Haematopoietic malignancies in rheumatoid arthritis:: lymphoma risk and characteristics after exposure to tumour necrosis factor antagonists
Haematopoietic malignancies in rheumatoid arthritis:: lymphoma risk and characteristics after exposure to tumour necrosis factor antagonists
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DOI：
10.1136/ard.2004.033241
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发表时间：
2005-10-01
影响因子：
27.4
通讯作者：
Feltelius, N
中科院分区：
文献类型：
--
作者：
Askling, J;Fored, CM;Feltelius, N
背景：类风湿关节炎（RA）患者发生恶性淋巴瘤的风险增加，也可能发生白血病和多发性骨髓瘤。肿瘤坏死因子（TNF）拮抗剂对淋巴瘤风险和特征的影响尚不清楚。目的：评估RA患者队列中造血系统恶性肿瘤的预期发生率和相对风险，尤其是与TNF拮抗剂相关的恶性肿瘤。对RA患者进行了一项基于人群的队列研究，（一个流行队列（n = 53067），一个事件队列（n = 3703），和一个TNF拮抗剂治疗队列，1999年至2003年（n = 4160）），与瑞典癌症登记相关。此外，回顾了1999年至2004年瑞典暴露于TNF拮抗剂的RA患者中发生的12例淋巴瘤的淋巴瘤标本。对近500例观察到的造血系统恶性肿瘤的研究表明，RA的流行和偶发患者患淋巴瘤的风险增加（SIR分别为1.9和2.0）和白血病（SIR分别为2.1和2.2），但不是骨髓瘤。与一般人群相比，接受TNF拮抗剂治疗的RA患者淋巴瘤风险增加了3倍（SIR = 2.9）。在调整性别、年龄和病程后，暴露于TNF拮抗剂后的淋巴瘤风险并不高于其他RA队列。与TNF拮抗剂相关的淋巴瘤有类似的特点，其他RA lymphomas.Conclusion：总体而言，RA患者淋巴瘤和白血病的风险同样增加。与其他RA患者相比，接受TNF拮抗剂治疗的RA患者的淋巴瘤风险并不高。需要长期观察以确定TNF拮抗剂对淋巴瘤风险的长期影响。
Background: Patients with rheumatoid arthritis ( RA) are at increased risk of malignant lymphomas, and maybe also of leukaemia and multiple myeloma. The effect of tumour necrosis factor (TNF) antagonists on lymphoma risk and characteristics is unclear.Objective: To assess expected rates and relative risks of haematopoietic malignancies, especially those associated with TNF antagonists, in large population based cohorts of patients with RA.Methods: A population based cohort study was performed of patients with RA ( one prevalent cohort (n = 53 067), one incident cohort ( n = 3703), and one TNF antagonist treated cohort 1999 through 2003 ( n = 4160)), who were linked with the Swedish Cancer Register. Additionally, the lymphoma specimens for the 12 lymphomas occurring in patients with RA exposed to TNF antagonists in Sweden 1999 through 2004 were reviewed.Results: Study of almost 500 observed haematopoietic malignancies showed that prevalent and incident patients with RA were at increased risk of lymphoma ( SIR = 1.9 and 2.0, respectively) and leukaemia ( SIR = 2.1 and 2.2, respectively) but not of myeloma. Patients with RA treated with TNF antagonists had a tripled lymphoma risk ( SIR = 2.9) compared with the general population. After adjustment for sex, age, and disease duration, the lymphoma risk after exposure to TNF antagonists was no higher than in the other RA cohorts. Lymphomas associated with TNF antagonists had characteristics similar to those of other RA lymphomas.Conclusion: Overall, patients with RA are at equally increased risks for lymphomas and leukaemias. Patients with RA treated with TNF antagonists did not have higher lymphoma risks than other patients with RA. Prolonged observation is needed to determine the long term effects of TNF antagonists on lymphoma risk.