Originally published as JCO Early Release 10.1200/JCO.2005.04.6227 on March 6 2006

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mikuls, T. R. Articles by Habermann, T. M. Search for Related Content PubMed PubMed Citation Articles by Mikuls, T. R. Articles by Habermann, T. M.

Prospective Study of Survival Outcomes in Non-Hodgkin's Lymphoma Patients With Rheumatoid Arthritis

Ted R. Mikuls, Justin O. Endo, Susan E. Puumala, Patricia A. Aoun, Natalie A. Black, James R. O'Dell, Julie A. Stoner, Eugene C. Boilesen, Martin A. Bast, Debra A. Bergman, Kay M. Ristow, Melissa Ooi, James O. Armitage, Thomas 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.

Address reprint requests to Ted R. Mikuls, MD, MSPH, Assistant Professor, Section of Rheumatology and Immunology, Department of Medicine, 983025 Nebraska Medical Center, Omaha, NE 68198-3025; e-mail: tmikuls{at}unmc.edu

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 [HR] = 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.

Supported in part by training grants from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (Grant No. K23 AR0500004-01A1) and the Arthritis Foundation (T.R.M.).

This study was approved by the institutional review boards at both the University of Nebraska Medical Center (Omaha, NE) and Mayo Clinic (Rochester, MN).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

This article has been cited by other articles:

				A Torresin, M Feasi, and G Cassola Lymphoma and human immunodeficiency virus (HIV) infection: another favourable setting? Ann. Onc., August 1, 2007; 18(8): 1422 - 1423. [Full Text] [PDF]

				T. Mikuls The treatment of lymphoma complicating autoimmune disease: two birds with one stone? Ann. Onc., April 1, 2007; 18(4): 615 - 618. [Full Text] [PDF]

				K. E. Smedby, E. Baecklund, and J. Askling Malignant Lymphomas in Autoimmunity and Inflammation: A Review of Risks, Risk Factors, and Lymphoma Characteristics. Cancer Epidemiol. Biomarkers Prev., November 1, 2006; 15(11): 2069 - 2077. [Abstract] [Full Text] [PDF]