N, Ozeri DJ, Watler E, Frefer M, Vaitkus V, Matthew K, Arroyo-Mercado F, Lyo H, Feoktistov A, Sanchez R, Soliman F, Valdez FR, Dronamraju V, Trevisonno M, Grant C, Clerger G, Sun K, Amin K, Dawkins M, Green J, Fahmy S, Jayarangaiah A, Waite SA, Burza A. Prevalence of Malignancy Among Urban Black Rheumatoid Arthritis Patients. INTERNATIONAL JOURNAL OF CLINICAL RESEARCH & TRIALS 2020; 5. [PMID: 32661506 DOI: 10.15344/2456-8007/2020/145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Rheumatoid arthritis (RA) patients have an increased risk of malignancy with postulated risk factors that include chronic inflammation, smoking and the use of immunosuppressants have been postulated as drivers of higher malignancies rates. Our study aimed to describe the prevalence and type of malignancies encountered in an urban, predominantly Black RA patient population. METHODS Cross sectional analysis of 1142 patients with RA diagnosis by ICD-codes of which 501 cases met the inclusion criteria for the study. Blacks accounted for 88.4% of the study population. Fifty-six patients had cancer recorded in their medical records and these cases were further reviewed for tumor type, timing of diagnosis and patient clinical characteristics. RESULTS The cancer prevalence was 11.2% (56/501) in our Black RA population being studied. Mean age at cancer diagnosis was 59.9 ± 5.2 for the patients who developed cancer before RA diagnosis and 58.25 ± 16.02 for those who developed malignancy after RA diagnosis. There were 18 breast cancers, 4 colon and 4 cervical cancers; for lung, multiple myeloma, thyroid, squamous cell carcinoma and pancreas there were 3 cases each; for endometrial, Non-Hodgkin's lymphoma, meningioma and prostate, 2 cases each and 1 each for urinary bladder, esophageal adenocarcinoma, lymphoma, glioblastoma, liver, Hodgkin's lymphoma, sarcoma, ovary and renal cell carcinoma. No differences were found in years of RA duration, joint erosion, joint space narrowing or SENS score except for significantly higher ESR among the cancer group and RF seropositivity in the non-cancer group.Therapeutic modalities were not significantly different between the cancer and no cancer groups. CONCLUSION Breast cancer was the most prevalent malignancy among our Black RA population. Further studies are needed to identify the contributing factors to the malignancy risk of breast cancer in our Black RA population and whether it is gender-related since RA is more prevalence in women.
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Affiliation(s)
- Isabel M McFarlane
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Manjeet S Bhamra
- Department of Medicine, Division of Rheumatology SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Abhimnayu Amarnani
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Su Yien Zhaz
- NCH Healthcare System Department of Rheumatology, Naples, FL 34110, USA
| | - Srinivas Kolla
- Department of Radiology SUNY Downstate Medical Center/Health and Hospitals Kings County, Brooklyn, NY 11203, USA
| | - Milena Rodriguez Alvarez
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - George Mo
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Maya Srinivasan
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Gil Hevroni
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Talia Meisel
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Abida Hasan
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Marie S Baguidy
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Michael Hadaddin
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Adielle Melamed
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Kristaq Koci
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Nicholas Taklalsingh
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Joshy Pathiparampil
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Latoya Freeman
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Ian Kaplan
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Naureen Kabani
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | | | - Elsie Watler
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Mosab Frefer
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Vytas Vaitkus
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Keron Matthew
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Fray Arroyo-Mercado
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Helen Lyo
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Aleksander Feoktistov
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Randolph Sanchez
- Department of Rheumatology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Faisal Soliman
- Department of Internal Medicine, Baptist Memorial Hospital-Tipton, 1995 Highway 51, South Covington, TN 38019, USA
| | - Felix Reyes Valdez
- Department of Pulmonary and Critical Care, Montefiore Medical Center Albert Einstein College of Medicine, Bronx, NY 10468, USA
| | - Veena Dronamraju
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Michael Trevisonno
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Christon Grant
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Guerrier Clerger
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Kunfeng Sun
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Khabbab Amin
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Makeda Dawkins
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Jason Green
- Department of Medicine, Division of Rheumatology SUNY Downstate Medical Center/Health and Hospitals/Kings County, Brooklyn, NY 11203, USA
| | - Samir Fahmy
- NCH Healthcare System Department of Rheumatology, Naples, FL 34110, USA
| | - Apoorva Jayarangaiah
- Department of Internal Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, NY, USA
| | - Stephen Anthony Waite
- Department of Radiology SUNY Downstate Medical Center/Health and Hospitals Kings County, Brooklyn, NY 11203, USA
| | - Aaliya Burza
- Department of Medicine, Division of Pulmonary and Critical Care State, SUNY Downstate Medical Center/Health and Hospitals Kings County, Brooklyn, NY 11203, USA
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Diffuse large B-cell lymphoma involving the left sternoclavicular joint mimicking rheumatoid arthritis flare: a case-based review. Rheumatol Int 2020; 40:651-655. [PMID: 32036399 DOI: 10.1007/s00296-020-04528-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting primarily joints and an increased risk of developing malignant lymphomas in RA has been well reported. However, primary lymphoma in a joint in RA patient is rare. We report the case of a 65-year-old man with RA suffering from pain and swelling of left sternoclavicular (SC) joint, which was not relieved by adding low-dose glucocorticoid. Magnetic resonance imaging (MRI) showed a para-osseous soft tissue swelling around the SC joint and a fracture of proximal clavicle. Histology of the soft tissue demonstrated diffuse large B-cell lymphoma and the patient subsequently underwent R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. He was successfully treated with six cycles of R-CHOP chemotherapy, with discontinuation of MTX, resulting in a complete response. We performed a literature review and identified nine cases of lymphoma which involved joints in patients with rheumatoid arthritis. This is the first described case of a primary large B-cell lymphoma involving the unilateral SC joint in a patient with RA, which was initially confused with aggravation of RA. Therefore, malignant lymphoma should be considered in the differential diagnosis when a RA patient develops monoarthritis with spontaneous fracture, even without B symptoms.
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16
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Cancer risk and tumour necrosis factor inhibitors in patients with inflammatory arthritis. Pharmacol Res 2019; 158:104507. [PMID: 31678639 DOI: 10.1016/j.phrs.2019.104507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 12/24/2022]
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17
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Agrawal K, Agrawal N, Levin M. Primary Synovial Diffuse Large B-Cell Lymphoma Presenting as Loosening of Prosthetic Joint: A Case Report and Review of Literature. World J Oncol 2019; 10:181-185. [PMID: 31636792 PMCID: PMC6785272 DOI: 10.14740/wjon1213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/04/2019] [Indexed: 11/11/2022] Open
Abstract
Primary synovial diffuse B-cell lymphoma is a rare clinical condition. The condition presents primarily with localized joint symptoms such as swelling, pain and reduced range of motion. It may or may not be associated with lymphadenopathy, hepatosplenomegaly or B-type constitutional symptoms. We report a case of a 74-year-old woman who presented with persistent left knee pain and swelling after left knee replacement secondary to osteoarthritis. There was a concern for mechanical loosening of internal left knee prosthetic joint. On revision surgery (14 weeks after the initial surgery), hypertrophied synovium with areas of fibrotic scars, necrotic tissue and dark colored masses was resected. She was found to have diffuse large B-cell lymphoma (DLBCL) after histological analysis. In cases with persistent joint symptoms or postoperative complications, arthroscopy or arthrotomy should be considered and any atypical appearing tissue should be sent for histopathological analysis.
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Affiliation(s)
- Kavita Agrawal
- Department of Internal Medicine, Overlook Medical Center, Summit, NJ 07901, USA
| | - Nirav Agrawal
- The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA
| | - Miles Levin
- Department of Pathology, Overlook Medical Center, Summit, NJ 07901, USA
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18
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Yang CM, Fang MY. [The correlation between rheumatic immunopathy and lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:880-883. [PMID: 31775495 PMCID: PMC7364991 DOI: 10.3760/cma.j.issn.0253-2727.2019.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Indexed: 11/05/2022]
Affiliation(s)
- C M Yang
- Department of Zhongshan Hospital Affiliated to Dalian University, Dalian 116000, China
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19
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Next-Generation Sequencing Profiles of the Methylome and Transcriptome in Peripheral Blood Mononuclear Cells of Rheumatoid Arthritis. J Clin Med 2019; 8:jcm8091284. [PMID: 31443559 PMCID: PMC6780767 DOI: 10.3390/jcm8091284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open
Abstract
Using next-generation sequencing to decipher methylome and transcriptome and underlying molecular mechanisms contributing to rheumatoid arthritis (RA) for improving future therapies, we performed methyl-seq and RNA-seq on peripheral blood mononuclear cells (PBMCs) from RA subjects and normal donors. Principal component analysis and hierarchical clustering revealed distinct methylation signatures in RA with methylation aberrations noted across chromosomes. Methylation alterations varied with CpG features and genic characteristics. Typically, CpG islands and CpG shores were hypermethylated and displayed the greatest methylation variance. Promoters were hypermethylated and enhancers/gene bodies were hypomethylated, with methylation variance associated with expression variance. RA genetically associated genes preferentially displayed differential methylation and differential expression or interacted with differentially methylated and differentially expressed genes. These differentially methylated and differentially expressed genes were enriched with several signaling pathways and disease categories. 10 genes (CD86, RAB20, XAF1, FOLR3, LTBR, KCNH8, DOK7, PDGFA, PITPNM2, CELSR1) with concomitantly differential methylation in enhancers/promoters/gene bodies and differential expression in B cells were validated. This integrated analysis of methylome and transcriptome identified novel epigenetic signatures associated with RA and highlighted the interaction between genetics and epigenetics in RA. These findings help our understanding of the pathogenesis of RA and advance epigenetic studies in regards to the disease.
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20
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Other immunomodulatory agent-related lymphoproliferative diseases: a single-center series of 72 biopsy-confirmed cases. Mod Pathol 2018; 31:1457-1469. [PMID: 29765143 DOI: 10.1038/s41379-018-0054-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/12/2018] [Accepted: 03/24/2018] [Indexed: 02/08/2023]
Abstract
Ongoing development of new drugs, as well as novel indications in the treatment of autoimmune diseases leads to the increasing use of immunomodulatory and immunosuppressive drugs. Immunomodulatory agent-related lymphoproliferative disorders are a known and potentially life threatening complication of chronic administration of these drugs, but are less well characterized compared with post-transplant lymphoproliferative disorders. The heterogeneous drug targets, various underlying disease indications, different drug combinations used and relatively low incidence render data collection and interpretation difficult. In this retrospective paper, we describe the clinicopathological characteristics of a larger single-center series of 72 immunomodulatory agent-related lymphoproliferative disorder cases. We divided the cases according to the therapy, administered in the year preceding diagnosis of a lymphoproliferative disorder, in an immunosuppressive drug, an immunomodulatory drug and a combination of immunosuppressive and immunomodulatory drugs group. We observed differences in "time to lymphoproliferative disorder development" with a shorter time for all the immunomodulatory drug-related cases combined (immunomodulatory and immunomodulatory + immunosuppressive = immunomodulatory-all) vs immunosuppressive-only (p = 0.0031). The proportion of malignant cases in patients receiving immunomodulatory therapy was, however, also significantly lower when compared with the immunosuppressive treated cases (43 vs 88%; p = 0.0184). The immunomodulatory/suppressive agent-related lymphoproliferative disorders were less often associated with the Epstein-Barr virus (EBV) (31 vs 66%; p = 1.829e-05) and the lymphoproliferative disorders incidence in the first year after immunomodulatory/immunosuppressive therapy initiation was lower (18 vs 41%; p = 0.04151)-compared with a published series of 140 post-transplant lymphoproliferative disorder cases from the same center. However, a similar histopathological spectrum from nondestructive, to polymorphic and monomorphic lesions as in post-transplant lymphoproliferative disorders is observed. With increasing use of immunosuppressive and especially immunomodulatory therapy, a higher incidence of immunomodulatory/suppressive agent-related lymphoproliferative disorders is to be expected. Life-long awareness for development of immunomodulatory/suppressive agent-related lymphoproliferative disorders with clinical follow-up and timely biopsies of suspicious lesions is required since these lymphoproliferative disorders arise both early after therapy initiation and many years later. Histopathological confirmation and correct classification is necessary to guide therapy and EBV ISH should be a part of routine pathological diagnostics.
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21
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Hatano T, Ohishi M, Yoshimoto G, Yamauchi M, Maekawa A, Yamamoto H, Oda Y, Endo M, Bekki H, Matsunobu T, Nakashima Y, Okazaki K, Fukushi JI, Oyamada A, Iwamoto Y. Methotrexate-Related Lymphoproliferative Disorder Presenting with Severe Swelling of the Elbow Joint: A Case Report. JBJS Case Connect 2018; 7:e65. [PMID: 29252894 DOI: 10.2106/jbjs.cc.17.00002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A patient with rheumatoid arthritis (RA) who was being treated with methotrexate (MTX) therapy presented with severe swelling of the left elbow. Magnetic resonance imaging showed a tumor-like lesion around the elbow joint. Fluorodeoxyglucose positron emission tomography indicated multiple lesions in the lung and the lymph nodes. An open biopsy of a cervical lymph node was performed, and MTX-related lymphoproliferative disorder (MTX-LPD) was diagnosed. After cessation of the MTX therapy, the elbow swelling regressed, and the patient was in remission of MTX-LPD. CONCLUSION MTX-LPD should be considered in the differential diagnosis when a patient with RA develops severe joint swelling while on MTX therapy.
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Affiliation(s)
- Takashi Hatano
- Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan
| | - Masanobu Ohishi
- Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan
| | - Goichi Yoshimoto
- Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan
| | - Moriyasu Yamauchi
- Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan
| | - Akira Maekawa
- Departments of Anatomic Pathology and Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Departments of Anatomic Pathology and Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Departments of Anatomic Pathology and Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makoto Endo
- Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan
| | - Hirofumi Bekki
- Departments of Anatomic Pathology and Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoya Matsunobu
- Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan
| | - Yasuharu Nakashima
- Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan
| | - Ken Okazaki
- Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan
| | - Jun-Ichi Fukushi
- Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan
| | - Akiko Oyamada
- Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan
| | - Yukihide Iwamoto
- Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan
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Genomic Profile and Pathologic Features of Diffuse Large B-Cell Lymphoma Subtype of Methotrexate-associated Lymphoproliferative Disorder in Rheumatoid Arthritis Patients. Am J Surg Pathol 2018; 42:936-950. [DOI: 10.1097/pas.0000000000001071] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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23
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Gamage KKK, Rifath MIM, Fernando H. Migratory polyarthritis as a paraneoplastic syndrome in a patient with diffuse large B cell lymphoma: a case report. J Med Case Rep 2018; 12:189. [PMID: 29941035 PMCID: PMC6019218 DOI: 10.1186/s13256-018-1700-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Diffuse large B cell lymphoma is the commonest histological subtype of non-Hodgkin lymphoma and typically presents as a rapidly enlarging lymph node mass and B symptoms. It is unusual for diffuse large B cell lymphoma to present as carcinomatous polyarthritis which is a type of paraneoplastic arthritis. Case presentation We present a case of a 45-year-old Asian man with diffuse large B cell lymphoma presenting with generalized lymphadenopathy, transient macular rash, and migratory polyarthritis involving both upper and lower limb small and large joints. Treatment of the lymphoma but not the routine anti-inflammatory agents resulted in complete resolution of the arthritis suggesting the paraneoplastic nature. Conclusions Poor response to routine therapy for inflammatory arthritis should lead to early suspicion of paraneoplastic arthritis which will prompt investigation for an underlying malignancy. Suspicion of carcinomatous polyarthritis should be made in those with migratory polyarthritis and should be thoroughly investigated to exclude underlying malignancy.
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24
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Klein A, Polliack A, Gafter‐Gvili A. Rheumatoid arthritis and lymphoma: Incidence, pathogenesis, biology, and outcome. Hematol Oncol 2018; 36:733-739. [DOI: 10.1002/hon.2525] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Alina Klein
- Medicine A, Rabin Medical Center Petah‐Tikva Israel
| | - Aaron Polliack
- Department of Hematology, Hadassah University HospitalHebrew University Medical School Jerusalem Israel
| | - Anat Gafter‐Gvili
- Medicine A, Rabin Medical Center Petah‐Tikva Israel
- Sackler School of Medicine Tel‐Aviv Israel
- Institute of HematologyDavidoff Cancer Center Petah‐Tikva Israel
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25
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Iatrogenic T-Cell Lymphoma with Associated Hemophagocytic Lymphohistiocyotsis in a Patient with Long-Standing Rheumatoid Arthritis. Case Rep Hematol 2018. [PMID: 29515924 PMCID: PMC5821964 DOI: 10.1155/2018/8097965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Patients with rheumatoid arthritis are at increased risk of hematological malignancies, especially when exposed to immunosuppressive therapy. The mechanisms of lymphomagenesis remain poorly understood but factors implicated include high disease activity, exposure to antitumoral necrosis factor medications, and Epstein–Barr virus infection. Lymphoid malignancies of T-cell origin are uncommon in patients with rheumatoid arthirits. Clinical presentation with associated hemophagocytic lymphohistiocyotsis is rare and confers a poor prognosis. This case report illustrates a case of a patient with long-standing rheumatoid arthritis and an iatrogenic peripheral T-cell lymphoma with secondary hemophagocytic lymphohistiocytosis who achieved a complete response after intensive chemotherapy.
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Mercer LK, Regierer AC, Mariette X, Dixon WG, Baecklund E, Hellgren K, Dreyer L, Hetland ML, Cordtz R, Hyrich K, Strangfeld A, Zink A, Canhao H, Hernandez MV, Tubach F, Gottenberg JE, Morel J, Zavada J, Iannone F, Askling J, Listing J. Spectrum of lymphomas across different drug treatment groups in rheumatoid arthritis: a European registries collaborative project. Ann Rheum Dis 2017; 76:2025-2030. [PMID: 28822981 PMCID: PMC5705847 DOI: 10.1136/annrheumdis-2017-211623] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/13/2017] [Accepted: 07/19/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Lymphomas comprise a heterogeneous group of malignant diseases with highly variable prognosis. Rheumatoid arthritis (RA) is associated with a twofold increased risk of both Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). It is unknown whether treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) affect the risk of specific lymphoma subtypes. METHODS Patients never exposed to (bionaïve) or ever treated with bDMARDs from 12 European biologic registers were followed prospectively for the occurrence of first ever histologically confirmed lymphoma. Patients were considered exposed to a bDMARD after having received the first dose. Lymphomas were attributed to the most recently received bDMARD. RESULTS Among 124 997 patients (mean age 59 years; 73.7% female), 533 lymphomas were reported. Of these, 9.5% were HL, 83.8% B-cell NHL and 6.8% T-cell NHL. No cases of hepatosplenic T-cell lymphoma were observed. Diffuse large B-cell lymphoma (DLBCL) was the most frequent B-cell NHL subtype (55.8% of all B-cell NHLs). The subtype distributions were similar between bionaïve patients and those treated with tumour necrosis factor inhibitors (TNFi). For other bDMARDs, the numbers of cases were too small to draw any conclusions. Patients with RA developed more DLBCLs and less chronic lymphocytic leukaemia compared with the general population. CONCLUSION This large collaborative analysis of European registries has successfully collated subtype information on 533 lymphomas. While the subtype distribution differs between RA and the general population, there was no evidence of any modification of the distribution of lymphoma subtypes in patients with RA treated with TNFi compared with bionaïve patients.
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Affiliation(s)
- Louise K Mercer
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Anne C Regierer
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, Paris, France
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Eva Baecklund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Hellgren
- Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Lene Dreyer
- Center for Rheumatology and Spine Diseases, Gentofte University Hospital, Rigshospitalet, Hellerup, Denmark.,The Parker Institute, Frederiksberg, Denmark
| | - Merete Lund Hetland
- DANBIO, Copenhagen Center for Arthritis Research, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - René Cordtz
- Center for Rheumatology and Spine Diseases, Gentofte University Hospital, Rigshospitalet, Hellerup, Denmark.,The Parker Institute, Frederiksberg, Denmark
| | - Kimme Hyrich
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK.,Musculoskeletal Biomedical Research Unit, National Institute of Health Research Manchester, Central Manchester NHS Foundation Trust, Manchester Academic Health Science, Manchester, UK
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.,CharitéUniversitätsmedizin Berlin, Berlin, Germany
| | - Helena Canhao
- EpiDoC Unit, Universidade Nova de Lisboa, CEDOC, NOVA Medical School and National School of Public Health, Lisbon, Portugal
| | | | - Florence Tubach
- Département of BIOSPIM, Département BIOSPIM Hôpital Pitié-Salpétrière, AP-HP, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
| | | | - Jacques Morel
- Department of Rheumatology, University of Montpellier and Teaching Hospital Lapeyronie, Montpellier, France
| | - Jakub Zavada
- Institute of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Johan Askling
- Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Joachim Listing
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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Klein A, Reinhard H, Mueller AM, Horneff G. Spontaneous regression of Epstein-Barr virus-associated lymphoproliferative disorder in a juvenile idiopathic arthritis patient after the discontinuation of methotrexate and etanercept. Eur J Rheumatol 2017. [PMID: 28638688 DOI: 10.5152/eurjrheum.2016.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A case of a 16-year-old female with polyarticular juvenile idiopathic arthritis (JIA) since the age of 4 years is reported here. This patient also suffered from multiple congenital anomalies. On long-term treatment with oral methotrexate (MTX) and etanercept, multiple subcutaneous nodules were detected, which were accompanied by increased lactate dehydrogenase and uric acid levels. A biopsy of the largest nodule revealed Epstein-Barr (EB) virus-positive diffuse large B-cell lymphoma (DLBCL). The patient was classified as clinical stage IIIA due to a mediastinal lesion. Immunosuppressive treatment was discontinued immediately, which led to regression of the remaining nodules and normalization of the lactate dehydrogenase levels. The patient was considered to have an iatrogenic lymphoproliferative disorder classified as "other iatrogenic immunodeficiency-associated lymphoproliferative disorders" by the World health organization (WHO). To our knowledge, this is the first case report of a JIA patient with EBV-positive DLBCL following the administration of etanercept and methotrexate and spontaneous regression of lymphoproliferation after the discontinuation of antirheumatic treatment.
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Affiliation(s)
- Ariane Klein
- Department of General Pediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | - Harald Reinhard
- Department of General Pediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | - Annette M Mueller
- Center of Pediatric Pathology, MVZ Venusberg, University Clinic Bonn, Bonn, Germany
| | - Gerd Horneff
- Department of General Pediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
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28
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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.
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29
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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.
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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
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30
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Wilson-Robles H, Budke CM, Miller T, Dervisis N, Novosad A, Wright Z, Thamm DH, Vickery K, Burgess K, Childress M, Lori J, Saba C, Rau S, Silver M, Post G, Reeds K, Gillings S, Schleis S, Stein T, Brugmann B, DeRegis C, Smrkovski O, Lawrence J, Laver T. Geographical differences in survival of dogs with non-Hodgkin lymphoma treated with a CHOP based chemotherapy protocol. Vet Comp Oncol 2017; 15:1564-1571. [PMID: 28419683 DOI: 10.1111/vco.12302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND In humans geographical differences in the incidence and presentation of various cancers have been reported. However, much of this information has not been collected in veterinary oncology. AIM The purpose of this study was to determine if a geographic difference in progression free survival exists for dogs with lymphoma treated within the US. MATERIALS AND METHODS Medical records of 775 cases of canine lymphoma from 3 US regions (west, south and north), treated with CHOP chemotherapy, were retrospectively evaluated. Cases were collected from referral institutions and were required to have received at least one doxorubicin treatment and have follow up information regarding time to progression. RESULTS Significant differences in sex (p = 0.05), weight (p = 0.049), stage (p < 0.001), immunophenotype (p = <0.001), and number of doxorubicin doses (p = 0.001) were seen between regions. Upon univariate analysis, progression free survival (PFS) differed by region (p = 0.006), stage (p = 0.009), sub-stage (p = 0.0005), and immunophenotype (p = 0.001). A multivariable Cox regression model showed that dogs in the western region had a significantly shorter PFS when compared to the south and east. CONCLUSION PFS was significantly affected by stage, sub-stage and phenotype.
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Affiliation(s)
- H Wilson-Robles
- Small Animal Clinical Sciences Department, College of Veterinary Medicine, Texas A&M University, College Station, Texas
| | - C M Budke
- Veterinary Integrative Biosciences Department, College of Veterinary Medicine, Texas A&M University, College Station, Texas
| | - T Miller
- Small Animal Clinical Sciences Department, College of Veterinary Medicine, Texas A&M University, College Station, Texas
| | - N Dervisis
- Small Animal Clinical Sciences Department, Veterinary Medical Center, Michigan State University, East Lansing, Michigan
| | - A Novosad
- Sugar Land Veterinary Specialists and Emergency Care, Sugar Land, Texas
| | - Z Wright
- VCA Animal Diagnostic Clinic, Dallas, Texas
| | - D H Thamm
- Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
| | - K Vickery
- Hope Veterinary Specialists, Malvern, Pennsylvania
| | - K Burgess
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - M Childress
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - J Lori
- Animal Emergency and Specialty Center, Parker, Colorado
| | - C Saba
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota
| | - S Rau
- Metropolitan Veterinary Associates, Norristown, Pennsylvania
| | - M Silver
- New England Veterinary Oncology Group, Waltham, Massachusetts
| | - G Post
- Department of Oncology, The Veterinary Cancer Center, Norwalk, Connecticut
| | - K Reeds
- Veterinary Clinical Sciences Department, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - S Gillings
- Summit Veterinary Referral Center, Tacoma, Washington
| | - S Schleis
- Clinical Sciences Department, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - T Stein
- Medical Sciences Department, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - B Brugmann
- Veterinary Clinical Sciences Department, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana
| | - C DeRegis
- Pieper Memorial Veterinary Center, Middletown, Connecticut
| | - O Smrkovski
- Small Animal Clinical Sciences Department, College of Veterinary Medicine, University of Tennessee, Knoxville, Tennessee
| | - J Lawrence
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota
| | - T Laver
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
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31
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Wong VTL, Lao WN. Risk of malignancy in patients with rheumatic disorders. HONG KONG BULLETIN ON RHEUMATIC DISEASES 2016. [DOI: 10.1515/hkbrd-2016-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Patients with autoimmune rheumatic diseases including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren’s syndrome (SS), and inflammatory myositis are at increased risk of developing malignancies. Treatment of these conditions, including disease-modifying anti-rheumatic drugs (DMARDs) and biologic therapies, are also associated with increased risk of malignancies.Cancer adds to the disease burden in these patients, affecting their quality of life and life expectancy. The decision in choosing immunosuppressive agents in these rheumatic diseases should take into account the disease severity, expectation for disease control, comorbidities, as well asthe side effects including risks of cancer.
This article does not include the risk of malignancy in patients with the idiopathic inflammatory myopathies, which are well-recognized paraneoplastic conditions.
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Affiliation(s)
- Victor Tak-lung Wong
- MBChB (HK), MRCP (UK), Resident, Department of Medicine, Kwong Wah Hospital , 25 Waterloo Road , Kowloon , Hong Kong
| | - Weng-nga Lao
- MBBS (HK), MRCP (UK), FHKAM (Med), Associate Consultant, Department of Medicine, Kwong Wah Hospital , 25 Waterloo Road , Kowloon , Hong Kong
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32
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Benzerdjeb N, Ameur F, Ikoli JF, Sevestre H. Primary cardiac B cell lymphoma: Manifestation of Felty's syndrome or TNFα antagonist. Pathol Res Pract 2016; 212:1191-1193. [PMID: 27773517 DOI: 10.1016/j.prp.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/21/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
Primary cardiac B cell lymphoma is rare. To date, fewer than 90 cases have been described in the literature. We report a 67-year-old woman with a 30-year history of rheumatoid arthritis, who had received treatment with leflunomide for 10 years and infliximab for 2 years. Secondary Felty's syndrome appeared. She was admitted to the hospital for abdominal pain. Investigations disclosed a 5cm cardiac mass in the right atrium. Histopathologic examination of tissue specimens obtained at surgical myocardial biopsy demonstrated primary cardiac B cell lymphoma. The other iatrogenic lymphoproliferative disorders are reviewed. This lesion might be a manifestation of long term TNFα antagonists treatment.
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Affiliation(s)
| | - Fatima Ameur
- Department of Radiology, Amiens University Hospital, France
| | | | - Henri Sevestre
- Department of Pathology, Amiens University Hospital, France
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33
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Juneblad K, Rantapää-Dahlqvist S, Alenius GM. Disease Activity and Increased Risk of Cardiovascular Death among Patients with Psoriatic Arthritis. J Rheumatol 2016; 43:2155-2161. [DOI: 10.3899/jrheum.160070] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 01/22/2023]
Abstract
Objective.Recent studies indicate increased cardiovascular (CV) morbidity and mortality in patients with psoriatic arthritis (PsA), but results are inconsistent. This prompted our investigation of the mortality rate, cause of death, and incidence of acute CV events in patients from northern Sweden with PsA.Methods.Patients with established PsA (464) were included. To calculate standardized mortality ratio (SMR) and standardized incidence ratio (SIR) for CV events, data were extracted from the National Causes of Death Register and the National Inpatient Care Register in Sweden, and compared with the general population. The study period was 1995–2011. To study the effect of inflammatory activity, a composite disease activity index (DAI) was used.Results.The SMR (95% CI) for overall mortality and diseases of the circulatory system (International Classification of Diseases, 10th edition; I00-I99) was 1.22 (0.89–1.63) and 1.64 (1.02–2.52), respectively. In regression analysis, DAI was significantly associated with death (OR 1.99, 95% CI 1.41–2.80) when adjusted for age and sex (p < 0.001), and remained significant after stratifying patients into the 2 major causes of death: diseases of the circulatory system and malignant neoplasms. Peripheral and axial disease was associated with death (OR 4.02, 95% CI 1.84–8.84, p < 0.001) compared with peripheral disease only. The SIR (95% CI) for a CV event (myocardial infarction or stroke) was 0.597 (0.40–0.86); this association was only significant in men.Conclusion.Patients with PsA had a small but significant increase in SMR for death due to diseases of the circulatory system compared with the general population. Among patients, death was associated with DAI, as well as axial involvement in combination with peripheral disease, indicating more aggressive disease phenotypes.
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34
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Mercer LK, Galloway JB, Lunt M, Davies R, Low ALS, Dixon WG, Watson KD, Symmons DPM, Hyrich KL. Risk of lymphoma in patients exposed to antitumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Ann Rheum Dis 2016; 76:497-503. [PMID: 27502891 PMCID: PMC5446004 DOI: 10.1136/annrheumdis-2016-209389] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/22/2016] [Accepted: 06/19/2016] [Indexed: 11/24/2022]
Abstract
Objectives Patients with rheumatoid arthritis (RA) are at increased risk of lymphoma compared with the general population. There are concerns that tumour necrosis factor inhibitors (TNFi) may exacerbate this risk. However, since the excess risk of lymphoma in RA is related to the cumulative burden of inflammation, TNFi may conversely reduce the risk of lymphoma by decreasing the burden of inflammation. The aim of this study was to compare the risk of lymphoma in subjects with RA treated with TNFi with those treated with non-biological therapy. Methods Subjects diagnosed by a rheumatologist with RA enrolled in the British Society for Rheumatology Rheumatoid Arthritis Register (BSRBR-RA), a prospective cohort study, were followed until first lymphoma, death or until 30 November 2013. Rates of lymphoma in the TNFi and non-biological-treated cohorts were compared using Cox regression. Results 11 931 TNFi-treated patients were compared with 3367 biological-naive patients. 84 lymphomas (88 (95% CI 70 to 109) per 100 000 person-years) were reported in the TNFi cohort and 30 lymphomas (154 (95% CI 104 to 220)) in the biological-naive cohort. After adjusting for differences in baseline characteristics, there was no difference in the risk of lymphoma for the TNFi versus the biological-naive group: HR 1.00 (95% CI 0.56 to 1.80). No risk differences were observed for individual TNFi. Conclusions In medium-term follow-up, there is no evidence that tumour necrosis factor inhibition influences the risk of lymphoma over the background risk in subjects with RA.
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Affiliation(s)
- Louise K Mercer
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rebecca Davies
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Audrey L S Low
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - William G Dixon
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Kath D Watson
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | - Deborah P M Symmons
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
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35
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Kojima M, Itoh H, Shimizu K, Saruki N, Murayama K, Higuchi K, Tamaki Y, Matsumoto M, Hirabayashi K, Igarishi S, Masawa N, Nakamura S. Malignant Lymphoma in Patients with Systemic Rheumatic Disease (Rheumatoid Arthritis, Systemic Lupus Erythematosus, Systemic Sclerosis, and Dermatomyositis): A Clinicopathologic Study of 24 Japanese Cases. Int J Surg Pathol 2016; 14:43-8. [PMID: 16501834 DOI: 10.1177/106689690601400108] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We conducted clinicopathologic and immunohistochemical analyses of the prevalence of Epstein-Barr virus (EBV) among 24 patients with malignant lymphoma complicating systemic rheumatic diseases. (SRD) These 24 patients included 17 with rheumatoid arthritis (RA), 3 with systemic lupus erythematosus (SLE), 2 with systemic sclerosis (SS), and 2 with dermatomyositis (DM). There were 2 men and 22 women ranging in age from 30 to 86 years (mean: 64 years). The interval between the onset of rheumatic disease and that of malignant lymphomas ranged from 3 months to 35 years (mean: 142 months). The use of immunosuppressive drugs before the onset of malignant lymphoma was recorded in 15 patients. Among them, 5 patients received methotrexate (MTX) therapy. Malignant lymphomas were found at extranodal sites in 9 patients, and the disease was in the advanced stage in 17 patients. Histologic and immunohistochemical studies demonstrated that 18 cases (75%) were B-cell lymphoma (RA=12, SLE=2, SS=2, DM=2), 3 (12.5%) were peripheral T-cell lymphoma (RA=3), and 3 (12.5%) were classical Hodgkin lymphoma (RA=2, SLE=1). As in previous reports, there was an increased frequency of diffuse large B-cell lymphoma (50%) in the present series. Moreover, a majority of the diffuse large B-cell lymphomas exhibited activated B-cell phenotype. EBV-encoded small RNAs (Epstein-Barr early region [EBER]-) and/or LMP-1+tumor cells were identified in only 3 cases of classical Hodgkin lymphomas. Our findings suggested EBV-associated lymphoma comprised only a small fraction of all non-Hodgkin's lymphomas in the general SRD patient population.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD20/analysis
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/pathology
- Dermatomyositis/complications
- Dermatomyositis/pathology
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/epidemiology
- Epstein-Barr Virus Infections/pathology
- Female
- Herpesvirus 4, Human/genetics
- Hodgkin Disease/complications
- Hodgkin Disease/pathology
- Hodgkin Disease/virology
- Humans
- Immunohistochemistry
- Japan
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/pathology
- Lymphoma/complications
- Lymphoma/pathology
- Lymphoma/virology
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/virology
- Lymphoma, T-Cell/complications
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell/virology
- Male
- Middle Aged
- RNA, Viral/analysis
- Rheumatic Diseases/complications
- Rheumatic Diseases/pathology
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/pathology
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Affiliation(s)
- Masaru Kojima
- Department of Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, Ohta, Dokkyo University School of Medicine, Mibu, Japan
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Autoimmune/Inflammatory Arthritis Associated Lymphomas: Who Is at Risk? BIOMED RESEARCH INTERNATIONAL 2016; 2016:8631061. [PMID: 27429984 PMCID: PMC4939344 DOI: 10.1155/2016/8631061] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/17/2016] [Accepted: 05/25/2016] [Indexed: 12/13/2022]
Abstract
Specific autoimmune and inflammatory rheumatic diseases have been associated with an increased risk of malignant lymphomas. Conditions such as rheumatoid arthritis (RA), primary Sjögren's syndrome (pSS), systemic lupus erythematosus (SLE), dermatomyositis, and celiac disease have been consistently linked to malignant lymphomas. Isolated cases of lymphomas associated with spondyloarthropathies and autoinflammatory diseases have also been reported. Direct association between autoimmunity and lymphomagenesis has been reinforced by large epidemiological studies. It is still uncertain whether disease specific determinants or phenotypic or treatment related characteristics increase likelihood of lymphomagenesis in these patients. For example, recent literature has indicated a positive correlation between severity of inflammation and risk of lymphomas among RA and Sjögren's syndrome patients. It is also debated whether specific lymphoma variants are more commonly seen in accordance with certain chronic autoimmune arthritis. Previous studies have revealed a higher incidence of diffuse large B-cell lymphomas in RA and SLE patients, whereas pSS has been linked with increased risk of mucosa-associated lymphoid tissue lymphoma. This review summarizes recent literature evaluating risk of lymphomas in arthritis patients and disease specific risk determinants. We also elaborate on the association of autoimmune arthritis with specific lymphoma variants along with genetic, environmental, and therapeutic risk factors.
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Koff JL, Flowers CR. B cells gone rogue: the intersection of diffuse large B cell lymphoma and autoimmune disease. Expert Rev Hematol 2016; 9:553-61. [PMID: 27098121 DOI: 10.1080/17474086.2016.1180972] [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] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Diffuse large B cell lymphoma (DLBCL) is characterized by genetic, genomic and clinical heterogeneity. Autoimmune diseases (AIDs) have recently been shown to represent significant risk factors for development of DLBCL. AREAS COVERED Studies that examined the relationships between AIDs and lymphoma in terms of pathogenesis, genetic lesions, and treatment were identified in the MEDLINE database using combinations of medical subject heading (MeSH) terms. Co-authors independently performed study selection for inclusion based on appropriateness of the study question and nature of the study design and sample size. Expert commentary: Identification of AID as a substantial risk factor for DLBCL raises new questions regarding how autoimmunity influences lymphomagenesis and disease behavior. It will be important to identify whether DLBCL cases arising in the setting of AID harbor inferior prognoses, and, if so, whether they also exhibit certain molecular abnormalities that may be targeted to overcome such a gap in clinical outcomes.
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Affiliation(s)
- Jean L Koff
- a Department of Hematology and Medical Oncology, Winship Cancer Institute , Emory University , Atlanta , GA , USA
| | - Christopher R Flowers
- a Department of Hematology and Medical Oncology, Winship Cancer Institute , Emory University , Atlanta , GA , USA
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McKelvie P, Yixing Lai F, Verma A, Bazargan A. Methotrexate-associated EBV-positive CD20-negative diffuse large B-cell lymphoma localized to skin presenting as multiple chronic lower leg ulcers. Leuk Lymphoma 2015; 57:456-460. [PMID: 26110881 DOI: 10.3109/10428194.2015.1049165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Penelope McKelvie
- a Department of Anatomical Pathology , St Vincent's Hospital Melbourne , Fitzroy , VIC , Australia
| | - Francis Yixing Lai
- b Department of Dermatology , St Vincent's Hospital Melbourne , Fitzroy , VIC , Australia
| | - Amit Verma
- b Department of Dermatology , St Vincent's Hospital Melbourne , Fitzroy , VIC , Australia
| | - Ali Bazargan
- c Department of Haematology , St Vincent's Hospital Melbourne , Fitzroy , VIC , Australia
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Brauner S, Zhou W, Backlin C, Green TM, Folkersen L, Ivanchenko M, Löfström B, Xu-Monette ZY, Young KH, Møller Pedersen L, Boe Møller M, Sundström C, Enblad G, Baecklund E, Wahren-Herlenius M. Reduced expression of TRIM21/Ro52 predicts poor prognosis in diffuse large B-cell lymphoma patients with and without rheumatic disease. J Intern Med 2015; 278:323-32. [PMID: 25880119 DOI: 10.1111/joim.12375] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE TRIM21 (also known as Ro52) is an autoantigen in rheumatic disease and is predominantly expressed in leucocytes. Overexpression is associated with decreased proliferation, and the TRIM21 gene maps to a tumour suppressor locus. We therefore investigated the expression of TRIM21 in patients with diffuse large B-cell lymphoma (DLBCL) and its potential usefulness as a prognostic biomarker. MATERIALS AND METHODS TRIM21 expression levels were assessed by immunohistochemistry in lymphoma biopsies from three cohorts of patients with DLBCL: 42 patients with rheumatic disease treated with a cyclophosphamide, vincristine, doxorubicin and prednisone (CHOP)-like regimen, 76 CHOP-treated and 196 rituximab-CHOP-treated nonrheumatic patients. Expression was correlated with clinical and biomedical parameters. TRIM21 expression was assessed in relation to lymphocyte proliferation by quantitative PCR and correlated with (3) H-thymidine incorporation and propidium iodine staining. RESULTS TRIM21 expression levels differed in the lymphomas compared to normal lymphoid tissue, with reduced expression correlating with shorter overall survival in all three cohorts. In the two larger cohorts, progression-free survival was assessed and was also found to correlate with TRIM21 expression. The association was independent of commonly used clinical prognostic scores, lymphoma subtype and several previously reported prognostic biomarkers. In agreement with this clinical observation, we noted an inverse correlation between TRIM21 expression and proliferation of leucocytes in vitro. CONCLUSIONS We show that loss of TRIM21 expression is associated with more aggressive lymphoma and increased proliferation, whereas maintenance of TRIM21 expression is associated with better prognosis in patients with DLBCL. Based on our findings, we suggest that TRIM21 should be considered as a novel biomarker for lymphoma characterization and for predicting patient survival.
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Affiliation(s)
- S Brauner
- Unit of Experimental Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - W Zhou
- Unit of Experimental Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - C Backlin
- Unit of Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - T M Green
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Odense University Hospital, Odense, Denmark
| | - L Folkersen
- Unit of Experimental Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Ivanchenko
- Unit of Experimental Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - B Löfström
- Rheumatology Clinic, Malar Hospital, Eskilstuna, Sweden
| | - Z Y Xu-Monette
- Department of Hematopathology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - K H Young
- Department of Hematopathology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - M Boe Møller
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Odense University Hospital, Odense, Denmark
| | - C Sundström
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - G Enblad
- Unit of Oncology, Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala, Sweden
| | - E Baecklund
- Unit of Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - M Wahren-Herlenius
- Unit of Experimental Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Kastbom A, Ärlestig L, Rantapää-Dahlqvist S. Genetic Variants of the NLRP3 Inflammasome Are Associated with Stroke in Patients with Rheumatoid Arthritis. J Rheumatol 2015; 42:1740-5. [PMID: 26178285 DOI: 10.3899/jrheum.141529] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Inflammasomes are intracellular protein complexes important for the production of pro-inflammatory cytokines. Studies have suggested that the NLRP3 inflammasome influences both the severity of rheumatoid arthritis (RA) and development of atherosclerosis. Therefore, we investigated whether functional genetic variants related to the NLRP3 inflammasome influence the risk of cardiovascular (CV) disease (CVD) in patients with RA. METHODS The incidence of CVD was assessed in 522 patients with established RA by a retrospective survey of medical records in combination with a 6-year prospective followup. NLRP3-Q705K and CARD8-C10X genotypes were analyzed in relation to CVD by logistic regression, adjusting for traditional risk factors, antirheumatic treatment, and age at the onset of RA. RESULTS Carriage of the NLRP3-Q705K minor allele was associated with an increased risk of stroke/transient ischemic attack (TIA; OR 2.01, 95% CI 1.0-4.1, p = 0.05), while CARD8-C10X was not associated with any type of CV event. Patients with ≥ 1 variant allele in both polymorphisms had an increased risk of CVD when compared with patients without variant alleles present in both polymorphisms (adjusted OR 3.05, 95% CI 1.42-6.54, p = 0.004). Stratification showed that this risk was confined to stroke/TIA (adjusted OR 5.09, 95% CI 2.27-11.44, p < 0.0001) and not to myocardial infarction (MI)/angina pectoris (adjusted OR 1.58, 95% CI 0.67-3.73). Risk estimates were consistently higher among female patients. CONCLUSION Genetic variants of the NLRP3 inflammasome influence the risk of stroke/TIA, but not of MI/angina pectoris in Swedish patients with established RA.
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Affiliation(s)
- Alf Kastbom
- From the Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping; the Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.A. Kastbom, MD, PhD, Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University; L. Ärlestig, PhD; S. Rantapää-Dahlqvist, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University.
| | - Lisbeth Ärlestig
- From the Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping; the Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.A. Kastbom, MD, PhD, Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University; L. Ärlestig, PhD; S. Rantapää-Dahlqvist, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University
| | - Solbritt Rantapää-Dahlqvist
- From the Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping; the Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.A. Kastbom, MD, PhD, Department of Rheumatology, and Department of Clinical and Experimental Medicine, Linköping University; L. Ärlestig, PhD; S. Rantapää-Dahlqvist, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University
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Methotrexate-associated lymphoproliferative disorders of the tongue developing in patients with rheumatoid arthritis: a report of 2 cases and a review. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:e1-5. [DOI: 10.1016/j.oooo.2014.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/27/2014] [Accepted: 04/03/2014] [Indexed: 11/23/2022]
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Nader K, Behrens DS, Leon CA, Schwarting R, Ferber A. Iatrogenic lymphoproliferative disorder. Am J Hematol 2014; 89:787-8. [PMID: 24729413 DOI: 10.1002/ajh.23739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Kamyar Nader
- MD Anderson Cancer Center at Cooper; Department of Hematology and Medical Oncology
| | | | - Chady Abboud Leon
- MD Anderson Cancer Center at Cooper; Department of Hematology and Medical Oncology
| | - Roland Schwarting
- MD Anderson Cancer Center at Cooper; Department of Hematology and Medical Oncology
| | - Andres Ferber
- MD Anderson Cancer Center at Cooper; Department of Hematology and Medical Oncology
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Ponce RA, Gelzleichter T, Haggerty HG, Heidel S, Holdren MS, Lebrec H, Mellon RD, Pallardy M. Immunomodulation and lymphoma in humans. J Immunotoxicol 2013; 11:1-12. [DOI: 10.3109/1547691x.2013.798388] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Tarella C, Gueli A, Ruella M, Cignetti A. Lymphocyte transformation and autoimmune disorders. Autoimmun Rev 2013; 12:802-13. [DOI: 10.1016/j.autrev.2012.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ichikawa A, Arakawa F, Kiyasu J, Sato K, Miyoshi H, Niino D, Kimura Y, Takeuchi M, Yoshida M, Ishibashi Y, Nakashima S, Sugita Y, Miura O, Ohshima K. Methotrexate/iatrogenic lymphoproliferative disorders in rheumatoid arthritis: histology, Epstein-Barr virus, and clonality are important predictors of disease progression and regression. Eur J Haematol 2013; 91:20-8. [DOI: 10.1111/ejh.12116] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2013] [Indexed: 12/13/2022]
Affiliation(s)
| | - Fumiko Arakawa
- Department of Pathology; School of Medicine; Kurume University; Kurume; Japan
| | - Junichi Kiyasu
- Department of Pathology; School of Medicine; Kurume University; Kurume; Japan
| | - Kensaku Sato
- Biostatistics Center; School of Medicine; Kurume University; Kurume; Japan
| | - Hiroaki Miyoshi
- Department of Pathology; School of Medicine; Kurume University; Kurume; Japan
| | - Daisuke Niino
- Department of Pathology; School of Medicine; Kurume University; Kurume; Japan
| | - Yoshizo Kimura
- Department of Pathology; School of Medicine; Kurume University; Kurume; Japan
| | - Masanori Takeuchi
- Department of Pathology; School of Medicine; Kurume University; Kurume; Japan
| | - Maki Yoshida
- Department of Pathology; School of Medicine; Kurume University; Kurume; Japan
| | - Yukinao Ishibashi
- Department of Pathology; School of Medicine; Kurume University; Kurume; Japan
| | - Shinji Nakashima
- Department of Pathology; School of Medicine; Kurume University; Kurume; Japan
| | - Yasuo Sugita
- Department of Pathology; School of Medicine; Kurume University; Kurume; Japan
| | - Osamu Miura
- Department of Hematology; Tokyo Medical and Dental University; Tokyo; Japan
| | - Koichi Ohshima
- Department of Pathology; School of Medicine; Kurume University; Kurume; Japan
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Jain P, Benjamini O, Konoplev S, Mohamed MS, Romo CG, Estrov Z. Spontaneous remission of chemo-immunotherapy related, non-transplant Epstein-Barr virus-associated lymphoproliferative disorder in a patient with chronic lymphocytic leukemia. Leuk Lymphoma 2013; 54:2540-2. [PMID: 23387894 DOI: 10.3109/10428194.2013.773995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Preetesh Jain
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center , Houston, TX , USA
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Mansouri S, Tahiri L, Elmezouar I, Cherqui N, Khammar Z, Berradi R, Rabhi S, Harzy T, Bono W. A case of rheumatoid arthritis complicated by a chronic myeloid leukemia associated with pyoderma gangrenosum. EGYPTIAN RHEUMATOLOGIST 2013. [DOI: 10.1016/j.ejr.2012.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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AIKO K, MICHIWAKI Y. A case of methotrexate-associated lymphoproliferative disorder in the lower gingiva of a patient with rheumatoid arthritis that completely resolved after drug withdrawal. ACTA ACUST UNITED AC 2013. [DOI: 10.5794/jjoms.59.341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Dunleavy K, Roschewski M, Wilson WH. Lymphomatoid granulomatosis and other Epstein-Barr virus associated lymphoproliferative processes. Curr Hematol Malig Rep 2012; 7:208-15. [PMID: 22814713 DOI: 10.1007/s11899-012-0132-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We now recognize that the Epstein-Barr virus (EBV), which is a member of the γ- herpesvirus family, plays a pivotal role in the development of several lymphomas and lymphoproliferative disorders that include B-cell, T-cell and NK-cell processes. While over recent years, EBV associated lymphomas that arise in patients with known defects in cellular immunity are relatively well characterized, these diseases are becoming increasingly recognized in patients without overt immunodeficiency. Improved understanding of the biology of these lymphomas including elucidating the role that EBV plays in their pathogenesis has paved the way for improved therapies targeted at critical signaling pathways as well as the development of novel cellular therapies. In this review, we focus on recent progress that has been made in the biology and treatment of the rare EBV-associated disorder lymphomatoid granulomatosis (LYG) and also discuss other EBV-associated processes that occur in both immunocompetent and immunocompromised hosts.
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Affiliation(s)
- Kieron Dunleavy
- Metabolism Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.
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Simard JF, Baecklund F, Chang ET, Baecklund E, Hjalgrim H, -Olov Adami H, Glimelius B, Smedby KE. Lifestyle factors, autoimmune disease and family history in prognosis of non-hodgkin lymphoma overall and subtypes. Int J Cancer 2012; 132:2659-66. [PMID: 23160780 DOI: 10.1002/ijc.27944] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 10/29/2012] [Indexed: 12/26/2022]
Abstract
Lifestyle factors and medical history are known to influence risk of non-Hodgkin lymphoma (NHL). Whether these factors affect the prognosis of NHL, especially its subtypes, is unclear. To investigate this, the association between these factors and all-cause and lymphoma-related mortality was assessed in a population-based cohort of 1,523 Swedish NHL patients included in the Scandinavian Lymphoma Etiology study in 1999-2002. Participants contributed time from NHL diagnosis until death or October 1, 2010, with virtually complete follow-up through linkage to the Swedish Cause of Death Register. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using stratified and multivariable-adjusted Cox regression models. During a median follow-up of 8.8 years, 670 patients (44%) died, with the majority of deaths attributed to lymphoma (86%). Current versus never smoking at diagnosis was associated with increased rate of all-cause death for all NHL (HR = 1.5, 1.2-1.8) and diffuse large B-cell lymphoma (HR = 1.8, 1.2-2.7). Low educational level (HR = 1.3, 1.1-1.7, <9 vs. >12 years) and NHL risk-associated autoimmune disease (HR = 1.4, 1.0-1.8) were associated with death for all NHL combined. However, evidence of an association with lymphoma-related death was limited. Body mass index, recent sunbathing and family history of hematopoietic malignancy were not consistently associated with death after NHL or its specific subtypes. These results add to the evidence that cigarette smoking, socioeconomic status and certain autoimmune diseases affect survival after NHL. Further investigations are needed to determine how these factors should be incorporated into clinical prognostic assessment.
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Affiliation(s)
- Julia F Simard
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
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