Mercer Louise K, Regierer Anne C, Mariette Xavier, Dixon William G, Baecklund Eva, Hellgren Karin, Dreyer Lene, Hetland Merete Lund, Cordtz René, Hyrich Kimme, Strangfeld Anja, Zink Angela, Canhao Helena, Hernandez M Victoria, Tubach Florence, Gottenberg Jacques-Eric, Morel Jacques, Zavada Jakub, Iannone Florenzo, Askling Johan, Listing Joachim
Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK.
Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany.
Ann Rheum Dis. 2017 Dec;76(12):2025-2030. doi: 10.1136/annrheumdis-2017-211623. Epub 2017 Aug 19.
Lymphomas comprise a heterogeneous group of malignant diseases with highly variable prognosis. Rheumatoid arthritis (RA) is associated with a twofold increased risk of both Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). It is unknown whether treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) affect the risk of specific lymphoma subtypes.
Patients never exposed to (bionaïve) or ever treated with bDMARDs from 12 European biologic registers were followed prospectively for the occurrence of first ever histologically confirmed lymphoma. Patients were considered exposed to a bDMARD after having received the first dose. Lymphomas were attributed to the most recently received bDMARD.
Among 124 997 patients (mean age 59 years; 73.7% female), 533 lymphomas were reported. Of these, 9.5% were HL, 83.8% B-cell NHL and 6.8% T-cell NHL. No cases of hepatosplenic T-cell lymphoma were observed. Diffuse large B-cell lymphoma (DLBCL) was the most frequent B-cell NHL subtype (55.8% of all B-cell NHLs). The subtype distributions were similar between bionaïve patients and those treated with tumour necrosis factor inhibitors (TNFi). For other bDMARDs, the numbers of cases were too small to draw any conclusions. Patients with RA developed more DLBCLs and less chronic lymphocytic leukaemia compared with the general population.
This large collaborative analysis of European registries has successfully collated subtype information on 533 lymphomas. While the subtype distribution differs between RA and the general population, there was no evidence of any modification of the distribution of lymphoma subtypes in patients with RA treated with TNFi compared with bionaïve patients.
淋巴瘤是一组异质性恶性疾病，预后差异很大。类风湿性关节炎（RA）与霍奇金淋巴瘤（HL）和非霍奇金淋巴瘤（NHL）的发病风险增加两倍有关。尚不清楚使用生物性改善病情抗风湿药物（bDMARDs）治疗是否会影响特定淋巴瘤亚型的风险。
对来自12个欧洲生物登记处从未接触过（初治）或曾接受过bDMARDs治疗的患者进行前瞻性随访，以观察首次组织学确诊淋巴瘤的发生情况。患者在接受第一剂bDMARDs后被视为暴露于该药物。淋巴瘤归因于最近使用的bDMARDs。
在124997例患者（平均年龄59岁；73.7%为女性）中，报告了533例淋巴瘤。其中，9.5%为HL，83.8%为B细胞NHL，6.8%为T细胞NHL。未观察到肝脾T细胞淋巴瘤病例。弥漫性大B细胞淋巴瘤（DLBCL）是最常见的B细胞NHL亚型（占所有B细胞NHL的55.8%）。初治患者和接受肿瘤坏死因子抑制剂（TNFi）治疗的患者之间的亚型分布相似。对于其他bDMARDs，病例数太少，无法得出任何结论。与普通人群相比，RA患者发生的DLBCL更多，慢性淋巴细胞白血病更少。
这项对欧洲登记处的大型合作分析成功整理了533例淋巴瘤的亚型信息。虽然RA和普通人群的亚型分布不同，但没有证据表明与初治患者相比，接受TNFi治疗的RA患者淋巴瘤亚型分布有任何改变。
