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Accepted (AM)Open Access (License Unspecified), Open
Journal article
Lymphoma risk in systemic lupus: effects of disease activity versus treatment
Annals of the rheumatic diseases, v 73(1), pp 138-142
01 Jan 2014
PMID: 23303389
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective To examine disease activity versus treatment as lymphoma risk factors in systemic lupus erythematosus (SLE). Methods We performed case–cohort analyses within a multisite SLE cohort. Cancers were ascertained by regional registry linkages. Adjusted HRs for lymphoma were generated in regression models, for time-dependent exposures to immunomodulators (cyclophosphamide, azathioprine, methotrexate, mycophenolate, antimalarial drugs, glucocorticoids) demographics, calendar year, Sjogren's syndrome, SLE duration and disease activity. We used adjusted mean SLE Disease Activity Index scores (SLEDAI-2K) over time, and drugs were treated both categorically (ever/never) and as estimated cumulative doses. Results We studied 75 patients with lymphoma (72 non-Hodgkin, three Hodgkin) and 4961 cancer-free controls. Most lymphomas were of B-cell origin. As is seen in the general population, lymphoma risk in SLE was higher in male than female patients and increased with age. Lymphomas occurred a mean of 12.4 years (median 10.9) after SLE diagnosis. Unadjusted and adjusted analyses failed to show a clear association of disease activity with lymphoma risk. There was a suggestion of greater exposure to cyclophosphamide and to higher cumulative steroids in lymphoma cases than the cancer-free controls. Conclusions In this large SLE sample, there was a suggestion of higher lymphoma risk with exposure to cyclophosphamide and high cumulative steroids. Disease activity itself was not clearly associated with lymphoma risk. Further work will focus on genetic profiles that might interact with medication exposure to influence lymphoma risk in SLE.
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Details
- Title
- Lymphoma risk in systemic lupus: effects of disease activity versus treatment
- Creators
- Sasha Bernatsky - McGill University Health CentreRosalind Ramsey-Goldman - Northwestern UniversityLawrence Joseph - McGill UniversityJean-Francois Boivin - McGill UniversityKaren H Costenbader - Brigham and Women's HospitalMurray B Urowitz - Toronto Western HospitalDafna D Gladman - Toronto Western HospitalPaul R Fortin - Université LavalOla Nived - Lund UniversityMichelle A Petri - Johns Hopkins MedicineSoren Jacobsen - Copenhagen University HospitalSusan Manzi - Allegheny Health NetworkEllen M Ginzler - State University of New YorkDavid Isenberg - University College LondonAnisur Rahman - University College LondonCaroline Gordon - University of BirminghamGuillermo Ruiz-Irastorza - Hospital de CrucesEdward Yelin - University of California SystemSang-Cheol Bae - Hanyang University Seoul HospitalDaniel J Wallace - Cedars-Sinai Medical CenterChristine A Peschken - University of ManitobaMary Anne Dooley - University of North Carolina at Chapel HillSteven M Edworthy - University of CalgaryCynthia Aranow - Feinstein Institute for Medical ResearchDiane L Kamen - Medical University of South CarolinaJuanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránAnca Askanase - New York University Langone Orthopedic HospitalTorsten Witte - Medizinische Hochschule HannoverSusan G Barr - University of CalgaryLindsey A Criswell - University of California, San FranciscoGunnar K Sturfelt - Lund UniversityIrene Blanco - Albert Einstein College of MedicineCandace H Feldman - Brigham and Women's HospitalLene Dreyer - Copenhagen University HospitalNeha M Patel - State University of New YorkYvan St Pierre - McGill University Health CentreAnn E Clarke - McGill University Health Centre
- Publication Details
- Annals of the rheumatic diseases, v 73(1), pp 138-142
- Publisher
- British Medical Journal (BMJ)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000327835100025
- Scopus ID
- 2-s2.0-84889686638
- Other Identifier
- 991021933904704721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology