Clinical manifestations of autoimmune disease-related non-Hodgkin lymphoma: a Korean single-center, retrospective clinical study
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Recently, large cohort studies regarding associations between autoimmune disease and lymphomas have been reported in a few Western countries. However, Asian data concerning autoimmune-related lymphomas are limited. Therefore, we evaluated the clinical characteristics and prognostic factors of patients with autoimmune disease-related non-Hodgkin lymphoma (NHL) in a single center in Korea. Methods: We analyzed the data from 11 patients with autoimmune-related NHL. Patients were categorized into two groups, those with rheumatoid arthritis (RA) and those with non-RA-related NHL. Then patients were re-categorized into a group with methotrexate (MTX) usage and a MTX non-usage group. Histological subtype, MTX duration, autoimmune disease duration, treatment modalities, and other data were collected and analyzed. Results: Our study revealed that older RA patients have a greater likelihood of occurrence of NHL (p = 0.042). We confirmed that MTX duration and cumulative dose of MTX have no significant correlation with autoimmune disease and NHL (p = 0.073). In the management of autoimmune disease-related NHL, all patients were directly treated with systemic chemotherapy instead of employing a wait and watch approach. Overall survival (OS) and progression-free survival (PFS) in all autoimmune disease-related NHL were 100% and 87.5%, with no treatment-related mortality during the 2-year follow-up period of our study. Conclusions: Our study suggests that patients with RA-NHL are characterized by older age at onset compared to those with non-RA-NHL. Also considering of OS and PFS, intensive treatment strategy instead of delayed watchful managements may be required for autoimmune disease-related NHL including of old age group.
Abstract
Background/Aims: Recently, large cohort studies regarding associations between autoimmune disease and lymphomas have been reported in a few Western countries. However, Asian data concerning autoimmune-related lymphomas are limited. Therefore, we evaluated the clinical characteristics and prognostic factors of patients with autoimmune disease-related non-Hodgkin lymphoma (NHL) in a single center in Korea. Methods: We analyzed the data from 11 patients with autoimmune-related NHL. Patients were categorized into two groups, those with rheumatoid arthritis (RA) and those with non-RA-related NHL. Then patients were re-categorized into a group with methotrexate (MTX) usage and a MTX non-usage group. Histological subtype, MTX duration, autoimmune disease duration, treatment modalities, and other data were collected and analyzed. Results: Our study revealed that older RA patients have a greater likelihood of occurrence of NHL (p = 0.042). We confirmed that MTX duration and cumulative dose of MTX have no significant correlation with autoimmune disease and NHL (p = 0.073). In the management of autoimmune disease-related NHL, all patients were directly treated with systemic chemotherapy instead of employing a wait and watch approach. Overall survival (OS) and progression-free survival (PFS) in all autoimmune disease-related NHL were 100% and 87.5%, with no treatment-related mortality during the 2-year follow-up period of our study. Conclusions: Our study suggests that patients with RA-NHL are characterized by older age at onset compared to those with non-RA-NHL. Also considering of OS and PFS, intensive treatment strategy instead of delayed watchful managements may be required for autoimmune disease-related NHL including of old age group.
참고문헌 (21)
- Groves FD, "Cancer surveillance series: non-Hodgkin’s lymphoma incidence by histologic subtype in the United States from 1978through 1995", J Natl Cancer Inst, 92, pp.1240~1251 (2000)
- Fisher SG, "The epidemiology of non-Hodgkin’s lymphoma", Oncogene, 23, pp.6524~6534 (2004)
- Goldin LR, "Autoimmunity and lymphomagenesis", Int J Cancer, 124, pp.1497~1502 (2009)
- Maegawa S, "Clinical manifestation and prognostic factors of 32 Japanese patients with autoimmune disease-associated diffuse large B-cell lymphoma", Leuk Lymphoma, 56, pp.785~788 (2015)
- Alexander DD, "The non-Hodgkin lymphomas: a review of the epidemiologic literature", Int J Cancer, 120(Suppl 12), pp.1~39 (2007)
- Mellemkjaer L, "Autoimmune disease in individuals and close family members and susceptibility to non-Hodgkin’s lymphoma", Arthritis Rheum, 58, pp.657~666 (2008)
- Conde L, "A search for overlapping genetic susceptibility loci between non-Hodgkin lymphoma and autoimmune diseases", Genomics, 98, pp.9~14 (2011)
- Hoshida Y, "Lymphoproliferative disorders in autoimmune diseases in Japan: analysis of clinicopathological features and Epstein-Barr virus infection", Int J Cancer, 108, pp.443~449 (2004)
- van de Schans SA, "Excess of autoimmune and chronic inflammatory disorders in patients with lymphoma compared with all cancer patients: a cancer registry-based analysis in the south of the Netherlands", Autoimmun Rev, 10, pp.228~234 (2011)
- Smedby KE, "Malignant lymphomas in autoimmunity and inflammation: a review of risks, risk factors, and lymphoma characteristics", Cancer Epidemiol Biomarkers Prev, 15, pp.2069~2077 (2006)
- Tokuhira M, "Clinicopathological analyses in patients with other iatrogenic immunodeficiency-associated lymphoproliferative diseases and rheumatoid arthritis", Leuk Lymphoma, 53, pp.616~623 (2012)
- Ichikawa A, "Methotrexate", iatrogenic lymphoproliferative disorders in rheumatoid arthritis: histology, Epstein-Barr virus, and clonality are important predictors of disease progression and regression, 2013, pp.91, 20~28
- Chang KL, "Description of an in situ hybridization methodology for detection of Epstein-Barr virus RNA in paraffin-embedded tissues, with a survey of normal and neoplastic tissues", Diagn Mol Pathol, 1, pp.246~255 (1992)
- Sabattini E, "WHO classification of tumours of haematopoietic and lymphoid tissues in 2008: an overview", Pathologica, 102, pp.83~87 (2010)
- Peto R, "Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples", Br J Cancer, 35, pp.1~39 (1977)
- Feng WH, "Reactivation of latent Epstein-Barr virus by methotrexate: a potential contributor to methotrexate-associated lymphomas", J Natl Cancer Inst, 96, pp.1691~1702 (2004)
- Toussirot E, "Epstein-Barr virus in autoimmune diseases", Best Pract Res Clin Rheumatol, 22, pp.883~896 (2008)
- Mariette X, "Lymphomas in rheumatoid arthritis patients treated with methotrexate: a 3-year prospective study in France", Blood, 99, pp.3909~3915 (2002)
- Mariette X, "Lymphomas in patients with Sjogren’s syndrome:review of the literature and physiopathologic hypothesis", Leuk Lymphoma, 33, pp.93~99 (1999)
- Moder KG, "Hematologic malignancies and the use of methotrexate in rheumatoid arthritis: a retrospective study", Am J Med, 99, pp.276~281 (1995)
- 정요셉, "Nodal involvement of extranodal marginal zone lymphoma with extreme plasmacytic differentiation (Mott cell formation) simulating plasma cell neoplasm and lymphoplasmacytic lymphoma", Blood Research, 49(4), pp.275~278 (2014), 대한혈액학회