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SLE Patients at Higher Risk for Some Blood Cancers, Study Says FEBRUARY 18, 2019 BY JOANA CARVALHO IN NEWS. Click Here to receive Lupus News via e-mail Systemic lupus erythematosus (SLE) patients have a higher risk for certain cancers — including cervical, thyroid, ovarian, and oral cancer, as well as lymphoma, multiple myeloma, and leukemia — than the general population, emphasizing the importance of cancer screening programs as part of SLE management. The findings of the study, “Systemic lupus erythematosus is a risk factor for cancer: a nationwide population-based study in Korea,” were published in Lupus. SLE, the most prevalent form of lupus, is a chronic autoimmune disease characterized by behavioral and psychological symptoms including pain, fatigue, depression, and impaired cognition. Previous studies have suggested that SLE patients are more likely to be affected by certain types of cancers, including non-Hodgkin’s lymphoma, lung, liver, and vaginal cancer. “However, some studies have found a decreased risk of some hormone-sensitive cancers, such as breast, ovarian, and endometrial cancer, in SLE patients. However, whether patients with SLE have increased or decreased risk of breast cancer remains unclear,” the researchers said. In this study, investigators set out to characterize the relationship between SLE and cancer in the entire Korean population. The nationwide, retrospective, cohort study involved 21,016 SLE patients and 105,080 age- and sex-matched controls without SLE. The cohort was selected from the Korean National Health Insurance Service (NHIS) database between 2008 and 2014. Over a follow-up period of seven years, 763 (3.36%) SLE patients and 2,667 (2.54%) controls developed cancer. The incidence risk of cancer was higher in SLE patients compared to controls (6.427 vs 4.466). Incidence risk refers to the chance of a disease happening over a defined period of time. After accounting for age and sex, SLE patients showed a 44% higher risk of developing cancer. No differences in cancer risk were found between female and male SLE patients. SLE patients at higher risk for cancer were younger (under 40) and male, being 12 and 29 times more likely of developing lymphoma than control subjects. Looking at different cancer types, researchers found that SLE patients were more likely to develop cervical, thryoid, ovarian, and oral cancer, as well as lymphoma, leukemia, and multiple myeloma than controls. On the other hand, no significant differences in the risk of stomach, colorectal, liver, pancreatic, lung, breast, prostate, biliary, laryngeal, renal, bladder, nerve, and skin cancer were found between SLE patients and controls. While the mechanisms leading to increased risk of cancer in SLE patients are yet to be fully understood, the findings highlight the need for cancer screening programs among this patient population. “In conclusion, SLE is an independent risk factor for malignancy, especially cervical, thyroid, ovarian, oral … as well as lymphoma, multiple myeloma, and leukemia. The importance of cancer screening programs should be emphasized in SLE patients,” the scientists concluded. https://lupusnewstoday.com/2019/02/18/sle-patients-may-be-at-higher-risk-of-developing-certain-types-of-cancer/?utm_source=LUP+NEws+E-mail+List&utm_campaign=1e70fc3e85-RSS_WEEKLY_EMAIL_CAMPAIGN_US&utm_medium=email&utm_term=0_50dac6e56f-1e70fc3e85-71887989
Increased Risk of Leukaemia Associated with an Autoimmune Disease Treatment Researchers reporting at the American Society of Haematology (ASH) annual meeting in San Diego this week highlight a study that shows autoimmune disease patients receiving the immunosuppressive drug azathioprine, have a seven-fold increased risk of acute myeloid leukaemia and myelodysplastic syndromes. study of 40,011 patients who were seen at Mayo Clinic in Arizona and Florida, confirmed 86 cases of autoimmune diseases with myelodysplastic syndromes (MDS) in 55 patients, 21 patients in the early stages of acute myeloid leukaemia (AML) and 10 patients with a history of acute myeloid leukaemia. The development of myeloid neoplasms (MN) after treatment for an autoimmune disease is of increasing concern among physicians. But whether a myeloid neoplasm will occur depends on a number of variables: type of autoimmune disease; whether it is associated with a chronically activated inflammatory cascade known to be associated with an increased risk of myeloid malignancy and, the effects of other disease modifying therapies. “The addition of therapeutic agents for treatment of autoimmune diseases theoretically amplifies the opportunity for myeloid neoplasms to develop in genetically susceptible individuals,” the researchers wrote in their conference presentation. The study presented at ASH examines the association of cytotoxic, anti-inflammatory and immune-modulating agents to treat autoimmune disease as risk factors for developing myelodysplastic syndromes (MDS) or acute myeloid laeukemia (AML). The most common autoimmune profiles includes rheumatoid arthritis at 26.4 percent, psoriasis at 20.7 percent and systemic lupus at 13.8 percent. The average patient was 72 years old, 57 percent of which were male. The median onset of autoimmune disease to diagnosis of a myeloid neoplasm was six years (1-54 year range). While 12.8 percent of these patients received no treatment, the patients who were treated with oral or intravenous therapies had similar exposures for immune-modulating agents (33.7% and 37.8% respectively) and cytotoxic therapies, such as chemotherapy and radiotherapy (47.7 and 44.8% respectively). And, 57 out of 86 cases (66.3%) received either a cytotoxic or immune-modulating agent. By comparison, 105 out of 172 (61.1%) controls received either agent; p=0.495. “Azathioprine was the only statistically significant agent exposure observed more frequently in the study cohort than controls with an OR of 7.05 (p= < 0.001). There was no increased incidence of MDS or AML in TNF-antagonist treated patients. No significant correlation for duration of agent exposure by drug category was observed,” the researchers reported in their conference abstract. Methotrexate, the first line of defense for rheumatoid arthritis and other autoimmune diseases, and mercaptopurine, and mycophenolate reported favorable odd ratios, but they were not statistically significant. Nor were associations found for anti-TNF agents, the second line of defense in autoimmune disorders. The findings were reported by Natalie Ertz-Archambault, M.D., of Mayo Clinic in Arizona.