Lymphoproliferative cancer and other malignancy in patients with rheumatoid arthritis treated with azathioprine: a 20 year follow up study.

Silman, Alan J.; Petrie, James J.B.; Hazleman, B. L.; Evans, Stephen

doi:10.1136/ard.47.12.988

Cited by 247 publications

(107 citation statements)

References 7 publications

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“…ii) Carcinogenesis is linked to medications administered for treatment of renal disease, such as azathioprine for skin cancers (37) and lymphomas (38). iii) It was reported that long-term hemodialysis may suppress the DNA repair system of lymphocytes (39), and plasma glutathione peroxidase deficiency caused by renal dysfunction may lead to DNA damage (40), which impairs the defense of the organism against oncogenic viral infections and a variety of nonviral tumor antigens.…”

Section: Heterogeneity ----------------------------------------------mentioning

confidence: 99%

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Shi

Huang

et al. 2016

Molecular and Clinical Oncology

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Abstract. It has been reported that patients receiving renal replacement therapy (RRT), including dialysis and kidney transplantation, tend to have an increased risk of cancer; however, studies on the degree of this risk have remained inconclusive. The present meta-analysis was therefore performed to quantify the cancer risk in patients with RRT. Cohort studies assessing overall cancer risk in RRT patients published before May 29, 2015 were included following systematic searches with of PubMed, EMBASE and the reference lists of the studies retrieved. Random-effects meta-analyses were used to pool standardized incidence rates (SIRs) with 95% confidence intervals (CIs). Heterogeneity tests, sensitivity analyses and publication bias assessment were performed. A total of 18 studies including 22 cohort studies were eventually identified, which comprised a total of 1,528,719 patients. In comparison with the general population, the pooled SIR for patients with dialysis including non-melanoma skin cancer (NMSC), dialysis excluding NMSC, transplantation including NMSC, transplantation excluding NMSC and RRT were 1.40 (95% CI, 1.36-1.45), 1.35 (95% CI, 1.23-1.50), 3.26 (95% CI, 2.29-4.63), 2.08 (95% CI, 1.73-2.50) and 2.01 (95% CI, 1.70-2.38), respectively. The cancer risk was particularly high in subgroups of large sample size trials, female patients, younger patients (age at first dialysis, 0-34 years; age at transplantation, 0-20 years), the first year of RRT and non-Asian transplant patients. A significant association was also found between RRT and the majority of organ-specific cancers. However, neither dialysis nor transplantation was associated with breast, body of uterus, colorectal or prostate cancer. Significant heterogeneity was found regarding the association between RRT and overall cancer as well as the majority of site-specific cancer types. However, this heterogeneity had no substantial influence on the pooled SIR for overall cancer in RRT according to the sensitivity analysis. Compared with the general population, RRT patients have a significantly increased risk of overall cancer and the majority of specific cancer types, particularly Kaposi sarcoma (KS), lip cancer and NMSC in patients subjected to kidney transplantation and cancer of the thyroid gland and kidney as well as myeloma in dialysis patients. Considering the high heterogeneity encountered, further high-quality studies are required.

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Section: Heterogeneity ----------------------------------------------mentioning

confidence: 99%

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Shi

Huang

et al. 2016

Molecular and Clinical Oncology

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“…The reason for this association is still incompletely understood, but immunosuppressive therapy in RA (6)(7)(8)(9)(10) as well as Epstein-Barr virus (EBV) infection may play a role in the development of these lymphomas (11)(12)(13)(14)(15). Additionally, both we (16) and others (17) have reported that high RA disease activity in itself may be associated with an increased lymphoma risk.…”

mentioning

confidence: 99%

Lymphoma subtypes in patients with rheumatoid arthritis: Increased proportion of diffuse large B cell lymphoma

Baecklund

Sundström

Ekbom

et al. 2003

Arthritis & Rheumatism

153

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Objective. Patients with rheumatoid arthritis (RA) have an increased risk of developing malignant lymphoma. It is not clear whether the increase is confined to certain subtypes of lymphomas. Immunosuppressive therapy and Epstein-Barr virus (EBV) have been linked to the development of these lymphomas. To gain information about the baseline pattern of lymphoma subtypes in RA before the current widespread use of immunosuppressive drugs, we examined the distribution of lymphoma subtypes and the presence of EBV in a cohort of RA patients with a low frequency and duration of treatment with immunosuppressive drugs.Methods. By linking data from the Swedish Hospital Discharge Register and the Swedish Cancer Register, 42 cases of lymphoma were identified among 11,683 patients with RA in the Uppsala Health Care Region between 1964 and 1984. The medical records and paraffin-embedded lymphoma tissues were collected, and the lymphomas were reclassified using the World Health Organization classification. In situ hybridization was used to detect EBV.Results. Tissues from 35 patients were reviewed. Non-Hodgkin's lymphoma (NHL) was found in 33 patients and Hodgkin's lymphoma in 2 patients. There was an increased frequency of diffuse large B cell lymphoma (DLBCL) (22 of 33 NHL patients, 67%) compared with that in the general population (30-40%). EBV was detected in 5 of 30 examined lymphomas from patients (17%). Twenty of the 22 DLBCL patients had RA with medium or high inflammatory activity, and 6 had been treated with a disease-modifying antirheumatic drug for >1 year.Conclusion. The findings of this study suggest an increased incidence of one specific lymphoma subtype,

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“…The first is the carcinogenesis related to medications administered for treating the renal disease: glomerulonephritides and vasculitides require citotoxic therapy such as cyclophosphamide and azathioprine, which are known to induce bladder, kidney, 17 skin cancer, or lymphomas. 18 The second is the carcinogenesis related to underlying renal disease: acquired polycystic kidney disease is associated with increased risk of renal cell carcinoma. 19 The third is the carcinogenesis caused by impaired immunity such as lymphocytes disregulation 20 and DNA damage.…”

Section: Discussionmentioning

confidence: 99%

Estimated Radiation Exposure from Medical Imaging in Hemodialysis Patients

Mauri¹,

Brambilla²,

Chiarinotti³

et al. 2011

Journal of the American Society of Nephrology

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Radiation exposure accompanying medical imaging associates with cancer risk. Patients with recurrent or chronic diseases may be especially at risk, because they may undergo more of these procedures. The aim of this study was to assess the individual cumulative effective doses (CEDs), which quantify radiation from medical imaging procedures, in a cohort of 106 hemodialysis patients during a median follow-up of 3 years. We retrospectively calculated individual radiation exposures by collecting the number and type of radiologic procedures from hospital records. We also estimated organ doses for computed tomography procedures. The mean and median annual CEDs were 21.9 and 11.7 mSv per patient-year, respectively. The mean and median total CEDs per patient during the study period were 57.7 and 27.3 mSv, respectively. By radiation dose group, we classified 22 patients as low (Ͻ3 mSv/yr), 51 as moderate (3 to Ͻ20 mSv/yr), 22 as high (20 to Ͻ50 mSv/yr), and 11 as very high (Ն50 mSv/yr). Seventeen patients had a total CED Ͼ100 mSv, a value associated with a substantial increase in risk for cancer-related mortality. Of the total CED,s 76% was a result of CT scanning. The annual CED significantly associated with age and transplant waitlist status. In summary, this study shows that a significant fraction of surviving hemodialysis patients during a 3-year period receives estimated radiation doses that may put them at an increased risk for cancer.

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Lymphoproliferative cancer and other malignancy in patients with rheumatoid arthritis treated with azathioprine: a 20 year follow up study.

Cited by 247 publications

References 7 publications

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Lymphoma subtypes in patients with rheumatoid arthritis: Increased proportion of diffuse large B cell lymphoma

Estimated Radiation Exposure from Medical Imaging in Hemodialysis Patients

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