Lymphoma in Autoimmune Disease

Non-Hodgkin's lymphoma, which is the fifth most common type of cancer seen in the United States, is a type of cancer affecting lymphocytes that causes malignant tumors within lymphoid tissue. Several recent studies have confirmed that the incidence of non-Hodgkin's lymphoma (NHL) is increased in patients with certain autoimmune diseases compared to people who do not have autoimmune disorders. For many years, an increase in NHL has been observed in people with celiac disease, autoimmune thyroid disease, and adult-onset diabetes of long duration, and a link with NHL and certain other autoimmune diseases, such as systemic lupus erythematosus (SLE), had been long suspected.

The recent rise in NHL in both adults and children also appears to run parallel to the recent increased incidence of autoimmune diseases. Both T-lymphocytes and B-lymphocytes may be affected in patients with NHL. NHL occurs more often in men than women, and people of any age may be affected. However, the incidence of NHL in women has risen in recent years and the increased incidence of autoimmune disease in women is thought to be responsible. The mean age for NHL at the time of diagnosis is 3-40 years. In patients who have both NHL and AD, the higher incidence seen in men may be related to the fact that it typically takes longer to diagnose autoimmune disorders in men than in women. Consequently, the autoimmune disease course in men is usually more severe, and treatment delays are common.

A common factor in the development of both NHL and autoimmune disease is the antigenic stimulation that induces the lymphocyte cells to respond and react. In these studies both primary NHL and NHL subtypes were increased in patients with rheumatoid arthritis, SLE, celiac disease and Sjogren's syndrome. An increased incidence of NHL was not seen in patients with psoriasis, sarcoidosis, and inflammatory bowel disease. The incidence of NHL was higher even in patients with rheumatoid arthritis who were on corticosteroid therapy and other non-corticosteroid immunosuppressant therapy. Patients who did not have rheumatoid arthritis who reported using these medications did not have a higher incidence of NHL, indicating that the disease itself and not its treatment, was linked to increased NHL Overall, the studies showed that patients with NHL were 2.6 times more likely to have had a prior history of autoimmune disease.

Symptoms in NHL include unexplained weight loss, profuse sweating especially at night, severe itchiness and fever. The lymph nodes close to the body's surface, for instance those in the neck, underarm or groin, may become swollen. If lymph nodes in the abdomen are affected, patients may experience abdominal swelling or bloating resulting from accumulating fluid or tumor growth. Patients with intestinal tumors may also have difficulty passing stools. When lymphoma develops in the thymus gland, the tumor may block the trachea or the superior vena can become compressed, causing a life-threatening condition known as superior vena cava (SVC) syndrome.

NHL is diagnosed by fine needle aspiration of the tumor and a histological examination of the excised specimen. Imaging tests and a bone marrow aspiration may also be performed to aid in diagnosis. Lymphomas also produce various growth factors such as tumor necrosis factor-alpha. Levels of these substances are sometimes also used to aid with diagnosis. Treatment depends on the type of lymphoma found, including its aggressiveness, disease stage and the patient's overall health.

Resources:

Karin Ekstrom Smedy et al., Autoimmune and Chronic Inflammatory Disorders and Risk of Non-Hodgkin Lymphoma by Subtype, Journal of the National Cancer Institute, January 4, 2006

David Douglas, Autoimmune Disease Tied to Non-Hodgkin's Lymphoma, Journal of Rheumatology, Oct 2005.

Print Article

Email Article

View All Articles

How to subscribe to feeds