Elsevier

Autoimmunity Reviews

Volume 10, Issue 4, February 2011, Pages 228-234
Autoimmunity Reviews

Review
Excess of autoimmune and chronic inflammatory disorders in patients with lymphoma compared with all cancer patients: A cancer registry-based analysis in the south of the Netherlands

https://doi.org/10.1016/j.autrev.2010.11.001Get rights and content

Abstract

Objective

We investigated the association between autoimmune and chronic inflammatory disorders and several cancer types including lymphomas.

Methods

All cancer patients diagnosed between 1995 and 2007, aged 15 to 90 years, and registered in the Eindhoven Cancer Registry were included in this study. Co-morbidity at diagnosis was recorded by qualified registry personnel who obtained the information from the clinical record. We determined the prevalence of rheumatoid arthritis (RA), chronic inflammatory bowel diseases, connective and vascular tissue diseases, ulcers of the stomach and duodenum, hepatitis, human immunodeficiency virus (HIV), and tuberculosis (TBC) among newly diagnosed patients with lymphoma and compared this with the prevalence among patients with all other cancers.

Results

The prevalence of most of these co-morbidities was higher in patients with lymphomas than those with other malignancies. RA was more often present in newly diagnosed patients with most lymphomas, ulcers of stomach and duodenum in patients with marginal zone lymphoma, hepatitis in case of diffuse large B-cell lymphoma, HIV with aggressive B-cell lymphoma, and TBC with mantle cell lymphoma.

Conclusion

This study confirms the positive association between autoimmune and chronic inflammatory disorders and the various lymphoproliferative malignancies, suggesting either a shared etiology or pathogenesis or a direct causal relation. This is a fairly new method to study aetiological questions about cancers in a population-based cancer registry.

Introduction

Since the 1970s, the incidence of lymphomas has been rising in Europe and North America [1], [2], [3], subsequently levelling off in for example Sweden, Denmark and the USA since 1990 [4]. Lymphoproliferative malignancies comprise heterogeneous groups of malignancies with markedly different biological and clinical features. The exact aetiology is largely unknown for the majority of these entities, and therefore the increase in incidence is still difficult to elucidate.

Positive associations have been revealed between certain lymphomas and inflammation, autoimmune disease and infectious agents [5]. This relationship has been described in case–control studies [6], [7], cohort studies [8], reviews [9], [10], [11], and expert opinions [12]. However, considering the inherent heterogeneity and rarity among both autoimmune and chronic inflammatory disorders and lymphomas, it has been challenging to identify significant associations [11].

Infectious agents causing lymphomas can be classified according to several mechanisms. First, some viruses can directly transform lymphocytes. Second, immunodeficiency is associated with a high risk for some non-Hodgkin lymphoma (NHL) subtypes. Third, some infections increase lymphoma risk through chronic immune stimulation [13], which is also present in autoimmune diseases. Treatment of autoimmune and chronic inflammatory disorders could also affect the risk of lymphoproliferative malignancies. Another reason for the association could be shared environmental risk factors [6], and in some autoimmune diseases genetic mutations are discovered, which also lead to lymphoproliferation [14].

Co-morbidity of cancer patients is most commonly used to study treatment differences and prognostic influences [15], but co-morbidity can also be used to study its association with malignancies in a cancer registry [16] by comparing the prevalence of autoimmune and chronic inflammatory disorders among lymphoma patients with other cancer patients.

Section snippets

Study population and data collection

The Eindhoven Cancer Registry records data on all patients newly diagnosed with cancer in the southern part of the Netherlands, an area with 2.4 million inhabitants, 10 general hospitals and two large radiotherapy institutes [17]. Trained registration clerks actively collect data on patient characteristics, diagnosis, topography, histology, stage and information about initial treatment (delivered within 6 months of diagnosis) from hospital medical records. The medical record is generally regarded

Results

The prevalence of the autoimmune and chronic inflammatory disorders in the newly diagnosed cancer populations (Table 1) varied between 7.6% and 0%. The prevalence was higher for lymphomas than the other cancers, but variation between subgroups of NHL existed (Fig. 1). The details are described below.

Discussion

In general, the prevalence of autoimmune and chronic inflammatory co-morbidities was higher among newly diagnosed patients with lymphoproliferative malignancies than with the various common cancers. Especially the positive association between RA and most lymphomas, ulcers of stomach and duodenum and marginal zone lymphoma, hepatitis and diffuse large B-cell lymphoma, HIV and aggressive B-cell lymphoma, and TBC and mantle cell lymphoma was striking.

The National Institute for Public Health and

Conclusion

In conclusion, this study confirms the positive association between some autoimmune and chronic inflammatory disorders and lymphomas in a population-based cancer registry. It further explores the different effects per subgroup of lymphoproliferative malignancies. Especially the positive association between RA and most lymphomas, ulcers of stomach and duodenum and marginal zone lymphoma, hepatitis and diffuse large B-cell lymphoma, HIV and aggressive B-cell lymphoma, and TBC and mantle cell

Take-home messages

  • There was a positive association between some autoimmune and chronic inflammatory disorders and lymphomas, and identified subtypes of haematological cancers.

  • In our population-based cohort the association between autoimmune or chronic inflammatory disorders and lymphomas was greater as compared to other cancers.

  • The development of lymphomas among patients with autoimmune and chronic inflammatory disorders is not unusual.

Acknowledgement

The authors thank the registration team of the Eindhoven Cancer Registry for their dedicated data collection. The study was performed with financial support from the Beunke fund at IKZ.

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