Rubbert-Roth A, Bittenbring J T, Assmann G
Medizinische Klinik I der Universität Köln, Joseph-Stelzmann Str. 9, 50924, Köln, Deutschland.
Medizinische Klinik I für Onkologie, Hämatologie, Klinische Immunologie und Rheumatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland.
Z Rheumatol. 2017 Oct;76(Suppl 2):46-56. doi: 10.1007/s00393-017-0383-4.
Various systemic inflammatory diseases, such as rheumatoid arthritis (RA), Sjögren's syndrome and systemic lupus erythematosus (SLE) are associated with an increased risk for the development of lymphomas. Studies on patients with RA and Sjögren's syndrome have shown that there is a clear association of the incidence of lymphoma with the severity and activity of the disease and lymphomas in particular are diseases which preferentially occur in immunosuppressed patients; therefore, knowledge of the different lymphoma subtypes, their prognosis and treatment options are important for rheumatologists. Currently, there is no evidence for an increased risk of lymphoma with the available conventional basis therapies or biologic disease-modifying antirheumatic drugs (DMARDs). The decision on how to treat a patient with previous lymphoma who requires antirheumatic treatment is more difficult as patients with previous malignancies are not included in clinical studies and in registries a bias with respect to patient selection must be taken into consideration. Decisions on the treatment approach, therefore need to be individualized and interdisciplinary management together with the treating hematologist is warranted.
多种全身性炎症性疾病,如类风湿性关节炎(RA)、干燥综合征和系统性红斑狼疮(SLE)与淋巴瘤发生风险增加相关。对RA和干燥综合征患者的研究表明,淋巴瘤发病率与疾病的严重程度和活动度存在明确关联,而且淋巴瘤尤其好发于免疫抑制患者;因此,了解不同淋巴瘤亚型、其预后及治疗选择对风湿病学家而言很重要。目前,尚无证据表明现有传统基础疗法或生物性改善病情抗风湿药(DMARDs)会增加淋巴瘤风险。对于既往有淋巴瘤且需要抗风湿治疗的患者,治疗决策更为困难,因为既往有恶性肿瘤的患者未纳入临床研究,而且在登记处必须考虑到患者选择方面的偏差。因此,治疗方法的决策需要个体化,有必要与主治血液科医生进行多学科管理。