Occurrence of Malignancies in Hungarian Patients with Systemic Lupus Erythematosus

Abstract

As a result of increasing life expectancy of lupus patients, malignant disorders have become major determinants of morbidity and mortality. The objectives of this study were to analyze cancer-associated morbidity and mortality, the type of malignancies in Hungarian lupus patients, and to analyze association with immune-suppressive therapy, disease duration, and age of the patients. Data from 860 systemic lupus erythematosus (SLE) patients were retrospectively analyzed in a study period between 1970 and 2004. Results were compared to data from age- and sex-matched population obtained from the Health for All database, and also to literature data. A total of 37 patients presented with cancer, reflecting 4.3% cancer-associated morbidity. Patients were 47 (20-73) years old at the onset of malignancy, which appeared 13 (1-45) years later than SLE. Cancer prevalence was the highest in the first 5-10 years of lupus. Breast cancer was the most common malignancy (n = 11) followed by gastrointestinal tumors (n = 9), cervix cancer and hematologic malignancies (n = 5 for both), bronchial cancer (n = 4), bladder, skin, and ovarian cancer (n = 1 for each). Standardized incidence ratio was the highest for non-Hodgkin lymphoma (standardized incidence ratio [SIR] 3.5, 95% CI 0.4-12.5) and cervix cancer (SIR 1.7, 95% CI 0.6-4.1). Although 76% of patients with cancer received immune-suppressive therapy besides corticosteroids, no direct correlation could be confirmed between therapy and malignancy. Out of the 164 patients that expired during the study period, 18 were cancer-related. As such the cancer-associated mortality was 11% (18/164). This peaked during the last 4 years of the study period (8/24, 33%). Lupus patients are at high risk for particular types of malignant disorders, highlighting the importance of screening measures and focused patient examination.

Malignancies in Autoimmune Rheumatic Diseases – A Mini-Review

“…No correlation between cancer risk and immunosuppressive therapy could be identified. Cancer-related mortality was 11% [23] .…”

“…Common genetic background and Epstein-Barr virus infection may be possible pathogenic factors in this respect. Older age and longer disease duration may be associated with elevated cancer risk in lupus [17,18,[23][24][25] .…”

Acute myeloid leukemia developing in patients with autoimmune diseases

“…No association between exposure to a specific therapy and the development of malignancy was observed in this study. 122 In the third study, risk factors for developing myeloid leukemia in SLE were studied in 5,715 hospitalized patients from the Swedish national registry and followed from 1964 through 1995. Except for preceding leukopenia, factors such as age, sex, disease duration and other SLE features were not significantly associated with leukemia development.…”

“…In this series, hematologic malignancies were third in frequency after breast and gastrointestinal cancers. 122 These studies were not specifically designed to estimate AML and autoimmune disease haematologica | 2012; 97 (6)the outcome of SLE patients who developed acute leukemia. Therefore, it is difficult to draw any conclusions about secondary leukemia related mortality in SLE patients.…”

Alfacalcidol treatment restores derailed immune-regulation in patients with undifferentiated connective tissue disease

“…A clearly increased risk for NHL has been described in patients with SLE as compared to those in the general population. It has still remained unclear to what extent the association with NHL is mediated by innate versus exogenous factors (10,11). Interestingly, diffuse, large B cell lymphoma was the first disease in our case preceding lupus.…”