TY - JOUR
T1 - Lymphoma risk in systemic lupus
T2 - Effects of disease activity versus treatment
AU - Bernatsky, Sasha
AU - Ramsey-Goldman, Rosalind
AU - Joseph, Lawrence
AU - Boivin, Jean Francois
AU - Costenbader, Karen H.
AU - Urowitz, Murray B.
AU - Gladman, Dafna D.
AU - Fortin, Paul R.
AU - Nived, Ola
AU - Petri, Michelle A.
AU - Jacobsen, Soren
AU - Manzi, Susan
AU - Ginzler, Ellen M.
AU - Isenberg, David
AU - Rahman, Anisur
AU - Gordon, Caroline
AU - Ruiz-Irastorza, Guillermo
AU - Yelin, Edward
AU - Bae, Sang Cheol
AU - Wallace, Daniel J.
AU - Peschken, Christine A.
AU - Dooley, Mary Anne
AU - Edworthy, Steven M.
AU - Aranow, Cynthia
AU - Kamen, Diane L.
AU - Romero-Diaz, Juanita
AU - Askanase, Anca
AU - Witte, Torsten
AU - Barr, Susan G.
AU - Criswell, Lindsey A.
AU - Sturfelt, Gunnar K.
AU - Blanco, Irene
AU - Feldman, Candace H.
AU - Dreyer, Lene
AU - Patel, Neha M.
AU - Pierre, Yvan St
AU - Clarke, Ann E.
PY - 2014/1
Y1 - 2014/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84889686638&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84889686638&partnerID=8YFLogxK
U2 - 10.1136/annrheumdis-2012-202099
DO - 10.1136/annrheumdis-2012-202099
M3 - Article
C2 - 23303389
AN - SCOPUS:84889686638
SN - 0003-4967
VL - 73
SP - 138
EP - 142
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 1
ER -
