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Liu SN, Wu MC, Lin WS, Lin CH, Cheng-Chung Wei J. Maternal autoimmune disease and offspring risk of haematological malignancies: a case-control study. EClinicalMedicine 2024; 75:102794. [PMID: 39281098 PMCID: PMC11402410 DOI: 10.1016/j.eclinm.2024.102794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 09/18/2024] Open
Abstract
Background Autoimmune diseases are known to be associated with an increased risk of cancer. Whether maternal immune dysregulation can have an impact on the development of haematological malignancies in offspring remains uncertain. Therefore, we explored the association between offspring risk of haematological malignancies and maternal autoimmune disease using a real-world nationwide population-based study. Methods In this case-control study, we identified 2172 children with haematological malignancies between 2004 and 2019 from Taiwan's National Health Insurance program and compared them with population-based controls without haematologic malignancies, who were matched with each individual at a ratio of 1:4. The medical information of the autoimmune mothers were obtained from the Taiwan Maternal and Child Health Database. Conditional logistic regression was used to estimate the odds ratio for haematologic malignancy in offspring. Furthermore, subgroup and stratified analyses were conducted. Findings Among the rheumatologic diseases in our study, Crohn's disease was the most common disease both in the haematological malignancy group (1.1%) and the control group (0.9%). In multivariable analysis, the odds ratio for haematological malignancy in offspring with maternal autoimmune diseases was 1.2 (95% confidence interval [CI] 0.91-1.58). The overall risk of haematologic malignancy was not significantly higher when adjusted for specific risk factors, including neonatal age, maternal age, family income, urbanization, maternal occupation, birth weight, or maternal comorbidity, except for prematurity. When comparing different autoimmune diseases among haematological malignancies and the control group, maternal psoriatic arthritis/psoriasis had the highest adjusted overall risk for haematological malignancies (adjusted OR 2.11, CI 0.89-5), followed by ankylosing spondylitis (adjusted OR 1.45, CI 0.7-3), autoimmune thyroiditis (OR 1.26, CI 0.57-2.81), systemic lupus erythematosus (OR 1.21, CI 0.48-3.02), Crohn's disease (OR 1.19, CI 0.75-1.9), and Sjogren's syndrome (OR 1.18, CI 0.65-2.15), but no significance was reached in these analyses. Multivariable analysis of risk factors associated with haematological malignancy subtypes was done. It showed no associations between maternal autoimmune disease and childhood haematological malignancies. Interpretation We found no significant relationship between maternal autoimmune disease and childhood haematological malignancies. The influence of maternal immune dysregulation on the next generation with respect to haematological malignancies development may be limited. Funding There was no funding source for this study.
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Affiliation(s)
- Shu-Ning Liu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Meng-Che Wu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Center for Pediatric Inflammatory Bowel Disease, MassGeneral Hospital for Children, Boston, MA, USA
| | - Wei-Szu Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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Zhang Y, Li W, Zhang P, Guo J, Sun J, Lu J, Liu S. Hematological malignancies in systemic lupus erythematosus: clinical characteristics, risk factors, and prognosis-a case-control study. Arthritis Res Ther 2022; 24:5. [PMID: 34980230 PMCID: PMC8722144 DOI: 10.1186/s13075-021-02692-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 12/05/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic and complex multi-system autoimmune disorder. Higher risks of hematological malignancies (HM) were observed in SLE patients, which was associated with higher mortality. The mechanism and risk factors of HM oncogenesis in SLE patients are still under investigation. The aim of this study was to explore clinical characteristics, risk factors, and prognosis of SLE patients with or without HM in the Chinese population. METHODS A retrospective, case-controlled study was conducted in 72 SLE patients between January 2013 and December 2020. Clinical and laboratory data were collected and compared between the two groups of patients with HM and those without HM. Logistic regression analysis was performed to determine risk factors of HM oncogenesis. The survival rate was estimated by Kaplan-Meier methods and Cox proportional hazards regression analysis. RESULTS Among 72 SLE patients in this study, fifteen complicated with HM and 57 without HM were identified. The incidence rate of HM was approximately 0.24% with elevated standardized incidence ratios of lymphoma and leukemia (27.559 and 12.708, respectively). Patients with HM were older when diagnosed with SLE, with a higher frequency of infection and splenomegaly, lower levels of hemoglobin and high-density lipoprotein compared with those without HM. Fewer patients with HM expressed positive anti-dsDNA antibody (26.7% vs 66.7%, P = 0.005) or received hydroxychloroquine treatment (40.0% vs 86.0%, P = 0.001). Older age at SLE diagnosis (OR=1.122, 95% CI: 1.037-1.214) was regarded as an independent risk factor of HM oncogenesis. Female (RR= 0.219, 95% CI: 0.070-0.681) and hydroxychloroquine (RR= 0.281, 95% CI: 0.094-0.845) were protective factors of mortality in SLE patients. CONCLUSIONS SLE patients with an older age are at an increased risk of HM carcinogenesis. The prognosis of male patients with SLE tends to be poorer whether complicated with HM. The association of antinuclear antibody spectrum, medication, and HM oncogenesis in SLE needs further investigation.
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Affiliation(s)
- Yuqi Zhang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Wei Li
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Panpan Zhang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Jinyan Guo
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Jinlei Sun
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Jiameng Lu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China
| | - Shengyun Liu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou, 450052, Henan Province, China.
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Abstract
Background and aims Primary sclerosing cholangitis (PSC) is associated with an increased risk of hepatobiliary and colorectal cancer, but the risks of other cancer forms have not been explored. The aim of this study was to evaluate the risk of intestinal and extraintestinal cancers in a large, well-defined cohort of PSC patients. Material and method A matched cohort study of Swedish PSC patients was performed with up to ten comparators for each patient, matched for sex, age, and residency. The data were retrieved from national registers. Patients were followed from PSC diagnosis until cancer diagnosis, liver transplantation, first emigration date, death, or December 31, 2016. The risk of cancer was estimated using the Kaplan–Meier method and Cox regression models. Results In total, 1432 PSC patients with a verified diagnosis and 14,437 comparators were studied. The mean follow-up time was 15.9 years. Eighty-eight percent of the PSC patients had concomitant inflammatory bowel disease. PSC patients ran significantly increased risks of developing any cancer [HR 3.8, 95% confidence interval (CI) 3.3–4.3], hepatobiliary cancer (HR 120.9, 95% CI 72.0–203.1), colorectal cancer (HR 7.5, 95% CI 5.6–10.0), pancreatic cancer (HR 8.0, 95% CI 3.2–20.2), gastric cancer (HR 4.2, 95% CI 1.5–11.3), small bowel cancer (HR 21.1, 95% CI 3.5–128.2), and lymphoma (HR 3.0, 95% CI 1.6–5.7). PSC was not associated with a lower risk of any cancer form. Conclusions PSC patients have a four times overall increased risk of developing cancer compared to the general population, with increased risk of developing hepatobiliary, colorectal, and pancreatic cancer, as well as lymphoma. Supplementary Information The online version contains supplementary material available at 10.1007/s12072-021-10214-6.
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Schifferli A, Cavalli F, Godeau B, Liebman HA, Recher M, Imbach P, Kühne T. Understanding Immune Thrombocytopenia: Looking Out of the Box. Front Med (Lausanne) 2021; 8:613192. [PMID: 34249957 PMCID: PMC8266194 DOI: 10.3389/fmed.2021.613192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 05/28/2021] [Indexed: 01/15/2023] Open
Abstract
The pathogenesis of immune thrombocytopenia (ITP) is increasingly being elucidated, and its etiology is becoming more frequently identified, leading to a diagnostic shift from primary to secondary ITP. The overlap between autoimmunity, immunodeficiency, and cancer is evident, implying more interdisciplinarity in daily care. This mini-review is based on an expert meeting on ITP organized by the Intercontinental Cooperative ITP Study Group and presents the challenges of hematologists in understanding and investigating "out of the box" concepts associated with ITP.
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Affiliation(s)
- Alexandra Schifferli
- Department of Hematology/Oncology, University Children's Hospital Basel, Basel, Switzerland
- Intercontinental Cooperative Immune thrombocytopenia (ITP) Study Group, Basel, Switzerland
| | - Franco Cavalli
- Lymphoma Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Bertrand Godeau
- Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Service de Médecine Interne, CHU Henri Mondor, AP-HP, Université Paris-Est Créteil, Créteil, France
| | - Howard A. Liebman
- Jane Anne Nohl Division of Hematology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mike Recher
- Medical Outpatient Clinic and Immunodeficiency Laboratory, Department of Biomedicine, University Hospital and University Basel, Basel, Switzerland
| | - Paul Imbach
- Intercontinental Cooperative Immune thrombocytopenia (ITP) Study Group, Basel, Switzerland
| | - Thomas Kühne
- Department of Hematology/Oncology, University Children's Hospital Basel, Basel, Switzerland
- Intercontinental Cooperative Immune thrombocytopenia (ITP) Study Group, Basel, Switzerland
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Autoimmune Hemolytic Anemia as Presenting Symptom of Hodgkin Lymphoma. Case Rep Hematol 2021; 2021:5580823. [PMID: 33859850 PMCID: PMC8026303 DOI: 10.1155/2021/5580823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/04/2022] Open
Abstract
Autoimmune hemolytic anemia (AIHA) is related to an underlying condition in an estimated 50 to 60%, while the remaining is idiopathic, as a result of a combination of immune activation, deficiency, or dysregulation. AIHA is associated with viral infections, autoimmune disorders, immunodeficiencies, lymphoproliferative disorders, and pregnancy. AIHA has predictive properties and may be a harbinger of future lymphoproliferative disorders in up to 20% of AIHA cases. Autoimmune hemolytic anemia (AIHA) has been associated with lymphoproliferative disorders particularly chronic lymphocytic leukemia and non-Hodgkin lymphoma. Rarely is it seen in Hodgkin disease. In the following report, we describe the presentation of AIHA, ultimately resulting in the diagnosis of nodular sclerosis Hodgkin lymphoma (stage III). From the limited reports and reviews available, it is understood that advanced Hodgkin (stage III or IV) of nodular sclerosis (NS) or mixed cellularity (MC) types portend a stronger affiliation to AIHA. The majority of AIHA-associated Hodgkin lymphoma presents as stage III or IV disease with the hemolysis being the presenting symptom, as in this case. The mainstay of AIHA therapy has been corticosteroids; however, this first-line regimen appears to be less effective when treating AIHA in the setting of HL. The exact mechanism of AIHA related to HL is unclear, and it may be thought to be that tumor cell produced autoantibodies. Other hypotheses include paraneoplastic phenomena or more, perhaps immunity to tumor cells may cross-react with antigens on the red cells. Although these mechanisms require further investigation, the relationship of the AIHA and HL represents a piece to a larger puzzle between autoimmune disorders and lymphoproliferative conditions.
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Hughes MS, Pietropaolo M, Vasudevan MM, Marcelli M, Nguyen H. Checking the Checkpoint Inhibitors: A Case of Autoimmune Diabetes After PD-1 Inhibition in a Patient with HIV. J Endocr Soc 2020; 4:bvaa150. [PMID: 33225197 PMCID: PMC7660136 DOI: 10.1210/jendso/bvaa150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
Immune checkpoint inhibitor-associated diabetes mellitus (ICI-DM) is a known immune-related adverse event (irAE) following treatment with programmed cell death protein 1 (PD-1), with a reported 0.9% incidence. We hereby present the first case, to our knowledge, of ICI-DM following ICI use in a human immunodeficiency virus (HIV) patient. In this case, a 48-year-old man with HIV stable on highly active antiretroviral therapy (HAART) was diagnosed with Hodgkin lymphoma and initiated treatment with the PD-1 inhibitor nivolumab. His lymphoma achieved complete response after 5 months. However, at month 8, he reported sudden polydipsia and polyuria. Labs revealed a glucose level of 764 mg/dL and glycated hemoglobin A1c (HbA1c) of 7.1%. Low C-peptide and elevated glutamic acid decarboxylase 65 (GAD65) antibody levels confirmed autoimmune DM, and he was started on insulin. Major histocompatibility complex class II genetic analysis revealed homozygous HLA DRB1*03-DQA1*0501-DQB1*02 (DR3-DQ2), which is a known primary driver of genetic susceptibility to type 1 DM. Autoimmune DM has been reported as an ICI-associated irAE. However, patients with immunocompromising conditions such as HIV are usually excluded from ICI trials. Therefore, little is known about such irAEs in this population. In this case, risk of ICI-DM as an irAE was likely increased by several factors including family history, a high-risk genetic profile, islet-related immunologic abnormalities, active lymphoma, and HIV infection with a possible immune reconstitution event. Clinicians should maintain a high index of suspicion for development of irAEs associated with ICI, particularly as use of these therapies broadens. Thorough investigation for presence of higher-risk features should be conducted and may warrant inclusion of pre-therapy genetic and/or autoantibody screening.
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Affiliation(s)
- Michael S Hughes
- Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | | | - Madhuri M Vasudevan
- Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Marco Marcelli
- Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Ha Nguyen
- Baylor College of Medicine, Houston, Texas, USA
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Y RNA: An Overview of Their Role as Potential Biomarkers and Molecular Targets in Human Cancers. Cancers (Basel) 2020; 12:cancers12051238. [PMID: 32423154 PMCID: PMC7281143 DOI: 10.3390/cancers12051238] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/03/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
Y RNA are a class of small non-coding RNA that are largely conserved. Although their discovery was almost 40 years ago, their function is still under investigation. This is evident in cancer biology, where their role was first studied just a dozen years ago. Since then, only a few contributions were published, mostly scattered across different tumor types and, in some cases, also suffering from methodological limitations. Nonetheless, these sparse data may be used to make some estimations and suggest routes to better understand the role of Y RNA in cancer formation and characterization. Here we summarize the current knowledge about Y RNA in multiple types of cancer, also including a paragraph about tumors that might be included in this list in the future, if more evidence becomes available. The picture arising indicates that Y RNA might be useful in tumor characterization, also relying on non-invasive methods, such as the analysis of the content of extracellular vesicles (EV) that are retrieved from blood plasma and other bodily fluids. Due to the established role of Y RNA in DNA replication, it is possible to hypothesize their therapeutic targeting to inhibit cell proliferation in oncological patients.
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Oei SL, Thronicke A, Kröz M, Matthes H, Schad F. Use and Safety of Viscum album L Applications in Cancer Patients With Preexisting Autoimmune Diseases: Findings From the Network Oncology Study. Integr Cancer Ther 2019; 18:1534735419832367. [PMID: 30808274 PMCID: PMC6432670 DOI: 10.1177/1534735419832367] [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] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Viscum album L (VA, mistletoe) extracts are commonly used in integrative oncology. Here the clinical safety profile of additional VA-treatments to standard care in cancer patients with preexisting autoimmune diseases was analyzed. METHODS In this observational cohort study medical data and recorded adverse events (AEs) of treated patients were retrieved from the Network Oncology registry and a safety analysis was performed. RESULTS A total of 106 patients (median age 63 years) treated with add-on VA-extracts were analyzed. Most frequent autoimmune diseases were Hashimoto's thyroiditis (27%), psoriasis (19%), and ulcerative colitis (15%). Seventeen patients (16%) experienced VA-related AEs, but neither long-term side effects nor VA-therapy discontinuations were recorded. In a subgroup of 30 patients receiving long-term VA-therapy no exacerbations or flares of underlying autoimmune diseases were recorded. Additionally, a significant halving of overall AE-rates was observed during VA-treatment periods (p= 0.019). CONCLUSIONS Our findings suggest that add-on VA-therapy in cancer patients with preexisting autoimmune diseases as Hashimoto's thyroiditis, psoriasis, ulcerative colitis, Grave's disease, and some rheumatic diseases is safe. No higher rates of VA-associated AEs were observed and the overall AE-rates were significantly lowered in VA-therapy periods. However, results should be interpreted with caution in light of the study's observational character.
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Affiliation(s)
| | | | - Matthias Kröz
- 1 Research Institute Havelhöhe, Berlin, Germany.,3 Institute for Social Medicine, Charité, Berlin, Germany.,4 Institute for Integrative Medicine, Witten/Herdecke, Germany
| | - Harald Matthes
- 1 Research Institute Havelhöhe, Berlin, Germany.,3 Institute for Social Medicine, Charité, Berlin, Germany.,5 Medical Clinic for Gastroenterology, CBF, Charité, Berlin, Germany
| | - Friedemann Schad
- 1 Research Institute Havelhöhe, Berlin, Germany.,2 Oncological Centre, Hospital Havelhöhe, Berlin, Germany
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Parachini-Winter C, Carioto LM, Gara-Boivin C. Retrospective evaluation of anemia and erythrocyte morphological anomalies in dogs with lymphoma or inflammatory bowel disease. J Am Vet Med Assoc 2019; 254:487-495. [DOI: 10.2460/javma.254.4.487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zarins A, Smith D, Fahim S. A Case of Cutaneous B-Cell Lymphoma in Longstanding Systemic Lupus Erythematosus. J Cutan Med Surg 2016; 20:579-581. [PMID: 27358312 DOI: 10.1177/1203475416658001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The association between lymphoproliferative malignancies and autoimmune rheumatological diseases, such as systemic lupus erythematosus (SLE), remains of great interest. It is known that individuals with immune dysregulation also have an increased risk of lymphoma. OBJECTIVE To report a case of primary cutaneous diffuse large B-cell lymphoma of the leg type associated with longstanding SLE, as well as to review the literature for similar cases. METHODS A PubMed search was done using the following search terms: lupus and B-cell lymphoma. RESULTS Although several studies show that non-Hodgkin lymphoma is significantly increased in SLE, there is currently no literature reporting specifically on the risk of primary cutaneous lymphomas in patients with SLE. CONCLUSION Our report highlights the possibility that patients with autoimmune disease are at increased risk of not only the classic forms of non-Hodgkin lymphoma but also primary cutaneous B-cell lymphomas.
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Affiliation(s)
- Andrea Zarins
- Dermatology Division, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas Smith
- Rheumatology Division, Department of Medicine, The Ottawa Hospital-Riverside Campus, University of Ottawa, Ottawa, Ontario, Canada
| | - Simone Fahim
- Dermatology Division, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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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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Predispositions to Lymphoma: A Practical Review for Genetic Counselors. J Genet Couns 2016; 25:1157-1170. [PMID: 27265405 DOI: 10.1007/s10897-016-9979-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 05/24/2016] [Indexed: 12/19/2022]
Abstract
This review provides a synopsis for genetic counselors of the major concepts of lymphoma predisposition: genomic instability, immune deficiency, inappropriate lymphoproliferation, and chronic antigen stimulation. We discuss syndromes typifying each of these mechanisms. Importantly, our review of the genetic counseling literature reveals sparse discussion of genetically-based immune-mediated lymphoma predisposition, which we address in depth here. We aim to increase awareness among genetic counselors and colleagues in oncology about familial susceptibility and facilitate critical thinking about lymphoma risk assessment. Clinical application of this knowledge is aided by recommendations for collection of personal and family history to guide risk assessment and testing. Lastly, we include a special discussion of genetic counseling issues including perceptions of the context, nature, and magnitude of lymphoma risk, as well as coping with awareness of susceptibility to lymphoma.
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Abstract
Central nervous system infiltration of Waldenström's macroglobulinemia is referred to as Bing-Neel Syndrome. We describe 2 patients whose clinical presentation was due to isolated involvement of the anterior visual pathways. The mechanism of visual failure in Bing-Neel Syndrome may involve both infiltrative and autoimmune processes.
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Tumour necrosis factor α antagonists in the treatment of rheumatoid arthritis: an immunological perspective. BioDrugs 2015; 28 Suppl 1:S5-13. [PMID: 24687234 DOI: 10.1007/s40259-013-0063-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA) is one of the most prevalent autoimmune conditions, affecting approximately 1% of the adult population. It is associated with decreased quality of life and considerable morbidity and mortality. Various inflammatory cells, including macrophages, neutrophils, mast cells, natural killer cells, B and T cells and stromal cells play key pathophysiological roles in joint inflammation and RA progression. Several cytokines, including interleukin (IL)-1α and/or IL-1β, and tumour necrosis factor (TNF)-α, are involved at each stage of RA pathogenesis; namely, by augmenting autoimmunity, sustaining long-term inflammatory synovitis and promoting joint damage. Different cell types are involved in RA pathogenesis through upregulation of several cytokine and soluble pro-inflammatory mediators. As early as the late 1980s, TNF had been identified as a potential target in RA. Five anti-TNF drugs, infliximab, adalimumab, certolizumab pegol, etanercept and golimumab, are now approved for the treatment of RA in various countries. All are bivalent monoclonal antibodies, with the exception of the monovalent certolizumab and etanercept, which is an engineered dimeric receptor. Although all react with and neutralise soluble TNF in vitro, structural differences in the molecules may contribute to differences in their therapeutic effects and the occurrence of side effects. Pegylated certolizumab permits once-monthly dosing. Other mechanisms of action proposed to be important for the efficacy of anti-TNF agents are as follows: induction of apoptosis of both monocytes and T cells; neutralization of membrane TNF; antibody-dependent cell-mediated and complement-dependent cytotoxicity; and reverse signaling via membrane TNF.
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Marino S, Di Cataldo A, Magro G, D'Amico S, La Spina M, Di Benedetto V, Meli M, Moscheo C, Russo G. A difficult diagnosis of Hodgkin lymphoma due to immune thrombocytopenia. Clin Case Rep 2015; 3:179-82. [PMID: 25838909 PMCID: PMC4377251 DOI: 10.1002/ccr3.176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 10/09/2014] [Accepted: 10/25/2014] [Indexed: 12/12/2022] Open
Abstract
We report a rare clinical presentation of childhood Hodgkin lymphoma with immune thrombocytopenia. Diagnostic biopsy of the abdominal mass was performed after administration of intravenous immunoglobulins, steroids, and platelet transfusion. Concomitant thrombocytopenia complicated the whole diagnosis work up and the initial management of neoplasia.
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Affiliation(s)
- Silvia Marino
- Unit of Paediatric Haematology and Oncology, Department of Paediatrics, University of Catania Catania, Italy
| | - Andrea Di Cataldo
- Unit of Paediatric Haematology and Oncology, Department of Paediatrics, University of Catania Catania, Italy
| | - Gaetano Magro
- Anatomic Pathology, Department G.F. Ingrassia, University of Catania Catania, Italy
| | - Salvatore D'Amico
- Unit of Paediatric Haematology and Oncology, Department of Paediatrics, University of Catania Catania, Italy
| | - Milena La Spina
- Unit of Paediatric Haematology and Oncology, Department of Paediatrics, University of Catania Catania, Italy
| | | | - Mariaclaudia Meli
- Unit of Paediatric Haematology and Oncology, Department of Paediatrics, University of Catania Catania, Italy
| | - Carla Moscheo
- Unit of Paediatric Haematology and Oncology, Department of Paediatrics, University of Catania Catania, Italy
| | - Giovanna Russo
- Unit of Paediatric Haematology and Oncology, Department of Paediatrics, University of Catania Catania, Italy
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A mutation in caspase-9 decreases the expression of BAFFR and ICOS in patients with immunodeficiency and lymphoproliferation. Genes Immun 2015; 16:151-61. [PMID: 25569260 DOI: 10.1038/gene.2014.74] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 10/09/2014] [Accepted: 11/17/2014] [Indexed: 01/25/2023]
Abstract
Lymphocyte apoptosis is mainly induced by either death receptor-dependent activation of caspase-8 or mitochondria-dependent activation of caspase-9. Mutations in caspase-8 lead to autoimmunity/lymphoproliferation and immunodeficiency. This work describes a heterozygous H237P mutation in caspase-9 that can lead to similar disorders. H237P mutation was detected in two patients: Pt1 with autoimmunity/lymphoproliferation, severe hypogammaglobulinemia and Pt2 with mild hypogammaglobulinemia and Burkitt lymphoma. Their lymphocytes displayed defective caspase-9 activity and decreased apoptotic and activation responses. Transfection experiments showed that mutant caspase-9 display defective enzyme and proapoptotic activities and a dominant-negative effect on wild-type caspase-9. Ex vivo analysis of the patients' lymphocytes and in vitro transfection experiments showed that the expression of mutant caspase-9 correlated with a downregulation of BAFFR (B-cell-activating factor belonging to the TNF family (BAFF) receptor) in B cells and ICOS (inducible T-cell costimulator) in T cells. Both patients carried a second inherited heterozygous mutation missing in the relatives carrying H237P: Pt1 in the transmembrane activator and CAML interactor (TACI) gene (S144X) and Pt2 in the perforin (PRF1) gene (N252S). Both mutations have been previously associated with immunodeficiencies in homozygosis or compound heterozygosis. Taken together, these data suggest that caspase-9 mutations may predispose to immunodeficiency by cooperating with other genetic factors, possibly by downregulating the expression of BAFFR and ICOS.
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Hughes CL, Yorio JT, Kovitz C, Oki Y. Treatment decisions in a man with Hodgkin lymphoma and Guillian-Barré syndrome: a case report. J Med Case Rep 2014; 8:455. [PMID: 25528252 PMCID: PMC4307131 DOI: 10.1186/1752-1947-8-455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/18/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction Guillain-Barre syndrome, or acute inflammatory demyelinating polyneuropathy, has been described in the presence of malignancies such as lymphoma. Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy causes paresthesias and weakness, which can make the treatment of lymphoma with chemotherapy challenging. Given the rarity of this co-presentation it is not known if the effects of Guillain-Barre syndrome should be considered when selecting a treatment regimen for Hodgkin lymphoma. To the best of our knowledge, the impact of these treatment modifications has not been previously reported. Case presentation We report the case of a 37-year-old Caucasian man with a diagnosis of stage IIB classical Hodgkin lymphoma with concomitant Guillain-Barre syndrome. Our patient originally presented with an enlarged cervical lymph node and quickly developed distal paresthesia and progressive weakness of all four extremities. He was diagnosed with Hodgkin’s lymphoma and initiated on treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine. Doses of bleomycin and vinblastine were held or dose-reduced throughout his initial treatment course due to underlying neuropathy and dyspnea. He continued to have persistent disease after five cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine and went on to receive salvage treatments including more chemotherapy, radiation, autologous stem cell transplant and is currently preparing for an allogeneic stem cell transplant. Conclusions Paraneoplastic syndromes such as Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy can make the treatment of patients with Hodgkin lymphoma more challenging and can interfere with delivering full-dose chemotherapy. Further case series are needed to evaluate the effect that paraneoplastic syndromes, or adjustments made in therapy due to these syndromes, negatively affect the prognosis of patients with Hodgkin lymphoma.
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Affiliation(s)
- Caren L Hughes
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Basta I, Pekmezovic T, Peric S, Nikolic A, Rakocevic-Stojanovic V, Stevic Z, Marjanovic I, Lavrnic D. Extrathymic malignancies in a defined cohort of patients with myasthenia gravis. J Neurol Sci 2014; 346:80-4. [DOI: 10.1016/j.jns.2014.07.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 01/21/2023]
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Roche J, Capablo J, Ara J. Miastenia gravis y asociación con neoplasias extratímicas. Neurologia 2014; 29:507-9. [DOI: 10.1016/j.nrl.2013.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 04/18/2013] [Accepted: 04/28/2013] [Indexed: 02/04/2023] Open
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Roche J, Capablo J, Ara J. Myasthenia gravis in association with extrathymic neoplasia. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Pedersen EG, Pottegård A, Hallas J, Friis S, Hansen K, Jensen PEH, Gaist D. Myasthenia and risk of cancer: a population-based case-control study. Eur J Neurol 2014; 21:773-8. [DOI: 10.1111/ene.12383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/10/2014] [Indexed: 01/22/2023]
Affiliation(s)
- E. G. Pedersen
- Department of Neurology; Odense University Hospital and Institute of Clinical Research; Faculty of Health Sciences; University of Southern Denmark (SDU); Odense Denmark
| | - A. Pottegård
- Institute of Public Health, Clinical Pharmacology; University of Southern Denmark; Odense Denmark
| | - J. Hallas
- Institute of Public Health, Clinical Pharmacology; University of Southern Denmark; Odense Denmark
| | - S. Friis
- Danish Cancer Society Research Centre and Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - K. Hansen
- Department of Neurology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - P. E. H. Jensen
- Neuroimmunology Laboratory; DMSC; Department of Neurology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - D. Gaist
- Department of Neurology; Odense University Hospital and Institute of Clinical Research; Faculty of Health Sciences; University of Southern Denmark (SDU); Odense Denmark
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Prevalence of anti-citrullinated protein antibodies (ACPA) in patients with diffuse large B-cell lymphoma (DLBCL): a case-control study. PLoS One 2014; 9:e88177. [PMID: 24516607 PMCID: PMC3917867 DOI: 10.1371/journal.pone.0088177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 01/06/2014] [Indexed: 11/19/2022] Open
Abstract
Background Antibodies against citrullinated proteins (ACPA) have been recognised as the most specific serum marker for rheumatoid arthritis. However, serum autoantibodies such as anti-nuclear antibodies have also been detected in the sera of different lymphatic malignancies without accompanying rheumatologic disease. Therefore, we conducted a study to evaluate the prevalence of ACPA in diffuse large B-cell non-Hodgkin lymphoma (DLBCL). Methods Sera of 395 DLBCL patients and 258 age-matched healthy controls were investigated to evaluate the prevalence of ACPA and RF. ACPA-positive data were stratified into subgroups of RF positivity and established prognostic parameters for DLBCL, including overall survival. In addition, the ACPA serum concentrations levels were compared to an ACPA-positive RA cohort (n = 175). The statistics were performed with χ2 test and Mann- Whitney-U test; Kaplan-Meyer curves (log rank test) were used to analyse the overall survival. P-value <0.05 was statistically significant. Results ACPA, but not RF, occurred significantly more frequently in the sera of DLBCL patients than in healthy controls (3.5% versus 0.8%, p = 0.030). However, the ACPA serum concentration levels were significantly lower than in RA patients (median 10.4 versus 124.1 U/ml, p = 0.0001). After subgroup stratification, ACPA positivity in DLBCL was significantly associated with male gender (4.4% versus 0%, p = 0.022; odds ratio 1.046, CI 1.014–1.079) and with RF-IgM seropositivity (1.77% versus 0%, p = 0.043), but not with prognostic parameters for DLBCL. Conclusions DLBCL is associated with a significantly higher prevalence of ACPA, with an increased prevalence in male patients, and simultaneous RF-IgM positivity. However, ACPA is not prognostic for DLBCL. The prevalence of RF-IgM, -IgA, or -IgG did not differ from healthy controls.
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Pedersen EG, Pottegård A, Hallas J, Friis S, Hansen K, Jensen PEH, Gaist D. Risk of non-melanoma skin cancer in myasthenia patients treated with azathioprine. Eur J Neurol 2013; 21:454-8. [DOI: 10.1111/ene.12329] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 11/18/2013] [Indexed: 02/03/2023]
Affiliation(s)
- E. G. Pedersen
- Department of Neurology; Faculty of Health Sciences; Odense University Hospital and Institute of Clinical Research; University of Southern Denmark (SDU); Odense Denmark
| | - A. Pottegård
- Institute of Public Health, Clinical Pharmacology; SDU; Odense Denmark
| | - J. Hallas
- Institute of Public Health, Clinical Pharmacology; SDU; Odense Denmark
| | - S. Friis
- Danish Cancer Society Research Centre and Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - K. Hansen
- Department of Neurology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - P. E. H. Jensen
- Neuroimmunology Laboratory; DMSC; Department of Neurology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - D. Gaist
- Department of Neurology; Faculty of Health Sciences; Odense University Hospital and Institute of Clinical Research; University of Southern Denmark (SDU); Odense Denmark
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Dey D, Kenu E, Isenberg DA. Cancer complicating systemic lupus erythematosus--a dichotomy emerging from a nested case-control study. Lupus 2013; 22:919-27. [PMID: 23857987 PMCID: PMC4107831 DOI: 10.1177/0961203313497118] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives We determined whether any individual cancers are increased or decreased in a cohort of
595 patients with systemic lupus erythematosus (SLE) followed for up to 32 years at the
University College London Hospitals Lupus Clinic, looking for any associated clinical or
serological factors and the prognosis after cancer diagnosis. Methods We undertook a careful retrospective review of the medical records and identified all
individuals diagnosed with cancer. For controls, we selected three other patients in the
cohort who had not developed cancer, carefully matched for age, sex, ethnicity and
disease duration, to determine if any obvious differences emerged in a nested
case-control design. Results Thirty-three patients developed cancer after being diagnosed with SLE. There was a
statistically insignificant small increase in overall cancer risk, standardized
incidence ratios (SIRs) 1.05 (95% CI 0.52–1.58) and increased SIRs for cervical,
prostate, anal and pancreatic cancers and reduction in breast cancer SIRs. Haematological and musculoskeletal manifestations, anticardiolipin and antithyroid
globulin antibodies were found to be positively associated with cancer risk in
multivariate analysis. There was no drug, dose or duration was associated with cancer
risk. There was a reduction in survival with a cancer fatality rate of 84.2%
(p < 0.0001). Conclusion We found a very small but statistically insignificant increased cancer risk with
reduction in survival. Whereas some cancers appear to be more common in SLE, notably
prostate and cervical cancer, others, particularly breast cancer, are less frequent.
Multiple clinical and serological factors are involved in the increased risk of
malignancy in SLE. No drug dose or duration effect was identified.
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Affiliation(s)
- D Dey
- Centre for Rheumatology, Department of Medicine, University College London Hospitals, London, UK.
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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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Abstract
Mel Greaves discusses the mechanisms underlying transformation in B cell chronic lymphocytic leukemia, including a new study suggesting a role for BCR ligation driven by recognition of an antigenic component of common yeast and fungi. Relatively few cancers arise in mature, differentiated cells. The propensity of mature B cells to transform has been linked to their longevity and proliferative potential, and stimulation of the B cell receptor (BCR) by cognate antigen may promote the transformation process. A study in this issue (Hoogeboom et al.) lends support to this notion, showing that cancer cells from a subset of patients with chronic lymphocytic leukemia (CLL) express a BCR specific for a sugar expressed by commensal yeast species. Another study, in contrast, suggests that B-CLL cells uniquely acquire the ability to signal in the complete absence of ligand.
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Affiliation(s)
- Mel Greaves
- Division of Molecular Pathology, Institute of Cancer Research, Sutton, Surrey SM2 5NG, England, UK.
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Pedersen EG, Pottegård A, Hallas J, Friis S, Hansen K, Jensen PEH, Gaist D. Use of azathioprine for non-thymoma myasthenia and risk of cancer: a nationwide case-control study in Denmark. Eur J Neurol 2013; 20:942-8. [DOI: 10.1111/ene.12108] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 12/19/2012] [Indexed: 01/10/2023]
Affiliation(s)
- E. G. Pedersen
- Department of Neurology; Faculty of Health Sciences; Institute of Clinical Research; Odense University Hospital; University of Southern Denmark (SDU); Odense; Denmark
| | - A. Pottegård
- Clinical Pharmacology Unit; Institute of Public Health; SDU; Odense; Denmark
| | - J. Hallas
- Clinical Pharmacology Unit; Institute of Public Health; SDU; Odense; Denmark
| | - S. Friis
- Danish Cancer Society Research Centre; Department of Public Health; University of Copenhagen; Copenhagen; Denmark
| | - K. Hansen
- Department of Neurology; Rigshospitalet; Copenhagen University Hospital; Copenhagen; Denmark
| | - P. E. H. Jensen
- Neuroimmunology Laboratory; Department of Neurology; Rigshospitalet; Copenhagen University Hospital; DMSC; Copenhagen; Denmark
| | - D. Gaist
- Department of Neurology; Faculty of Health Sciences; Institute of Clinical Research; Odense University Hospital; University of Southern Denmark (SDU); Odense; Denmark
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Maverakis E, Goodarzi H, Wehrli LN, Ono Y, Garcia MS. The etiology of paraneoplastic autoimmunity. Clin Rev Allergy Immunol 2012; 42:135-44. [PMID: 21246308 DOI: 10.1007/s12016-010-8248-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although they may sometimes appear similar, paraneoplastic autoimmunity has a unique pathogenesis, different from the classical autoimmune diseases not associated with cancer. When distinguished clinically, paraneoplastic autoimmunity is more severe and often presents with a broader range of clinical signs and symptoms. Management of these patients is difficult and is usually centered in part on treatment of the underlying malignancy. Self-antigens recognized in the setting of paraneoplastic autoimmunity can be diverse, and the number of determinants recognized within a single antigen can be numerous. This review uses prototypic examples of paraneoplastic immune-mediated diseases and their associated malignancies to describe the mechanisms by which immune dysregulation can occur in the setting of cancer. Specific diseases covered include paraneoplastic pemphigus, Sweet's syndrome, pyoderma gangrenosum, thymoma-associated multiorgan autoimmunity, myasthenia gravis, autoimmune hemolytic anemia, immune thrombocytopenia, and the paraneoplastic neurological syndromes. The malignancies discussed include thymoma, non-Hodgkin's lymphoma, and chronic lymphocytic leukemia, among others. The mechanisms by which cancers induce autoimmunity are broken down into the following categories: disruption of central tolerance, peripheral immune dysregulation, and alteration of self-antigens. For each category, examples of paraneoplastic autoimmune diseases and their associated malignancies are discussed. Finally, mechanisms by which cancer treatment can lead to autoimmunity and examples of polymorphisms that are linked to both cancer and autoimmunity are discussed.
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Affiliation(s)
- Emanual Maverakis
- Department of Dermatology, School of Medicine, University of California-Davis, 3301 C Street, Sacramento, CA, 95816, USA.
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Autoimmune hemolytic anemia and immune thrombocytopenia as unusual presentations of childhood Hodgkin lymphoma: a case report and review of the literature. J Pediatr Hematol Oncol 2012; 34:280-2. [PMID: 22258348 DOI: 10.1097/mph.0b013e318236c4e4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We discuss an unusual clinical presentation of childhood Hodgkin lymphoma; a 16-year-old girl was referred for Coombs-positive severe anemia, thrombocytopenia, and asymptomatic anterior mediastinal mass. Bone marrow examination showed no evidence of neoplastic disease. Biopsy of the mass was possible only after administration of both intravenous immunoglobulins and steroids resulting in a prompt rise of the platelet count and partial hemoglobin level stabilization. The identification of this clinical picture as a possible complication of an underlying Hodgkin lymphoma presents difficulties in diagnosis and management of the primary condition.
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Hokama A, Kishimoto K, Ihama Y, Kobashigawa C, Nakamoto M, Hirata T, Kinjo N, Higa F, Tateyama M, Kinjo F, Iseki K, Kato S, Fujita J. Endoscopic and radiographic features of gastrointestinal involvement in vasculitis. World J Gastrointest Endosc 2012; 4:50-6. [PMID: 22442741 PMCID: PMC3309893 DOI: 10.4253/wjge.v4.i3.50] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 11/04/2011] [Accepted: 03/01/2012] [Indexed: 02/05/2023] Open
Abstract
Vasculitis is an inflammation of vessel walls, followed by alteration of the blood flow and damage to the dependent organ. Vasculitis can cause local or diffuse pathologic changes in the gastrointestinal (GI) tract. The variety of GI lesions includes ulcer, submucosal edema, hemorrhage, paralytic ileus, mesenteric ischemia, bowel obstruction, and life-threatening perforation.The endoscopic and radiographic features of GI involvement in vasculitisare reviewed with the emphasis on small-vessel vasculitis by presenting our typical cases, including Churg-Strauss syndrome, Henoch-Schönlein purpura, systemic lupus erythematosus, and Behçet’s disease. Important endoscopic features are ischemic enterocolitis and ulcer. Characteristic computed tomographic findings include bowel wall thickening with the target sign and engorgement of mesenteric vessels with comb sign. Knowledge of endoscopic and radiographic GI manifestations can help make an early diagnosis and establish treatment strategy.
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Affiliation(s)
- Akira Hokama
- Akira Hokama, Kazuto Kishimoto, Yasushi Ihama, Tetsuo Hirata, Futoshi Higa, Masao Tateyama, Jiro Fujita, Department of Infectious, Respiratory and Digestive Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa 903-0125, Japan
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Rezania K, Soliven B, Baron J, Lin H, Penumalli V, van Besien K. Myasthenia gravis, an autoimmune manifestation of lymphoma and lymphoproliferative disorders: case reports and review of literature. Leuk Lymphoma 2011; 53:371-80. [PMID: 21864038 DOI: 10.3109/10428194.2011.615426] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kourosh Rezania
- Department of Neurology, University of Chicago Medical Center, Chicago, IL 60637, USA.
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Synchronous second primary neoplasms detected by initial staging F-18 FDG PET/CT examination in patients with non-Hodgkin lymphoma. Clin Nucl Med 2011; 36:509-12. [PMID: 21637049 DOI: 10.1097/rlu.0b013e318217541d] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REPORT Cases of synchronous non-Hodgkin lymphoma (NHL) and second primary carcinoma in previously untreated immunocompetent patients are relatively rare. The aim of this part of our prospective study was to a revealed 2-F-18 fluoro-2-deoxy-D-glucose (F-18 FDG) positron emission tomography (PET)-positive lesion in an extranodal organ suggestive of second primary neoplasm in newly diagnosed NHL patients. MATERIALS AND METHODS A total of 209 patients with NHL underwent initial staging F-18 FDG PET/computed tomography (CT). The finding was assessed by a radiologist, nuclear medicine physician, and hematologist. In 6 suspicious cases (2.9%) of second neoplasm, the decision was made to perform further investigations before lymphoma therapy. RESULTS Two patients were diagnosed with colorectal carcinoma, 1 with esophageal adenocarcinoma, 1 with invasive ductal breast carcinoma, 1 with medullary thyroid carcinoma, and 1 with squamous cell lung carcinoma. In 5 of the 6 patients, the second solid tumor was completely asymptomatic and revealed only by F-18 FDG PET/CT examination. CONCLUSIONS We conclude that in patients with NHL, appropriate imaging, clinical, and histologic analysis of organ lesions detected by F-18 FDG PET/CT will occasionally demonstrate significant synchronous neoplasms.
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White CA, Seth Hawkins J, Pone EJ, Yu ES, Al-Qahtani A, Mai T, Zan H, Casali P. AID dysregulation in lupus-prone MRL/Fas(lpr/lpr) mice increases class switch DNA recombination and promotes interchromosomal c-Myc/IgH loci translocations: modulation by HoxC4. Autoimmunity 2011; 44:585-98. [PMID: 21585311 DOI: 10.3109/08916934.2011.577128] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Immunoglobulin gene somatic hypermutation (SHM) and class switch DNA recombination (CSR) play important roles in the generation of autoantibodies in systemic lupus erythematosus. Systemic lupus is characterized by the production of an array of pathogenic high-affinity mutated and class-switched, mainly IgG, antibodies to a variety of self-antigens, including nuclear components, such as dsDNA, histones, and chromatin. We previously found that MRL/Fas(lpr/lpr) mice, which develop a systemic autoimmune syndrome sharing many features with human lupus, display greatly upregulated CSR, particularly to IgG2a, in B cells of the spleen, lymph nodes, and Peyer's patches. In MRL/Fas(lpr/lpr) mice, the significant upregulation of CSR is associated with increased expression of activation-induced cytidine deaminase (AID), which is critical for CSR and SHM. We also found that HoxC4 directly activates the promoter of the AID gene to induce AID expression, CSR and SHM. Here, we show that in both lupus patients and lupus-prone MRL/Fas(lpr/lpr) mice, the expression of HoxC4 and AID is significantly upregulated. To further analyze the role of HoxC4 in lupus, we generated HoxC4(-/-) MRL/Fas(lpr/lpr) mice. In these mice, HoxC4-deficiency resulted in reduced AID expression, impaired CSR, and decreased serum anti-dsDNA IgG, particularly IgG2a, autoantibodies, which were associated with a reduction in IgG deposition in kidney glomeruli. In addition, consistent with our previous findings in MRL/Fas(lpr/lpr) mice that upregulated AID expression is associated with extensive DNA lesions, comprising deletions and insertions in the IgH locus, we found that c-Myc to IgH (c-Myc/IgH) translocations occur frequently in B cells of MRL/Fas(lpr/lpr) mice. The frequency of such translocations was significantly reduced in HoxC4(-/-) MRL/Fas(lpr/lpr) mice. These findings suggest that in lupus B cells, upregulation of HoxC4 plays a major role in dysregulation of AID expression, thereby increasing CSR and autoantibody production and promoting c-Myc/IgH translocations.
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Affiliation(s)
- Clayton A White
- School of Medicine and School of Biological Sciences, Institute for Immunology, University of California, 3028 Hewitt Hall, Irvine, CA 92697-4120, USA
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Jarrassé C, Pagnier A, Edan C, Landman-Parker J, Mazingue F, Mansuy L, Bertrand Y, Paillard C, Pellier I, Margueritte G, Plantaz D. [Hodgkin disease and autoimmunity in children: 11 case reports]. Arch Pediatr 2011; 18:376-82. [PMID: 21397466 DOI: 10.1016/j.arcped.2011.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 12/01/2010] [Accepted: 01/22/2011] [Indexed: 12/20/2022]
Abstract
The association of lymphoma and autoimmune manifestations has been predominantly studied in adults affected by non-Hodgkin lymphoma. Few publications exist in the literature concerning Hodgkin lymphoma, particularly in children and adolescents. The objectives of this study were to define the characteristics of the link between Hodgkin disease and autoimmunity in childhood. The present 25-year retrospective study was conducted in all centers affiliated with the French Society of Paediatric Oncology (SFCE). Eleven children with Hodgkin disease presented manifestations of disimmunity preceding or following their diagnosis. Four patients had thrombocytopenic purpura, the remaining 7 each had a different autoimmune pathology: lupus syndrome, antiphospholipid syndrome with transient ischemic attack, Evans syndrome, leukocytoclastic vasculitis, autoimmune hemolytic anemia, autoimmune thyroiditis, and juvenile idiopathic arthritis. Lymphoma relapse occurred in 3 patients. Two children died, death being directly attributed to the autoimmune disease in 1 case. Our data suggest that development of autoimmunity is related to significant morbidity. Possible pathophysiological mechanisms include lymphocyte proliferation secondary to chronic inflammation, cell-mediated immune deficiency in Hodgkin disease, molecular mimetics, and antineoplastic phenomena are discussed. A study with a larger patient population is needed to identify the group of children at high risk of autoimmunity for whom additional investigations and modified therapy may be indicated.
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Affiliation(s)
- C Jarrassé
- Service d'oncohématologie pédiatrique, CHU de Grenoble, BP 217, 38043 Grenoble, France.
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Fleissig Y, Reichenberg E, Redlich M, Zaks B, Deutsch O, Aframian DJ, Palmon A. Comparative proteomic analysis of human oral fluids according to gender and age. Oral Dis 2011; 16:831-8. [PMID: 20561216 DOI: 10.1111/j.1601-0825.2010.01696.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, interest in finding disease bio-markers in human body fluids including oral fluids (OF), mainly saliva has increased. However, the physiologic differences in salivary proteins according to gender and age should be explored to establish a clinical diagnostic tool. OBJECTIVE To compare OF protein expression according to gender and age, using proteomic approaches. MATERIALS AND METHODS Oral fluids from 27 healthy volunteers (14 males, 13 females) was collected and divided into three age-groups. OF proteins were separated by means of 2D-SDS-PAGE. A total of 51 proteins in 37 protein spots were identified by ESI-MS/MS. RESULTS Gender differences revealed six proteins with significant higher expression in females, including β-2-microglobulin and transferrin. Age differences revealed decrease in expression of eight proteins with aging among males and seven proteins differentially expressed with aging among females including prolactin inducible protein, Ig-k light chain, transferrin, and calgranulin-B. CONCLUSION Proteomic analysis of OF revealed differences in protein expression according to gender and age and therefore can highlight future use of this technique for diagnostic purposes in health and in disease.
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Affiliation(s)
- Y Fleissig
- Institute of Dental Sciences, Hadassah Faculty of Dental Medicine, the Hebrew University, Jerusalem, Israel
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36
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Onel KB, Onel K. Anti-tumor necrosis factor therapy and cancer risk in patients with autoimmune disorders. Arthritis Care Res (Hoboken) 2010; 62:1024-8. [DOI: 10.1002/acr.20228] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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37
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Martin DN, Mikhail IS, Landgren O. Autoimmunity and hematologic malignancies: associations and mechanisms. Leuk Lymphoma 2009; 50:541-50. [DOI: 10.1080/10428190902780677] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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38
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A common repertoire of autoantibodies is shared by cancer and autoimmune disease patients: Inflammation in their induction and impact on tumor growth. Cancer Lett 2008; 281:8-23. [PMID: 19091462 DOI: 10.1016/j.canlet.2008.11.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 09/16/2008] [Accepted: 11/07/2008] [Indexed: 01/09/2023]
Abstract
The repertoire of autoantibodies found in cancer patients partly overlaps with that typical of patients with autoimmune diseases. Beside the biochemical and immunological properties of the target antigens and their altered expression in tumor tissues, the intratumoral inflammatory context can play a key role in the induction of autoimmune disease-associated autoantibodies in cancer patients. Furthermore, the impact of such antibodies on cancer growth and progression can be deeply influenced by the interplay with inflammation. The characterization of the spontaneous humoral responses occurring in cancer patients, of the mechanisms that trigger and sustain the autoantibody response and of the biological effects of such autoantibodies may help the rational design of anti-cancer immunotherapeutic protocols.
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Sjöberg K, Roth EB, Gustavsson L, Jönsson C, Simán H, Henriksson G, Stenberg P, Lindblom A, Svensson P. Autoimmune Markers in Lymphoid Malignancies. Scand J Immunol 2008; 67:509-15. [DOI: 10.1111/j.1365-3083.2008.02095.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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40
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Abstract
There is evidence that certain connective tissue diseases such as scleroderma are associated with an increased risk of malignancy. Although it has been claimed that systemic lupus erythematosus (SLE) carries an increased risk of breast cancer, review of the available literature suggests that this is not the case, or, any increase is very small. Women with SLE do not need to be under close surveillance for breast cancer. In patients suffering from both SLE and breast cancer, radiotherapy has been regarded as relatively contraindicated because of fears concerning early and late complications. This view is not supported by the available literature and the majority of such cases can be treated by standard breast-conserving therapy, including breast irradiation.
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Affiliation(s)
- Michalis Kontos
- Hedley Atkins Breast Unit, Guy's Hospital, London, United Kingdom
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41
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Saka B, Kalayoglu-Besisik S, Ozturk GB, Dogan O, Erten N. Primary Biliary Cirrhosis and IgG-kappa Type Multiple Myeloma Both Respond Well to Vincristine, Adriamycin and Dexamethasone: Is There a Pathogenic Relationship? J Formos Med Assoc 2008; 107:185-90. [DOI: 10.1016/s0929-6646(08)60133-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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42
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Autoimmune disease in individuals and close family members and susceptibility to non-Hodgkin's lymphoma. ACTA ACUST UNITED AC 2008; 58:657-66. [DOI: 10.1002/art.23267] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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43
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Leonard JP, Link BK, Emmanouilides C, Gregory SA, Weisdorf D, Andrey J, Hainsworth J, Sparano JA, Tsai DE, Horning S, Krieg AM, Weiner GJ. Phase I trial of toll-like receptor 9 agonist PF-3512676 with and following rituximab in patients with recurrent indolent and aggressive non Hodgkin's lymphoma. Clin Cancer Res 2007; 13:6168-74. [PMID: 17947483 DOI: 10.1158/1078-0432.ccr-07-0815] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE PF-3512676 (formerly CpG 7909) is a novel Toll-like receptor 9-activating oligonucleotide with single-agent antitumor activity that augments preclinical rituximab efficacy. This Phase I trial was designed to investigate the safety, tolerability, and preliminary antitumor activity of PF-3512676 in combination with rituximab. EXPERIMENTAL DESIGN Patients with relapsed/refractory CD20+ B cell non-Hodgkin's lymphoma received i.v. rituximab (375 mg/m2/week for 4 weeks) and PF-3512676 weekly for 4 weeks either i.v. (0.04, 0.16, 0.32, or 0.48 mg/kg) or s.c. (0.01, 0.04, 0.08, or 0.16 mg/kg). An additional extended-treatment cohort received 4 weeks of 0.24 mg/kg s.c. PF-3512676 in combination with rituximab followed by s.c. PF-3512676 alone weekly for 20 weeks. RESULTS Patients (N = 50) had received a median of three prior therapies (range, 1-11) including rituximab in 80% of patients. Treatment-related adverse events occurred in 11 of 19 (58%) i.v. patients, 15 of 19 (79%) s.c. patients, and all 12 patients in the extended-treatment cohort. Most common adverse events were mild to moderate systemic flu-like symptoms and injection-site reactions (s.c. cohorts only). Grade 3/4 neutropenia occurred in four patients. Objective responses occurred in 12 of 50 (24%) patients overall and in 6 of 12 (50%) patients in the extended-treatment cohort, including 2 patients with rituximab-refractory disease. CONCLUSION Brief or extended-duration PF-3512676 can be safely administered in combination with rituximab in patients with relapsed/refractory non-Hodgkin's lymphoma.
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Affiliation(s)
- John P Leonard
- Weill Medical College of Cornell University, New York, New York, USA
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44
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Cutaneous vasculitis as an initiating paraneoplastic symptom in Hodgkin lymphoma. Rheumatol Int 2007; 28:719-23. [DOI: 10.1007/s00296-007-0513-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Accepted: 11/28/2007] [Indexed: 12/19/2022]
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45
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Niscola P, Scaramucci L, Perrotti A, Fratoni S, Piccioni D, Tendas A, Cupelli L, Dentamaro T, Del Poeta G, de Fabritiis P. Acute lymphoblastic leukemia subsequent to autoimmune hemolytic anemia: a case report. Ann Hematol 2007; 87:237-8. [PMID: 17874103 DOI: 10.1007/s00277-007-0370-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Accepted: 08/12/2007] [Indexed: 10/22/2022]
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46
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Lachenal F, Berger F, Ghesquières H, Biron P, Hot A, Callet-Bauchu E, Chassagne C, Coiffier B, Durieu I, Rousset H, Salles G. Angioimmunoblastic T-cell lymphoma: clinical and laboratory features at diagnosis in 77 patients. Medicine (Baltimore) 2007; 86:282-292. [PMID: 17873758 DOI: 10.1097/md.0b013e3181573059] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We retrospectively analyzed 77 patients with pathologically diagnosed angioimmunoblastic T-cell lymphoma from a single city. There were 43 men and 34 women; the median age was 64.5 years (range, 30-91 yr). Average time between first symptoms of the disease and diagnosis was 3.6 months. At diagnosis, peripheral nodes were present in all but 1 patient, and were generalized in 90% of cases. Constitutional symptoms were reported in 77% of cases and spleen enlargement in 51%. A cutaneous eruption--morbilliform, urticarial, or more polymorphic--was present in 45% of patients; in one-third of them, the eruption occurred after drug administration. Other clinical manifestations included pleuritis (22%); arthralgia or arthritis (17%); ear, nose, and throat involvement (14%); central or peripheral neurologic manifestations (10%); and ascites (5%). Most patients presented with advanced disease at diagnosis (bone marrow involvement in 60% of cases). The main laboratory abnormalities were elevated lactate dehydrogenase levels (71%), inflammatory syndrome (67%), hypergammaglobulinemia (50%), anemia (51%), and lymphopenia (52%). Auto- or disimmune manifestations were reported in one-third of patients: autoimmune hemolytic anemia was present at diagnosis in 19% of patients and thrombocytopenic purpura in 7%. Documented vasculitis was described in 12% of cases. Clonality was analyzed in lymph nodes in 47 patients: T-cell and B-cell clones were found in 45 (96%) and 20 (45%) patients, respectively. Chromosomal abnormalities were identified in 62% of cases: trisomies 3, 5, 18, 19, additional X chromosome, and deletion of chromosome 7 were the most common abnormalities. The current study underlines the diversity of presenting manifestations of angioimmunoblastic T-cell lymphoma.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers/blood
- Cytological Techniques
- Diagnostic Errors
- Disease Progression
- Female
- Follow-Up Studies
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunoblastic Lymphadenopathy/complications
- Immunoblastic Lymphadenopathy/diagnosis
- Immunoblastic Lymphadenopathy/immunology
- Immunoblastic Lymphadenopathy/pathology
- Immunoblastic Lymphadenopathy/virology
- Kaplan-Meier Estimate
- Lymphoma, T-Cell, Peripheral/complications
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/virology
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- RNA, Viral/analysis
- Retrospective Studies
- Severity of Illness Index
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Affiliation(s)
- Florence Lachenal
- From Hospices Civils de Lyon, Department of Internal Medicine (FL, ID, HR), Department of Pathology (FB), Department of Cytogenetic and Molecular Biology (ECB), and Department of Hematology (BC, GS), Centre Hospitalier Lyon Sud, Pierre-Bénite; Department of Internal Medicine (AH), Hospital Edouard Herriot, Lyon; Department of Hematology (HG, PB) and Department of Pathology (CC), Centre Léon Bérard, Lyon; and Université Claude Bernard Lyon 1 (FL, FB, AH, ECB, BC, ID, HR, GS), Lyon, France
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Stern M, Buser AS, Lohri A, Tichelli A, Nissen-Druey C. Autoimmunity and malignancy in hematology—More than an association. Crit Rev Oncol Hematol 2007; 63:100-10. [PMID: 17391977 DOI: 10.1016/j.critrevonc.2007.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 01/02/2007] [Accepted: 02/06/2007] [Indexed: 02/01/2023] Open
Abstract
Several associations between hematological malignancies and autoimmunity directed against hematopoietic cells exist. Antibody mediated elimination of mature blood cells such as autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) are frequent complications of non-Hodgkin lymphomas, most prominently chronic lymphocytic leukemia. Autoimmunity directed against hematopoietic precursor cells is the hallmark of aplastic anemia, but many features of this disease are shared by two related disorders, paroxysmal nocturnal hemoglobinuria (PNH) and myelodysplastic syndrome (MDS). While the clinical associations between hematological malignancy and autoimmunity have been described many decades ago, only in the last several years have the common pathogenetic mechanisms been elucidated. We summarize the recent progress made in understanding how hematological malignancy gives rise to autoimmunity directed against blood cells and vice versa, and illustrate parallels in the etiology of malignant and autoimmune hematological disorders. Specifically, recent progress in the recognition of the association of lymphoproliferative disorders and autoimmunity against mature blood cells, and common pathogenetic background of aplastic anemia, paroxysmal nocturnal hemoglobinuria, and myelodysplastic syndrome are discussed.
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Affiliation(s)
- Martin Stern
- Division of Experimental Hematology and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Perugia, Policlinico Monteluce, Perugia, Italy
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48
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Wang SS, Cozen W, Cerhan JR, Colt JS, Morton LM, Engels EA, Davis S, Severson RK, Rothman N, Chanock SJ, Hartge P. Immune mechanisms in non-Hodgkin lymphoma: joint effects of the TNF G308A and IL10 T3575A polymorphisms with non-Hodgkin lymphoma risk factors. Cancer Res 2007; 67:5042-54. [PMID: 17510437 DOI: 10.1158/0008-5472.can-06-4752] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two common single nucleotide polymorphisms in immunoregulatory genes (TNF G308A, rs1800629 and IL10 T3575A, rs1800890) have been recently reported as risk factors for non-Hodgkin lymphoma (NHL) in a large pooled analysis. We systematically investigated the effects of other established NHL risk factors in relation to the tumor necrosis factor (TNF) G308A or interleukin 10 (IL10) T3575A genotypes. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) from 1,172 cases and 982 population-based controls in a U.S. multicenter study. We investigated NHL overall and two common subtypes [diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma]. NHL risks were increased among those with both an autoimmune condition and the TNF G308A GA/AA (OR(NHL), 2.1; 95% CI, 1.0-4.2) or the IL10 T3575A TA/AA genotype (OR(NHL), 1.6; 95% CI, 0.9-2.6) compared with individuals without an autoimmune condition and with the common TNF G308A GG or IL10 T3575A TT genotype, respectively; results were similar for DLBCL and follicular lymphoma. We found that elevated DLBCL risk associated with last-born status was more pronounced among those with TNF G308A GA/AA (OR(DLBCL), 2.7; 95% CI, 1.1-6.4) or IL10 T3575A TA/AA (OR(DLBCL), 2.9; 95% CI, 1.6-5.2). Similarly, elevated DLBCL risk associated with obesity (body mass index, > or = 35 versus <25 kg/m(2)) was observed only among those with TNF G308A GA/AA (OR(DLBCL), 2.5; 95% CI, 1.1-5.7) or IL10 T3575A TA/AA genotypes (OR(DLBCL), 2.0; 95% CI, 1.1-3.5). These exploratory results require replication but provide evidence that autoimmune conditions, late birth order, and obesity act partly through a common inflammatory pathway, posing a greater risk to individuals with variant TNF and IL10 genotypes than those with wild-type alleles.
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Affiliation(s)
- Sophia S Wang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland 20892-7234, USA.
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Engels K, Oeschger S, Hansmann ML, Hillebrand M, Kriener S. Bone marrow trephines containing lymphoid aggregates from patients with rheumatoid and other autoimmune disorders frequently show clonal B-cell infiltrates. Hum Pathol 2007; 38:1402-11. [PMID: 17560629 DOI: 10.1016/j.humpath.2007.02.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 02/15/2007] [Accepted: 02/16/2007] [Indexed: 10/23/2022]
Abstract
In bone marrow trephines, morphological and immunohistochemical criteria may not be sufficient to discriminate reactive from malignant lymphoid infiltrates. The aim of this study was to determine whether the detection of clonal immunoglobulin heavy chain (IGH) gene rearrangements is a reliable and specific marker for malignant B-cell clones in bone marrow biopsies. Bone marrow trephines with infiltration by different types of low-grade B-cell non-Hodgkin lymphoma (n = 32), reactive lymphoid hyperplasia (n = 18), and reactive lymphoid aggregates (n = 15), including 5 patients with rheumatoid or other autoimmune disorders, were analyzed by morphology, immunohistochemistry, IGH gene rearrangement (polymerase chain reaction), and DNA sequence analysis in selected cases. In 22 (68.8%) of 32 patients with B-cell non-Hodgkin lymphoma, a clonal IGH gene rearrangement was detected. Of the reactive cases, 1 of 18 patients with lymphoid hyperplasia demonstrated clonality, and 9 (60%) of 15 patients with reactive lymphoid aggregates gave a clonal result (GeneScan analysis). DNA sequence analysis was performed in 7 of the latter patients confirming clonality in 6. Four of the patients with B-cell clonality had an autoimmune disorder. None of these patients developed a malignant lymphoma during follow-up. Thus, the molecular detection of a clonal rearrangement of the IGH gene may support the diagnosis of a malignant lymphoma infiltrating the bone marrow. However, morphologically and immunohistochemically benign lymphoid aggregates might also harbor B-cell clones especially in patients with autoimmune disorders. Therefore, the detection of clonality has to be interpreted with utmost care and does not qualify for the unequivocal diagnosis of a malignant B-cell lymphoma.
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Affiliation(s)
- Knut Engels
- Senckenbergisches Institut für Pathologie, Klinikum der Johann Wolfgang Goethe Universität, 60590 Frankfurt/M, Germany.
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Abstract
The etiology of non-Hodgkin lymphoma, as well as its global dramatic rise in incidence during the past decades, remains largely unexplained. However, there is increasing awareness that this group of malignancies may entail not only clinical, morphological and molecular heterogeneity, but also considerable variations in terms of etiologic factors. In this review, epidemiologic patterns are summarized as well as current evidence of associations between various known or suspected risk factors for non-Hodgkin lymphoma overall or for any of its subtypes. Central pathogenetic mechanisms include immunosuppression, especially in relation to T-cell function and loss of control of latent EBV infection, and chronic antigen stimulation. Some degree of familiar aggregation also implies a role for genetic susceptibility. A number of recent investigations of non-Hodgkin lymphoma etiology will hopefully lead to a better understanding of the causes of these malignancies.
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Affiliation(s)
- Karin Ekström-Smedby
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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