RESEARCH - Prospective study of survival outcomes in non-Hodgkin's lymphoma patients with RA

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Originally published as JCO Early Release 10.1200/JCO.2005.04.6227 on

March 6 2006

Journal of Clinical Oncology, Vol 24, No 10 (April 1), 2006: pp. 1597-1602

© 2006 American Society of Clinical Oncology.

Prospective Study of Survival Outcomes in Non-Hodgkin's Lymphoma

Patients With Rheumatoid Arthritis

Ted R. Mikuls, O. Endo, E. Puumala, A. Aoun,

A. Black, R. O'Dell, A. Stoner, Eugene C.

Boilesen, A. Bast, Debra A. Bergman, Kay M. Ristow,

Ooi, O. Armitage, M. Habermann

From the Departments of Medicine, Preventive and Societal Health, and

Pathology, University of Nebraska Medical Center, and Omaha Veterans'

Affairs Medical Center; Department of Medicine, Mayo Clinic,

Rochester, MN; Department of Hematology, University of College

Hospital Galway, Galway, Ireland.

PURPOSE: Although preliminary studies suggest that non-Hodgkin's

lymphoma (NHL) complicating rheumatoid arthritis (RA) may be a

clinically distinct entity compared with that occurring in the general

population, studies examining the impact of antecedent RA on survival

are limited. In this prospective study, we examined the association of

RA with survival in patients with NHL.

PATIENTS AND METHODS: Using two large lymphoma registries, we

identified patients with evidence of RA preceding NHL. Survival in RA

patients was compared with that of controls using proportional hazards

regression, adjusting for the effects of age, sex, lymphoma

diagnosis-to-treatment lag time, calendar year, International

Prognostic Index score, and NHL grade.

RESULTS: The frequency of NHL subtypes was similar in RA patients (n =

65) and controls (n = 1,530). Compared with controls, RA patients with

NHL had similar overall survival (hazard ratio

---

= 0.95; 95% CI,

0.70 to 1.30) but were at lower risk of lymphoma progression or

relapse (HR = 0.41; 95% CI, 0.25 to 0.68) or death related to lymphoma

or its treatment (HR = 0.60; 95% CI, 0.37 to 0.98), but were more than

twice as likely to die from causes unrelated to lymphoma (HR = 2.16;

95% CI, 1.33 to 3.50).

CONCLUSION: RA is associated with improved NHL-related outcomes,

including a 40% reduced risk of death occurring as a result of

lymphoma or its treatment and approximately a 60% lower risk of

lymphoma relapse or progression compared with non-RA controls.

However, the survival advantage gained in RA from the acquisition of

lymphomas with favorable prognoses is negated through an increased

mortality from other comorbid conditions.

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Read the full article here:

http://jco.ascopubs.org/cgi/content/full/24/10/1597

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