RESEARCH - Hematopoietic malignancies in RA. Lymphoma risk and characteristics following TNF- antagonists.

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Ann Rheum Dis. 2005 Apr 20; [Epub ahead of print]

Hematopoietic malignancies in rheumatoid arthritis. Lymphoma risk and

characteristics following TNF- antagonists.

Askling J, Fored M, Baecklund E, Brandt L, Backlin C, Ekbom A, Sundstrom C,

Bertilsson L, Coster L, Geborek P, sson L, Lindblad S, Lysholm J,

Rantapaa-Dahlqvist S, Saxne T, Klareskog L, Feltelius N.

Karolinska Institutet, Sweden.

BACKGROUND: Patients with Rheumatoid Arthritis (RA) are at increased risk of

malignant lymphomas, maybe also of leukemia and multiple myeloma. With

respect to TNF-antagonists, its effect on lymphoma risk and characteristics

is unclear. We therefore assessed expected rates and relative risks of

hematopoietic malignancies in large population-based cohorts of RA patients,

with special reference to the relative lymphoma risk -and lymphoma

characteristics- associated with TNF-antagonists. METHODS: We performed a

population-based cohort study of patients with RA (one prevalent cohort

[n=53,067], one incident cohort [n=3,703], and one TNF- antagonist treated

cohort 1999 through 2003 [n=4,160]), which were linked with the Swedish

Cancer Register. In addition, we reviewed the lymphoma specimens for the 12

reported lymphomas occurring in RA patients exposed to TNF-antagonists in

Sweden 1999 through 2004. RESULTS: Based on almost 500 observed

hematopoietic malignancies, prevalent and incident RA- patients were at

increased risk of lymphoma (SIR=1.9 and 2.0, respectively) and leukemia

(SIR=2.1 and 2.2, respectively) but not of myeloma. RA-patients treated with

TNF-antagonists were at tripled lymphoma risk (SIR=2.9) compared to the

general population. Following adjustment for sex, age, and disease duration,

the lymphoma risk following exposure to TNF-antagonists was not higher than

in the other RA cohorts. Review of the TNF-antagonist associated lymphomas

revealed lymphoma characteristics compatible with other RA-lymphomas.

CONCLUSION: Overall, RA-patients are at equally elevated risks for lymphomas

and leukemias. RA-patients treated with TNF-antagonists did not have higher

lymphoma risks than other RA-patients. Prolonged observation is needed to

determine the long-term effects of TNF-antagonists on lymphoma risk.

PMID: 15843454

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5843454 & dopt=Abstract

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