Session Information
Title: Rheumatoid Arthritis - Clinical Aspects III: Malignancies, Vaccinations, Pregnancy and Surgery
Session Type: Abstract Submissions (ACR)
Background/Purpose: Rheumatoid arthritis (RA) is associated with a 2-3 fold increased risk of both Hodgkin and non-Hodgkin lymphoma (HL; NHL). The risk of lymphoma, in particular diffuse large B-cell lymphoma (DLBCL) is greatest in patients with persistently active RA: those patients that are also most likely to receive biologics. There has been a concern that TNF inhibitors (TNFi) could increase the risk of lymphoma via reduced immunosurveillance. Conversely, TNFi may, by improved disease control, decrease lymphoma risk, especially risk of DLBCL. This abstract describes a EULAR initiative to describe the spectrum of lymphomas occurring in biologic-naïve patients with RA and those treated with biologics.
Methods: Patients with RA were included from 11 European biologics registers in 8 countries and followed prospectively for the occurrence of first ever lymphoma, confirmed with histology. Patients were considered to be exposed to a biologic agent after receiving the first dose and lymphomas were attributed to the most recently received biologic drug. For the TNFi cohort, prior exposure to biologic drugs was not permitted. Prior exposure to TNFi was allowed for other biologic drugs. Frequency of lymphoma subtypes was recorded for each drug class.
Results: Data for 130462 patients were available for the analysis (Sweden: n=61527, Denmark: n=21454, UK: n=17907, Germany: n=12581, Portugal: n=5031, Spain: n=4590, France: n=4512, Czech Republic: n=2860): mean age 59, 74% female. In total 520 lymphomas with subtype information were included in the table. Patient years were available for 493 lymphomas, corresponding to an overall crude incidence rate (IR) of 8.3 (95% CI 7.6, 9.1).
DLBCL was the most frequent subtype (37% of all lymphomas; Table). 9% of lymphomas were HL and 6% T-cell, with no cases of hepatosplenic T-cell lymphoma. Importantly, the distribution of subtypes was similar across treatment groups.
Conclusion: This large collaborative analysis of European registries has successfully collated subtype information on more than 500 lymphomas. There was no evidence of modification of the distribution of lymphoma subtypes reported in patients following exposure to biologics. This collaboration facilitates more detailed analyses, accounting for age, sex, country and specific TNFi, as well as RA-related factors.
Table. Subtypes of lymphoma reported in biologic-naïve and –exposed cohorts of patients with rheumatoid arthritis
|
|
All N= 130462 |
sDMARD N=71866 |
TNFi N= 41078
|
RTX N=9880 |
TOC N= 4800 |
ABA N=2838 |
|
Total follow up time (person-years)
|
592245 |
322422 |
226080 |
30606 |
7122 |
6015 |
|
Female (%) |
74.3 |
72.2 |
76.5 |
79.0 |
80.1 |
78.0 |
|
Age (mean) |
58.7 |
60.7 |
55.4 |
57.9 |
55.9 |
56.8 |
|
Total number of lymphomas |
520* |
288 |
219* |
6 |
5 |
2 |
|
Lymphoma subtypes: Number (% of total number) |
||||||
|
Hodgkin Lymphoma |
45 (9) |
21 (7) |
24 (11) |
0 |
0 |
0 |
|
B-cell lymphomas |
389 (75) |
220 ( 76) |
157 (72) |
5 ( 83) |
5 (100) |
2 (100) |
|
Chronic lymphocytic /small cell lymphoma |
55 (11) |
28 (10) |
24 (11) |
1 (17) |
2 (40) |
0 |
|
B-HHL Lymphoplasmocytic lymphoma (Waldenstrom macroglobulinemia) |
11 (2) |
4 (1) |
6 (3) |
1 (17) |
0 |
0 |
|
Marginal zone lymphoma |
9 ( 2) |
1 (0) |
8 (4) |
0 |
0 |
0 |
|
Follicular lymphoma |
67 (13) |
33 (11) |
32 (15) |
1 (17) |
0 |
1 ( 50) |
|
Mantle cell lymphoma |
5 (1) |
5 (2) |
0 |
0 |
0 |
0 |
|
Diffuse Large B Cell lymphoma |
194 (37) |
113 (39) |
75 (34) |
2 (33) |
3 (60) |
1 ( 50) |
|
Unspecified B-cell lymphomas |
48 (9) |
36 (13) |
12 ( 5) |
0 |
0 |
0 |
|
T-cell lymphomas |
32 (6) |
17 (6) |
14 (6) |
1 (17) |
0 |
0 |
|
Peripheral T-cell lymphoma |
12 (2) |
6 (2) |
5 (2) |
1 (17) |
0 |
0 |
|
Angioimmunoblastic lymphoma |
5 (1) |
3 (1) |
2 (1) |
0 |
0 |
0 |
|
Anaplastic large cell lymphoma |
1 (0) |
1 (0) |
0 |
0 |
0 |
0 |
|
LGL T-cell leukaemia |
0 |
0 |
0 |
0 |
0 |
0 |
|
Pleiomorphic T-cell lymphoma |
2 (0) |
0 |
2 (1) |
0 |
0 |
0 |
|
Hepatosplenic T-cell lymphoma |
0 |
0 |
0 |
0 |
0 |
0 |
|
Unspecified T-cell lymphomas |
12 (2) |
7 (2) |
5 (2) |
0 |
0 |
0 |
|
Unspecified non-Hodgkin lymphoma/ lymphoma |
53 (10) |
30 (10) |
23 (11) |
0 |
0 |
0 |
All percentages represent % of the total number of lymphomas in that cohort with % of Hodgkin lymphoma, B- and T-cell lymphomas and unspecified NHL/ lymphoma totaling 100%; *27 lymphomas, but no follow up time (person-years), are included from the RATIO registry, France. sDMARD synthetic disease modifying drugs; TNFi inhibitors of TNF; RTX rituximab; TOC tocilizumab; ABA abatacept.
Disclosure:
L. Mercer,
None;
X. Mariette,
None;
W. Dixon,
None;
E. Baecklund,
None;
K. Hellgren,
None;
L. Dreyer,
None;
M. L. Hetland,
None;
L. Mellemkjær,
None;
K. Hyrich,
None;
A. Strangfeld,
None;
A. Zink,
None;
H. Canhao,
None;
F. Martins,
None;
V. Hernández,
None;
F. Tubach,
None;
J. E. Gottenberg,
None;
J. Morel,
Roche Pharmaceuticals,
5,
Pfizer Inc,
5,
Bristol-Myers Squibb,
5,
Union Chimique Belge,
5,
Merck Pharmaceuticals,
5,
Abbott Laboratories,
5;
J. Zavada,
None;
P. van Riel,
None;
A. Finckh,
None;
F. Iannone,
None;
J. Askling,
AstraZeneca; Pfizer;,
2;
J. Listing,
None.
« Back to 2014 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/first-results-of-a-european-registries-collaborative-project-to-compare-the-spectrum-of-lymphomas-between-different-exposure-groups-in-rheumatoid-arthritis/