Rheumatoid arthritis and the risk of malignancy

Cibere, Jolanda; Sibley, John; Haga, May

doi:10.1002/art.1780400906

Cited by 147 publications

(78 citation statements)

References 34 publications

(11 reference statements)

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“…Likewise, entry into the cohorts in these studies was set to the date of the first discharge with RA, which may not necessarily equate to the date of diagnosis of RA. Although there are studies using other designs and follow up methods, [18][19][20][21][22][23] these have often been limited to a few hundred patients diagnosed and/or followed up before the 1990s.…”

Section: Discussionmentioning

confidence: 99%

Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists

Askling

2005

Annals of the Rheumatic Diseases

356

235

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Section: Discussionmentioning

confidence: 99%

Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists

Askling

2005

Annals of the Rheumatic Diseases

356

235

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“…Avoidance of additional cytotoxic agents in mobilisation may be desirable in RA patients who even without the risks of autologous transplantation are known to have a higher incidence of leukaemia from the disease and conventional treatments. 52 Further studies are necessary on stem cell mobilisation in patients with RA before large scale clinical trials of autologous HSCT can commence. Analysis of greater numbers of patients will define the risk of flare more accurately.…”

Section: Discussionmentioning

confidence: 99%

A randomised, blinded, placebo-controlled, dose escalation study of the tolerability and efficacy of filgrastim for haemopoietic stem cell mobilisation in patients with severe active rheumatoid arthritis

Snowden

Biggs

Milliken

et al. 1998

Bone Marrow Transplant

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Summary:Autologous haemopoietic stem cell transplantation (HSCT) represents a potential therapy for severe rheumatoid arthritis (RA). As a prelude to clinical trails, the safety and efficacy of haemopoietic stem cell (HSC) mobilisation required investigation as colony-stimulating factors (CSFs) have been reported to flare RA. A double-blind, randomised placebo-controlled dose escalation study was performed. Two cohorts of eight patients fulfilling strict eligibility criteria for severe active RA (age median 40 years, range 24-60 years; median disease duration 10.5 years, range 2-18 years) received filgrastim (r-Hu-methionyl granulocyte(G)-CSF) at 5 and 10 g/kg/day, randomised in a 5:3 ratio with placebo. Patients were unblinded on the fifth day of treatment and those randomised to filgrastim underwent cell harvesting (leukapheresis) daily until 2 ؋ 10 6 /kg CD34 ؉ cells (haemopoietic stem and progenitor cells) were obtained. Patients were assessed by clinical and laboratory parameters before, during and after filgrastim administration. RA flare was defined as an increase of 30% or more in two of the following parameters: tender joint count, swollen joint count or pain score. Efficacy was assessed by quantitation of CD34 ؉ cells and CFU-GM. One patient in the 5 g/kg/day group and two patients in the 10 g/kg/day group fulfilled criteria for RA flare, although this did not preclude successful stem cell collection. Median changes in swollen and tender joint counts were not supportive of filgrastim consistently causing exacerbation of disease, but administration of filgrastim at 10 g/kg/day was associated with rises in median C-reactive protein and median rheumatoid factor compared with placebo. Other adverse events were well recognised for filgrastim and included bone pain (80%) and increases in alkaline phosphatase (four-fold) and lactate dehydrogenase (two-fold). With respect to efficacy, filgrastim at 10 g/kg/day was more efficient with all patients (n = 5) achieving target CD34 ؉ cell counts with a single leuCorrespondence: Dr JA Snowden, Department of Haematology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK Received 2 May 1998; accepted 21 July 1998 kapheresis (median = 2.8, range = 2.3-4.8 ؋ 10 6 /kg, median CFU-GM = 22.1, range = 4.2-102.9 ؋ 10 4 /kg), whereas 1-3 leukaphereses were necessary to achieve the target yield using 5 g/kg/day. We conclude that filgrastim may be administered to patients with severe active RA for effective stem cell mobilisation. Flare of RA occurs in a minority of patients and is more likely with 10 than 5 g/kg/day. However, on balance, 10 g/kg/day remains the dose of choice in view of more efficient CD34 ؉ cell mobilisation.

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“…Only 2 of 12 cases had been exposed to cyclophosphamide alone or in combination with azathioprine. 35 The main data of large population-based studies exploring the risk of leukemia in rheumatoid arthritis are summarized in Table 1. The standardized incidence ratio is calculated by comparing the number of observed cases to what is expected in the general population as a control.…”

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confidence: 99%