Journal: Blood cancer journal
This population-based cohort study from Japan used health insurance claims data (2014–2023) from over 2.2 million individuals to quantify lymphoma risk in patients with autoimmune diseases (AIDs) and to examine the impact of specific immunosuppressive/immunomodulatory agents.
Key points:
- Cohort: 2,229,423 individuals from 15 municipalities; 211,592 had AIDs. During follow-up, 530 individuals with AIDs developed lymphoma.
- Overall lymphoma risk: Patients with AIDs had nearly double the incidence of lymphoma compared with those without AIDs (HR 1.9).
- Disease-specific risk:
- Among 23 AIDs analyzed, 14 showed significantly elevated lymphoma risk.
- Highest risks were seen in:
- Takayasu arteritis (HR 6.6)
- Adult-onset Still’s disease (HR 4.7)
- The abstract does not provide HRs for the remaining AIDs.
- Medication-related risk:
- Certain agents were associated with increased lymphoma risk in AID patients:
- Calcineurin inhibitors
- Iguratimod
- Methotrexate
- Cumulative treatment burden mattered: use of two or more immunosuppressive/immunomodulatory drugs markedly increased lymphoma risk (HR 2.7) compared with AID patients not receiving multiple agents.
- Certain agents were associated with increased lymphoma risk in AID patients:
- Lymphoma subtype findings: Subtype-specific analysis identified new associations, including a link between systemic lupus erythematosus and T/NK-cell lymphoma.
Clinical implications:
- Higher baseline risk: AID itself confers a higher baseline risk of lymphoma, varying substantially by disease.
- Impact of therapy: Both choice and number of immunosuppressive/immunomodulatory agents influence lymphoma risk, with combination or sequential multi-agent exposure particularly concerning.
- Monitoring: Patients with high-risk AIDs and/or on multiple immunosuppressants warrant heightened lymphoma vigilance (clinical exam, prompt evaluation of lymphadenopathy/B symptoms, and low threshold for workup).