1
|
Brufatto MZ, Lanças SHS, de Albuquerque Pedrosa Fernandes T, Sallum AME, Campos LMA, Sakamoto AP, Terreri MT, Sztajnbok FR, Bica BERG, Ferriani VPL, de Carvalho LM, Silva CAA, Saad-Magalhaes C. Childhood-onset systemic lupus erythematosus (cSLE) and malignancy: a nationwide multicentre series review. Adv Rheumatol 2024; 64:13. [PMID: 38321580 DOI: 10.1186/s42358-024-00353-3] [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: 10/03/2023] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Increased malignancy frequency is well documented in adult-systemic lupus erythematosus (SLE), but with limited reports in childhood-onset SLE (cSLE) series. We explored the frequency of malignancy associated with cSLE, describing clinical and demographic characteristics, disease activity and cumulative damage, by the time of malignancy diagnosis. METHOD A retrospective case-notes review, in a nationwide cohort from 27 Pediatric Rheumatology centres, with descriptive biopsy-proven malignancy, disease activity/damage accrual, and immunosuppressive treatment were compiled in each participating centre, using a standard protocol. RESULTS Of the 1757 cSLE cases in the updated cohort, 12 (0.7%) developed malignancy with median time 10 years after cSLE diagnosis. There were 91% females, median age at cSLE diagnosis 12 years, median age at malignancy diagnosis 23 years. Of all diagnosed malignancies, 11 were single-site, and a single case with concomitant multiple sites; four had haematological (0.22%) and 8 solid malignancy (0.45%). Median (min-max) SLEDAI-2 K scores were 9 (0-38), median (min-max) SLICC/ACR-DI (SDI) score were 1 (1-5) Histopathology defined 1 Hodgkin's lymphoma, 2 non-Hodgkin's lymphoma, 1 acute lymphoblastic leukaemia; 4 gastrointestinal carcinoma, 1 squamous cell carcinoma of the tongue and 1 anal carcinoma; 1 had sigmoid adenocarcinoma and 1 stomach carcinoid; 3 had genital malignancy, being 1 vulvae, 1 cervix and 1 vulvae and cervix carcinomas; 1 had central nervous system oligodendroglioma; and 1 testicle germ cell teratoma. CONCLUSION Estimated malignancy frequency of 0.7% was reported during cSLE follow up in a multicentric series. Median disease activity and cumulative damage scores, by the time of malignancy diagnoses, were high; considering that reported in adult series.
Collapse
Affiliation(s)
- Matheus Zanata Brufatto
- Department of Internal Medicine, Discipline of Rheumatology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
| | - Sean Hideo Shirata Lanças
- Department of Internal Medicine, Discipline of Rheumatology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | | | - Adriana Maluf Elias Sallum
- Pediatric Rheumatology Unit, Child and Adolescent Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lucia Maria Arruda Campos
- Pediatric Rheumatology Unit, Child and Adolescent Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Paula Sakamoto
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria Teresa Terreri
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Blanca Elena Rios Gomes Bica
- Pediatric Rheumatology Unit, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Virginia Paes Leme Ferriani
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luciana Martins de Carvalho
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Clovis Artur Almeida Silva
- Adolescent and Pediatric Rheumatology Units, Child and Adolescent Institute HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Claudia Saad-Magalhaes
- Pediatric Rheumatology Unit, Department of Pathology, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| |
Collapse
|
2
|
Choi MY, Flood K, Bernatsky S, Ramsey-Goldman R, Clarke AE. A review on SLE and malignancy. Best Pract Res Clin Rheumatol 2017; 31:373-396. [PMID: 29224679 PMCID: PMC6742439 DOI: 10.1016/j.berh.2017.09.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 08/26/2017] [Indexed: 12/11/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease characterized by autoantibody production, complement activation, and immune complex deposition. It predominantly affects young and middle-aged women. While improvements in the diagnosis and treatment of SLE have altered prognosis, morbidity and mortality rates remain higher than the general population. In addition to renal injury, cardiovascular disease, and infection, malignancy is known to be a significant cause of death in this population. There is increasing evidence to suggest that patients with SLE have a slightly higher overall risk of malignancy. The risk of malignancy in SLE is of considerable interest because the immune and genetic pathways underlying the pathogenesis of SLE and the immunosuppressant drugs (ISDs) used in its management may mediate this altered risk. Our current understanding of these and other risk factors and the implications for treating SLE and screening for malignancy is still evolving. This review summarizes the association between SLE and malignancy. The first section discusses the risk of overall and site-specific malignancies in both adult- and pediatric-onset SLE. Next, we evaluate the risk factors and possible mechanisms underlying the link between malignancy and SLE, including the use of ISDs, presence of certain SLE-related autoantibodies, chronic immune dysregulation, environmental factors, and shared genetic susceptibility. Finally, we review guidelines regarding cancer screening and vaccination for human papilloma virus.
Collapse
Affiliation(s)
- May Y Choi
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1, Alberta, Canada.
| | - Kelsey Flood
- Northwestern University and Feinberg School of Medicine, 420 E Superior St, Chicago, 60611, Illinois, USA.
| | - Sasha Bernatsky
- Divisions of Rheumatology, McGill University Health Centre, McGill University, A6-1650 Cedar Avenue A6.163, Montreal, H3G 1A4, Quebec, Canada.
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Northwestern University and Feinberg School of Medicine, 633 N. St. Clair, 18th Floor, Chicago, 60611, Illinois, USA.
| | - Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, T2N 4N1, Alberta, Canada.
| |
Collapse
|