Presence of autoimmune disease affects not only risk but also survival in patients with B‐cell non‐Hodgkin lymphoma

dc.contributor.author Kleinstern, Geffen
dc.contributor.author Averbuch, Mor
dc.contributor.author Abu Seir, Rania
dc.contributor.author Perlman, Riki
dc.contributor.author Ben Yehuda, Dina
dc.contributor.author Paltiel, Ora
dc.date.accessioned 2019-12-11T12:49:29Z
dc.date.available 2019-12-11T12:49:29Z
dc.date.issued 2018-01-10
dc.description.abstract Although autoimmune diseases (AIDs) are known to predispose to non‐Hodgkin lymphoma (NHL), their association with NHL prognosis has rarely been investigated. We examined associations between autoimmunity and B‐cell NHL onset by comparing AID history (determined by self‐report and medication review and supplemented by chart review where possible) among 435 adult B‐NHL patients in Hadassah‐Hebrew University Medical Center, diagnosed 2009‐2014, and 414 age‐and‐sex frequency‐matched controls. We examined AIDs as a whole, B‐ and T‐cell–mediated AIDs, and autoimmune thyroid diseases. Among cases, we used Kaplan‐Meier and Cox regression models to assess the association of AID with overall survival and relapse‐free survival, adjusting for prognostically important patient and disease characteristics such as Ki67% staining, International Prognostic Index, rituximab treatment, and histological subgroup. Autoimmune diseases were associated with B‐NHL (odds ratio [OR] = 1.95; 95% confidence interval (CI), 1.31‐2.92), especially AIDs mediated by B‐cell activation (OR = 5.20; CI, 1.90‐14.3), which were particularly associated with marginal zone lymphoma (OR = 19.3; CI, 4.59‐80.9). We found that time to relapse for all B‐NHL patients with AIDs was significantly shorter (mean of 49.21 mo [±3.22]) than among patients without AID (mean of 59.74 mo [±1.62]), adjusted hazard ratio [HRadj] = 1.69 (CI, 1.03‐2.79). Specifically, in patients with diffuse large B‐cell lymphoma, of whom 91.8% had received rituximab, a history of B‐cell–mediated AIDs was associated with shorter relapse‐free survival and overall survival, HRadj = 8.34 (CI, 3.01‐ 23.1) and HRadj = 3.83 (CI, 1.20‐12.3), respectively. Beyond confirming the well‐known association between AIDs and B‐NHL, we found that AID is an adverse prognostic factor in B‐cell lymphoma, associated with a shortened time to relapse, suggesting that there are specific therapeutic challenges in the subgroup of patients suffering from both these diseases. Further work is required to address mechanisms of resistance to standard treatment in the setting of AID‐associated B‐NHL. In the era of immunotherapy, these findings have particular relevance. en_US
dc.description.sponsorship This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID)/MERC grant no. TA‐MOU‐11‐M31‐025. The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government; Israel Science Foundation (ISF) grant no. 877/10; and the Hadassah University Hospital Compensatory Fund. We thank Noemie Cohen for data entry. en_US
dc.identifier.issn 1099-1069
dc.identifier.uri https://dspace.alquds.edu/handle/20.500.12213/5027
dc.language.iso en en_US
dc.publisher John Wiley & Sons, Ltd. en_US
dc.subject autoimmune disease en_US
dc.subject diffuse large B‐cell lymphoma en_US
dc.subject non‐Hodgkin lymphoma en_US
dc.subject risk en_US
dc.subject survival en_US
dc.title Presence of autoimmune disease affects not only risk but also survival in patients with B‐cell non‐Hodgkin lymphoma en_US
dc.type Article en_US
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