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. 2017 Dec;76(12):2025-2030.
doi: 10.1136/annrheumdis-2017-211623. Epub 2017 Aug 19.

Spectrum of lymphomas across different drug treatment groups in rheumatoid arthritis: a European registries collaborative project

Louise K Mercer  1 , Anne C Regierer  2 , Xavier Mariette  3 , William G Dixon  1 , Eva Baecklund  4 , Karin Hellgren  5 , Lene Dreyer  6   7 , Merete Lund Hetland  8   9 , René Cordtz  6   7 , Kimme Hyrich  1   10 , Anja Strangfeld  2 , Angela Zink  2   11 , Helena Canhao  12 , M Victoria Hernandez  13 , Florence Tubach  14 , Jacques-Eric Gottenberg  15 , Jacques Morel  16 , Jakub Zavada  17 , Florenzo Iannone  18 , Johan Askling  5 , Joachim Listing  2
Affiliations

Spectrum of lymphomas across different drug treatment groups in rheumatoid arthritis: a European registries collaborative project

Louise K Mercer et al. Ann Rheum Dis. 2017 Dec.

Abstract

Background: Lymphomas comprise a heterogeneous group of malignant diseases with highly variable prognosis. Rheumatoid arthritis (RA) is associated with a twofold increased risk of both Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). It is unknown whether treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) affect the risk of specific lymphoma subtypes.

Methods: Patients never exposed to (bionaïve) or ever treated with bDMARDs from 12 European biologic registers were followed prospectively for the occurrence of first ever histologically confirmed lymphoma. Patients were considered exposed to a bDMARD after having received the first dose. Lymphomas were attributed to the most recently received bDMARD.

Results: Among 124 997 patients (mean age 59 years; 73.7% female), 533 lymphomas were reported. Of these, 9.5% were HL, 83.8% B-cell NHL and 6.8% T-cell NHL. No cases of hepatosplenic T-cell lymphoma were observed. Diffuse large B-cell lymphoma (DLBCL) was the most frequent B-cell NHL subtype (55.8% of all B-cell NHLs). The subtype distributions were similar between bionaïve patients and those treated with tumour necrosis factor inhibitors (TNFi). For other bDMARDs, the numbers of cases were too small to draw any conclusions. Patients with RA developed more DLBCLs and less chronic lymphocytic leukaemia compared with the general population.

Conclusion: This large collaborative analysis of European registries has successfully collated subtype information on 533 lymphomas. While the subtype distribution differs between RA and the general population, there was no evidence of any modification of the distribution of lymphoma subtypes in patients with RA treated with TNFi compared with bionaïve patients.

Keywords: DMARDs(biologic); anti-TNF; epidemiology; rheumatoid arthritis.

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Conflict of interest statement

Competing interests: AR received speaker fees (less than $10 000) from Celgene and Janssen. XM received honorarium (less than $10 000) from BMS, Pfizer and UCB. LD has received speaker fees from UCB and MSD. KH received grant/research support from Pfizer and honoraria (less than $10 000) from Abbvie and Pfizer. AS received speaker fees (less than $10 000) from BMS, MSD, Pfizer, Roche and Sanofi-Aventis. AZ received grant/research support from Abbvie, Amgen, BMS, MSD, Roche, Pfizer and UCB for the German biologics register RABBIT and speaker fees (less than $10 000) from BMS, MSD, Novartis, Pfizer, Roche, Sanofi and UCB. JEG received honorarium (less than $10 000) from Abbvie, BMS, MSD, Pfizer, Roche and UCB. JM received less than $10 000 for honoraria and consultancies from Roche. JZ received honorarium (less than $10 000) from Abbvie and Hospira. FI received personal fees from Actelion, Celgene, Janssen, Pfizer, AbbVie, UCB and MSD outside the submitted work. JA received grant/research support from AstraZeneca, Merck, Lilly and Pfizer, and has received grant support from Abbvie, Pfizer, Merck, Roche, BMS and UCB for the ARTIS register. JL received honoraria (less than $10 000) from Novartis-Sandoz and Pfizer.

Comment in

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