History of autoimmune conditions and lymphoma prognosis

• Type of Material: Article
• Authors: Geffen Kleinstern, Mayo Clinic; Matthew J. Maurer, Mayo Clinic; Mark Liebow, Mayo Clinic; Thomas M. Habermann, Mayo Clinic; Jean Louise Koff, Emory University; Cristine Allmer, Mayo Clinic; Thomas E. Witzig, Mayo Clinic; Grzegorz S. Nowakowski, Mayo Clinic; Ivana N. Micallef, Mayo Clinic; Patrick B. Johnston, Mayo Clinic; David J. Inwards, Mayo Clinic; Carrie A. Thompson, Mayo Clinic; Andrew L. Feldman, Mayo Clinic; Brian K. Link, University of Iowa; Christopher R Flowers, Emory University; Susan L. Slager, Mayo Clinic; James R. Cerhan, Mayo Clinic
• Language: English
• Date: 2018-08-01
• Publisher: Springer Nature [academic journals on nature.com]: Fully open access journals
• Publication Version: Final Published Version
• Copyright Statement: © 2018, The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1038/s41408-018-0105-4
• Title of Journal or Parent Work: Blood Cancer Journal
• ISSN: 2044-5385
• Volume: 8
• Issue: 8
• Start Page: 73
• End Page: 73
• Grant/Funding Information: Dr. Kleinstern was supported by the National Institutes of Health grant, R25 CA92049 (Mayo Cancer Genetic Epidemiology Training Program).; Supported by P50 CA97274, U01 CA195568, and the Predolin Foundation
• Keywords: B-CELL LYMPHOMA; DISEASES; Life Sciences & Biomedicine; NON-HODGKIN-LYMPHOMA; EPIDEMIOLOGY; Hematology; Oncology; LIFE-STYLE; Science & Technology; RHEUMATOID-ARTHRITIS; MEDICAL HISTORY; SUBTYPES PROJECT; FAMILY-HISTORY; OCCUPATIONAL RISK-FACTORS
• Research Categories: Health Sciences, Pathology; Health Sciences, Oncology

Abstract

Autoimmune conditions are strong risk factors for developing lymphoma, but their role in lymphoma prognosis is less clear. In a prospective cohort study, we evaluated self-reported history of eight autoimmune conditions with outcomes in 736 diffuse large B-cell, 703 follicular, 302 marginal zone (MZL), 193 mantle cell (MCL), 297 Hodgkin lymphoma (HL), and 186 T-cell lymphomas. We calculated event-free survival (EFS) and overall survival (OS), and estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sex, prognostic score, and treatment. History of any of the eight autoimmune conditions ranged from 7.4% in HL to 18.2% in MZL, and was not associated with EFS or OS for any lymphoma subtype. However, there was a positive association of autoimmune conditions primarily mediated by B-cell responses with inferior EFS in MCL (HR = 2.23, CI: 1.15–4.34) and HL (HR = 2.63, CI: 1.04–6.63), which was largely driven by rheumatoid arthritis. Autoimmune conditions primarily mediated by T-cell responses were not found to be associated with EFS or OS in any lymphoma subtype, although there were few events for this exposure. Our results indicate that distinguishing autoimmune conditions primarily mediated by B-cell/T-cell responses may yield insight regarding the impact of this comorbid disease, affecting ~10% of lymphoma patients, on survival.