Risks of myeloid malignancies in patients with autoimmune conditions
Risks of myeloid malignancies in patients with autoimmune conditions
复制标题
DOI：
10.1038/sj.bjc.6604935
复制
发表时间：
2009-03-03
影响因子：
8.8
通讯作者：
Engels, E. A.
中科院分区：
文献类型：
--
作者：
Anderson, L. A.;Pfeiffer, R. M.;Engels, E. A.
自身免疫性疾病与淋巴增生性恶性肿瘤的风险升高有关，但很少有研究调查髓系恶性肿瘤的风险。从美国监测流行病学和最终结果(SEER)-Medicare数据库中，选择13486例髓系恶性肿瘤患者（67岁以上）和16086例基于人群的对照。使用调整了性别、年龄、种族、日历年和医生索赔数量的Logistic回归模型来估计与自身免疫性疾病相关的髓系恶性肿瘤的优势比（ORs）。采用Bonferroni校正控制多个比较（P < 0.0005）。总体而言，自身免疫性疾病与急性髓性白血病（AML） （OR 1.29）和骨髓增生异常综合征（MDS, OR 1.50）的风险增加相关。具体而言，AML与类风湿关节炎（OR 1.28）、系统性红斑狼疮（OR 1.92）、风湿性多肌痛（OR 1.73）、自身免疫性溶血性贫血（OR 3.74）、系统性血管炎（OR 6.23）、溃疡性结肠炎（OR 1.72）和恶性贫血（OR 1.57）相关。骨髓增生异常综合征与类风湿关节炎（OR为1.52）和恶性贫血（OR为2.38）相关。总体而言，自身免疫性疾病与慢性髓性白血病（OR为1.09）或慢性骨髓增生性疾病（OR为1.15）无关。用于治疗自身免疫性疾病的药物，共同的遗传易感性和/或自身免疫性疾病直接浸润骨髓，可以解释这些髓系恶性肿瘤的过度风险。
Autoimmune conditions are associated with an elevated risk of lymphoproliferative malignancies, but few studies have investigated the risk of myeloid malignancies. From the US Surveillance Epidemiology and End Results (SEER)-Medicare database, 13 486 myeloid malignancy patients (aged 67+ years) and 160 086 population-based controls were selected. Logistic regression models adjusted for gender, age, race, calendar year and number of physician claims were used to estimate odds ratios (ORs) for myeloid malignancies in relation to autoimmune conditions. Multiple comparisons were controlled for using the Bonferroni correction (P < 0.0005). Autoimmune conditions, overall, were associated with an increased risk of acute myeloid leukaemia (AML) (OR 1.29) and myelodysplastic syndrome (MDS, OR 1.50). Specifically, AML was associated with rheumatoid arthritis (OR 1.28), systemic lupus erythematosus (OR 1.92), polymyalgia rheumatica (OR 1.73), autoimmune haemolytic anaemia (OR 3.74), systemic vasculitis (OR 6.23), ulcerative colitis (OR 1.72) and pernicious anaemia (OR 1.57). Myelodysplastic syndrome was associated with rheumatoid arthritis (OR 1.52) and pernicious anaemia (OR 2.38). Overall, autoimmune conditions were not associated with chronic myeloid leukaemia (OR 1.09) or chronic myeloproliferative disorders (OR 1.15). Medications used to treat autoimmune conditions, shared genetic predisposition and/or direct infiltration of bone marrow by autoimmune conditions, could explain these excess risks of myeloid malignancies.