Clinical manifestations of autoimmune disease-related non-Hodgkin lymphoma: a Korean single-center, retrospective clinical study

Abstract

Background/Aims:Recently, large cohort studies regarding associations between autoimmune disease and lymphomas have been reported in a few Western countries. However, Asian data concerning autoimmune-related lymphomas are limited. Therefore, we evaluated the clinical characteristics and prognostic factors of patients with autoimmune disease-related non-Hodgkin lymphoma (NHL) in a single center in Korea.Methods:We analyzed the data from 11 patients with autoimmune-related NHL. Patients were categorized into two groups, those with rheumatoid arthritis (RA) and those with non-RA-related NHL. Then patients were re-categorized into a group with methotrexate (MTX) usage and a MTX non-usage group. Histological subtype, MTX duration, autoimmune disease duration, treatment modalities, and other data were collected and analyzed.Results:Our study revealed that older RA patients have a greater likelihood of occurrence of NHL (p = 0.042). We confirmed that MTX duration and cumulative dose of MTX have no significant correlation with autoimmune disease and NHL (p = 0.073). In the management of autoimmune disease-related NHL, all patients were directly treated with systemic chemotherapy instead of employing a wait and watch approach. Overall survival (OS) and progression-free survival (PFS) in all autoimmune disease-related NHL were 100% and 87.5%, with no treatment-related mortality during the 2-year follow-up period of our study.Conclusions:Our study suggests that patients with RA-NHL are characterized by older age at onset compared to those with non-RA-NHL. Also considering of OS and PFS, intensive treatment strategy instead of delayed watchful managements may be required for autoimmune disease-related NHL including of old age group.

Clinical management for other iatrogenic immunodeficiency-associated lymphoproliferative disorders

“…Although rituximab monotherapy can be effective against AIDs, especially RA, it is not suitable to cure DLBCL. Other MTX-DLBCL cases are also reported 24 , 56 - 59 , 63 - 71 …”

“…Several other subtypes of MTX-LPD, including low grade B cell lymphomas, such as follicular lymphoma (FL), 1 , 2 , 19 , 57 , 65 , 71 mucosa-associated lymphoid tissue (MALT) lymphoma, 1 , 2 , 19 , 36 , 57 , 65 , 66 , 71 , 127 - 129 Burkitt lymphoma (BL), 1 , 2 , 57 , 130 intravascular lymphoma (IVL), 131 , 132 lymphoplasmacytic lymphoma, 65 plasmablastic lymphoma, 19 , 71 adult T-cell leukemia/lymphoma (ATLL), 133 angioimmunoblastic T-cell lymphoma (AITL), 1 , 2 , 134 , 135 anaplastic large cell lymphoma, 1 , 2 , 65 , 136 , 137 subcutaneous panniculitis-like T-cell lymphoma (SPLTCL), 138 peripheral T-cell lymphoma (PLCL), 1 , 2 , 19 , 36 , 37 , 57 , 139 - 141 and extranodal natural killer/T (NK/T)-cell lymphoma, 1 , 2 , 66 , 71 , 142 - 144 have been reported. Their clinical patterns vary.…”

“…A number of studies described non-MTX-LPD in comparison with MTX-LPD, although non-MTX-LPD-to-MTX-LPD ratios vary 23 , 24 , 57 , 65 , 66 , 71 , 128 . For example, Yamada et al .…”