Autoimmune Disease Is a Risk Factor for the Development of Non-Hodgkin’s Lymphoma and May Account in Part for Its Increase in Women.

The incidence of non-Hodgkin’s lymphoma (NHL) has increased dramatically over the last several decades especially in people over 60 years of age. The reasons for this are likely to be multifactorial and may include a diminution of immune surveillance which occurs with aging. Patients with autoimmune disease may be at increased risk of developing NHL. Women have a higher incidence of autoimmune disease (AIMD). The use of immunosuppressive drugs to control autoimmune diseases decreases immune surveillance and may therefore increase the likelihood of developing lymphoma. We sought to determine if prior autoimmune disease increases the risk of developing NHL.

Methods: All patients seen by JC & KT from 1993 to 2002 form the basis of this report. There were 278 patients with NHL and these were compared with 317 patients with other hematological disorders (controls) seen at the same time period.

Findings: Thirty-six (13%) of NHL patients had an autoimmune disease prior to or at diagnosis of NHL compared to 5% of controls (p=.001). Sixty-nine percent of NHL patients with a prior AIMD were female compared to 43% without a prior AIMD and this was similar in control patients (69% and 48%) respectively. Twenty percent of all women with NHL had a prior history of autoimmune disease compared to 7% of women in the control group (p=.001). A logistic regression was performed to evaluate simultaneously the effects of gender, age and AIMD on disease status. Even adjusting for age and gender, autoimmune disease was significantly more likely to be associated with NHL, with an odds ratio of 2.6 and 95% confidence intervals of 1.4–4.9. Thus for patients of the same age and gender, patients with AIMD are 2.6 times more likely to have NHL than the control patients. The median time from AIMD to the diagnosis of NHL was 10 years. It was 14 years in the control group. The two most common autoimmune diseases in the NHL patients were rheumatoid arthritis and autoimmune hypothyroidism. In the control group it was autoimmune hypothyroidism and inflammatory bowel disease.

Conclusion:

Autoimmune disease may account in part for the increase in NHL especially in women.