B-CELL HEMATOTOLOGIC NEOPLASM IN A PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background: The association of systemic lupus erythematosus (SLE) and B-cell hematologic neoplasm is widely reported in the literature. Numerous different variants of B-cell malignancies can be developed in these patients.B-cell malignancies occurs after the diagnosis and treatment of SLE in most reported cases, altough it may precede SLE,or occur syncronously with it. The use of immunosuppressive drugs is comon in patients with SLE diagnosed prior to B-cell lymphoma,arguing that the effect of immunosuppression on the patogenesis of lymphoma can not be excluded. Probably,other patogenetic mechanisms are responcibile for association of this two disorders.Objectives: The aim of this study is to describe four cases of B-cell lymphoma in a patients with systemic lupus erythematosus. The use of immunosuppressive drugs before the onset of malignant lymphoma was not recorded.Methods: Here we report 4 cases of SLE patients treated with corticosteroids and antimalarics,wich developed malignant lymphoproliferative disease. All 4 patients were women ranging in age from 41-53years (mean 46 years). All of them fulfilled the diagnostic criteria for systemic lupus erythematosus according to ACR criteria (revised 1997). All the biopsed specimens showed malignant lymphoma. Three were Non Hodgkin's lymphoma and one was Hodgkin's disease. Three were nodal origin and one was extranodal (lung infiltrate). The lymphomas were classified according to WHO classification of hematologic malignancies (1997)Results: This is the report on four cases of patients with histologicaly confirmed lymphoma complicating lupus systemicus erythematosus. Three with Non Hodgkin's lymphoma (one anaplastic large cell lymphoma, one centrocytic-centroblastic lymphoma and one MALT-lymphoma) and one with Hodgin's disease (Lymphocytic predomonation type). The interval between diagnosis of SLE and the development of Non Hodgkin's lymphoma range from 2-4 years (2,3,4 years respectively), and the interval between diagnosis of SLE and the development of Hodgkin's disease was 25 years. In one patient the lymphoma was localised primarily in the lung.Conclusion: We conducted clinicopatologic analysis of four patients with lymphoma. B-cell malignancies occurs after diagnosis and treatment of SLE. The use of immunosuppressive drugs before the onset of malignant lymphoma was not recorded. The type of lymphoma was different in all four patients and thay range from some of the most indolent malignancies (MALT-lymphoma) to the most rapidly growing and highly agressive human tumors (anaplastic large cell lymphoma). Our results suggest that the development of lymphadenopaty in a patient with SLE should be an indication for early lymph node biopsy.1. Varoczy L, Gergely L, Zeher M, Szegedi G, Illes A: Malignant lymphoma-associated autoimmune diseases-a descriptive epidemiological study. Rheumatol Int 2002 Nov;22(6):233-7; 2. Xu Y, Wiernik PH: Systemic lupus erythematosus and B-cell hematologic neoplasm. Lupus 2001;10(12):841-50; 3. Mellemkjaer L, Andersen V, Linet MS, Gridley G, Hoover R, Olsen J: Non Hodgkin's lymphoma and other cancers among a cohort of patients with systemic lupus erythematosus. Arthritis Rheum 1997 Apr;40(4):761-8; 4. Kojima M, Nakamura S, Futamura N, Kurabayashi Y, Ban S et al.: Malignant lymphoma in patients with rheumatic disease other than Sjogrens's syndrom:a clinicopathologic study of five cases and a rewiev of the Japanese literature. Jpn J Clin Oncol 1997 Apr;27(2):84-90; 5. Milligan DW, Chang JG: Systemic lupus erythematosus and lymphoma. Acta Haematol 1980;64(2):109-110Citation: , volume , supplement , year 2003, page Session: SLE – Clinical aspects 1