Ekström Smedby Karin, Vajdic Claire M, Falster Michael, Engels Eric A, Martínez-Maza Otoniel, Turner Jennifer, Hjalgrim Henrik, Vineis Paolo, Seniori Costantini Adele, Bracci Paige M, Holly Elizabeth A, Willett Eleanor, Spinelli John J, La Vecchia Carlo, Zheng Tongzhang, Becker Nikolaus, De Sanjosé Silvia, Chiu Brian C-H, Dal Maso Luigino, Cocco Pierluigi, Maynadié Marc, Foretova Lenka, Staines Anthony, Brennan Paul, Davis Scott, Severson Richard, Cerhan James R, Breen Elizabeth C, Birmann Brenda, Grulich Andrew E, Cozen Wendy
Department of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
Blood. 2008 Apr 15;111(8):4029-38. doi: 10.1182/blood-2007-10-119974. Epub 2008 Feb 8.
Some autoimmune disorders are increasingly recognized as risk factors for non-Hodgkin lymphoma (NHL) overall, but large-scale systematic assessments of risk of NHL subtypes are lacking. We performed a pooled analysis of self-reported autoimmune conditions and risk of NHL and subtypes, including 29 423 participants in 12 case-control studies. We computed pooled odds ratios (OR) and 95% confidence intervals (CI) in a joint fixed-effects model. Sjögren syndrome was associated with a 6.5-fold increased risk of NHL, a 1000-fold increased risk of parotid gland marginal zone lymphoma (OR = 996; 95% CI, 216-4596), and with diffuse large B-cell and follicular lymphomas. Systemic lupus erythematosus was associated with a 2.7-fold increased risk of NHL and with diffuse large B-cell and marginal zone lymphomas. Hemolytic anemia was associated with diffuse large B-cell NHL. T-cell NHL risk was increased for patients with celiac disease and psoriasis. Results for rheumatoid arthritis were heterogeneous between studies. Inflammatory bowel disorders, type 1 diabetes, sarcoidosis, pernicious anemia, and multiple sclerosis were not associated with risk of NHL or subtypes. Thus, specific autoimmune disorders are associated with NHL risk beyond the development of rare NHL subtypes in affected organs. The pattern of associations with NHL subtypes may harbor clues to lymphomagenesis.
一些自身免疫性疾病日益被认为是整体非霍奇金淋巴瘤(NHL)的危险因素,但缺乏对NHL亚型风险的大规模系统评估。我们对自我报告的自身免疫性疾病以及NHL及其亚型的风险进行了汇总分析,纳入了12项病例对照研究中的29423名参与者。我们在联合固定效应模型中计算了汇总比值比(OR)和95%置信区间(CI)。干燥综合征与NHL风险增加6.5倍、腮腺边缘区淋巴瘤风险增加1000倍(OR = 996;95% CI,216 - 4596)相关,还与弥漫性大B细胞淋巴瘤和滤泡性淋巴瘤相关。系统性红斑狼疮与NHL风险增加2.7倍以及弥漫性大B细胞淋巴瘤和边缘区淋巴瘤相关。溶血性贫血与弥漫性大B细胞NHL相关。乳糜泻和银屑病患者的T细胞NHL风险增加。类风湿关节炎的研究结果在不同研究之间存在异质性。炎症性肠病、1型糖尿病、结节病、恶性贫血和多发性硬化与NHL或其亚型的风险无关。因此,特定的自身免疫性疾病与NHL风险相关,不仅仅是在受影响器官中发生罕见的NHL亚型。与NHL亚型的关联模式可能为淋巴瘤发生提供线索。