Lymphoproliferative malignancy in rheumatoid arthritis: a study of 20 cases.

Symmons, Deborah; Ahern, Michael; Bacon, P. A.; Hawkins, C F; Amlot, Peter; Jones, E.; Prior, P; Scott, David

doi:10.1136/ard.43.2.132

Cited by 58 publications

(14 citation statements)

References 15 publications

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“…22 Because most of the drugs used in the treatment of RD exert anti-inflammatory and immunosuppressive effects, there is a possibility that the RD treatment itself promotes cancer metastasis and consequently shorter survival. However, in our series, no correlation of corticosteroid treatment with TNM classification and prognosis was observed, and many previous reports have identified no association of RA therapy, including gold, penicillamine, prednisone, and methotrexate, with increased cancer-related mortality, [23][24][25] corroborating our result.…”

Section: Resultssupporting

confidence: 81%

Characteristics and Prognosis of Colorectal Cancer Associated With Rheumatic Disease

Kishikawa¹,

Kawai²,

Tsuno

et al. 2015

International Surgery

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It is well known that host immunity plays an important role in the defense against colorectal cancer (CRC) progression. The effects of autoimmune diseases, such as rheumatic disease (RD) in which the immune system is deregulated, on this immunity have not been fully investigated. The medical records of 1299 consecutive patients diagnosed with primary colorectal cancer who underwent surgical resection were retrospectively reviewed. The clinicopathologic factors of 28 subjects with RD (RD group) were compared with those of 1271 patients without RD (non-RD group). Compared to the non-RD group, the RD group was typified by a predominance of females (P , 0.01), older age (P , 0.01), and a lower incidence of rectal cancer (P ¼ 0.02). Although no difference was observed between the groups in terms of TNM classification, disease-free and overall survival were significantly poorer in the RD group in both univariate and multivariate analyses. Subjects who had RD for more than 10 years tended to have a higher frequency of lymph node metastasis (P ¼ 0.06) and a significantly higher incidence of synchronous distant metastasis (P ¼ 0.035) at the time of cancer diagnosis. RD was associated with a significantly poorer prognosis of colorectal cancer, suggesting that deregulation of the immune system by autoimmune diseases may adversely affect the host immune defense against colorectal cancer progression.Key words: Colorectal cancer -Rheumatic disease -Host immunity -Prognosis I t is well known that host immunity plays an important role in defenses against the development and progression of cancer. The degree of lymphocyte infiltration into tumors has been reported to correlate with improvements of patient survival.1 In carcinogen-induced mouse models of cancer, primary tumor susceptibility has been found to be enhanced in immunocompromised mice;Corresponding author: Junko Kishikawa, MD, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. In autoimmune diseases represented by rheumatic disease (RD), the immune system loses the ability to distinguish nonself from self, eliciting an immune response against self-antigens; in this process, there is a possibility that immune defenses against nonnormal cells are lost or impaired, facilitating the development and progression of cancer. In addition, the development of RD associated with cancer has been reported, and as its development is dependent on the production of substances such as hormones, peptides, autocrine and paracrine mediators, and antibodies or the stimulation of cytotoxic lymphocytes, the condition is known as paraneoplastic rheumatic syndrome. In such cases, RD tends to be less responsive to therapy than its nonparaneoplastic equivalents, and instead, treatment of the underlying cancer usually results in regression of RD.4,5 Thus, it is postulated that RD and cancer are closely associated. However, only a few reports on the incidence and risk of cancer among patients with RD exist,6,7 and the characteristics and prognosis of colorectal cancer (CRC) in these patients remain to ...

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Section: Resultssupporting

confidence: 81%

Characteristics and Prognosis of Colorectal Cancer Associated With Rheumatic Disease

Kishikawa¹,

Kawai²,

Tsuno

et al. 2015

International Surgery

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“…The increased risk for lymphoma is consistent with previous reports of increased risk of lymphoma in rheumatoid arthritis. [37][38][39][40] In a case-control study, patients with rheumatoid arthritis and high disease activity were estimated to have up to a 25.8-fold increased risk of lymphoma compared with controls without rheumatoid arthritis. 41 The SIR for lymphoma (3.71 (95% CI, 0.77 to 11.0)) observed in the present study is consistent with odds ratios varying from 1.9 to 20.0 in various reports of patients with rheumatoid arthritis.…”

Section: Discussionmentioning

confidence: 99%

Safety of extended treatment with anakinra in patients with rheumatoid arthritis

Fleischmann

Tesser²,

Schiff³

et al. 2006

Annals of the Rheumatic Diseases

271

181

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Objective: To determine the safety profile of anakinra after extended exposure in a diverse clinical trial population of patients with rheumatoid arthritis. Methods: A six month, randomised, double blind phase comparing anakinra (100 mg/day) with placebo was followed by open label anakinra treatment for up to three years in patients with rheumatoid arthritis. Concomitant non-steroidal anti-inflammatory drugs, corticosteroids, and other disease modifying antirheumatic drugs were permitted. Results: In all 1346 patients with rheumatoid arthritis received anakinra for up to three years. Patients had varying levels of disease severity, concomitant drug use, and comorbid conditions. Cumulative, exposure adjusted event (EAE) rates for all adverse events (AEs), serious AEs, and deaths were similar during each year of anakinra treatment; the overall rate (0 to 3 years) was similar to that observed for controls during the blinded phase. The most frequent AEs were injection site reactions (122.26 events/100 patient-years), rheumatoid arthritis progression (67.80 events/100 patient-years), and upper respiratory infections (26.09 events/100 patient-years). The EAE rate of serious infections was higher for patients treated with anakinra for 0 to 3 years (5.37 events/100 patient-years) than for controls during the blinded phase (1.65 events/100 patient-years). However, if the patient was not receiving corticosteroid treatment at baseline, the serious infection rate was substantially lower (2.87 event/100 patient-years). The overall incidence of malignancies was consistent with expected rates reported by SEER. Neutralising antibodies developed in 25 patients, but appeared to be transient in 12; neutralising antibody status did not appear related to occurrence of malignancies or serious infections. There were no clinically significant trends in laboratory data related to anakinra. Conclusion: Anakinra is safe and well tolerated for up to three years of continuous use in a diverse population of patients with rheumatoid arthritis.

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“…Individuals with RA appear to have higher risks for developing lymphohematopoietic malignancies, with some studies reporting two to eightfold increases in risk of non-Hodgkin's lymphoma (NHL) [8], leukemia [9, 10], and multiple myeloma [11]. With respect to solid tumors, increased risks of lung cancer [12] and melanoma [13] have been reported.…”

Section: Introductionmentioning

confidence: 99%

Risk of cancer among rheumatoid arthritis patients in California

Parikh‐Patel

White

Allen

et al. 2009

Cancer Causes Control

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Objective The objective of this retrospective cohort study was to evaluate cancer risk among rheumatoid arthritis (RA) patients in California. Methods The study cohort derived from statewide patient discharge records was followed via linkage with cancer registry data over the period 1991–2002. Age and sex adjusted standardized incidence ratios (SIRs) and 95% confidence intervals were calculated to compare observed to expected numbers of cancers based on age, race, and sex specific incidence rates in the California population. Results Among the 84,475 RA patients, who were observed for 405,540 person-years, 5,533 incident cancers were diagnosed during the observation interval. The risk of developing lymphohematopoietic cancer was significantly higher in the cohort for both sexes. Males had significantly higher risks of lung, liver, and esophageal cancer, but a lower risk of prostate cancer. Females were at significantly decreased risk for several cancers including breast, ovary, uterus, cervix, and melanoma, with the risk reduction ranging from 15 to 57% lower than the general population. Hispanics had increased risks of leukemia, vagina/vulva, lung, and liver cancers. Conclusion Studies investigating the mechanisms that underlie the reported associations between RA and specific cancer types are needed.

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Lymphoproliferative malignancy in rheumatoid arthritis: a study of 20 cases.

Cited by 58 publications

References 15 publications

Characteristics and Prognosis of Colorectal Cancer Associated With Rheumatic Disease

Characteristics and Prognosis of Colorectal Cancer Associated With Rheumatic Disease

Safety of extended treatment with anakinra in patients with rheumatoid arthritis

Risk of cancer among rheumatoid arthritis patients in California

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