People with lupus who were treated with hydroxychloroquine (HCQ), an anti-malarial drug, early after a diagnosis of lupus had less cumulative organ damage at three years after diagnosis than those who did not receive HCQ, according to a new analysis.
Study explores lupus treatments and disease activity as risk factors for lymphoma
A new study sheds light on the specific effects of drug treatments versus disease activity as risk factors for lymphoma, a type of cancer, among people with lupus. A team of researchers led by Drs. Sasha Bernatsky and Ann Clarke of McGill University, and Dr. Rosalind Ramsey-Goldman of Northwestern University, noted no clear association between lymphoma risk and most drug treatments for lupus. Also no clear association was observed between lupus disease activity and lymphoma risk.
Treatments studied included cyclophosphamide, azathioprine, methotrexate, mycophenolate, anti-malarial drugs, and steroids. Researchers did find a slight increase in lymphoma risk for people with lupus who are treated with cyclophosphamide or high cumulative doses of steroids, both commonly used treatments for lupus. But, the researchers emphasized, the absolute risk for lymphomas among lupus patients exposed to cyclophosphamide is still small (less than 0.1% per year) and the drug remains important for very severe manifestations of lupus.
Lymphomas are cancers of the lymphatic system, the body's disease-fighting center that includes the lymph nodes, spleen, thymus gland, and bone marrow. Lymphoma risk in people with lupus is of considerable interest because of concerns about the potential increased risk from immunosuppressive treatments. A recently updated, large international cohort study of over 16,000 lupus patients found a slight increased risk for all cancers combined, and a particular risk for hematologic cancers, particularly lymphoma (though as mentioned, even in high risk individuals, lymphomas in lupus remain a relatively rare event, occurring in less than one per 1000 patients).
Dr. Bernatsky et al.’s latest study included nearly 5,000 cancer-free lupus patients, comparing these to 75 lupus patients with lymphoma. The lymphoma cases occurred around 12 years after the lupus diagnosis. Most of the lymphomas observed in lupus patients were of the non-Hodgkin’s type, and most cases involved B cells- a category of white blood cells that are a vital part of the body’s immune system and which make antibodies to fight bacteria and viruses.
Other work by Dr. Bernatsky and the team show a decreased risk of breast cancer in lupus (an unexpected but welcome finding, under further study by the investigators). Their research is supported by many agencies including the Canadian Institutes of Health Research, the National Institutes of Health, the Arthritis Society, and the Singer Family Fund for SLE research. The project was possible through the endorsement of the Systemic Lupus International Collaborating Clinics (SLICC) and the Canadian Network for Improved Outcomes in SLE (CaNIOS).
Lymphoma risk in systemic lupus: effects of disease activity versus treatment. Bernatsky S, Ramsey-Goldman R., et al. Annals of the Rheumatic Diseases. 2013. Jan 8. doi: 10.1136/annrheumdis-2012-202453. [Epub ahead of print]
The findings highlight specific kinds of changes in lupus biomarkers that are most associated with effective use of belimumab in the treatment of lupus.