title: Incidence and characteristics of non-Hodgkin lymphomas in a multicenter case file of patients with hepatitis C virus-related symptomatic mixed cryoglobulinemias.
abstract: BACKGROUND
  Some patients with cryoglobulinemic syndrome (CS) develop frank non-Hodgkin lymphoma (NHL), but the incidence and timing of this event are still poorly defined.
  
  
  METHODS
  A retrospective multicenter study was performed of hepatitis C virus-positive patients with CS observed in 11 Italian centers belonging to the Italian Group for the Study of Cryoglobulinemia.
  
  
  RESULTS
  The inclusion criteria were satisfied by 1,255 patients. During a cumulative follow-up of 8,928 patient-years, 59 cases of NHL were diagnosed, for an estimated rate of 660.8 new cases per 100,000 patient-years with 224.1 new cases of aggressive NHL subtypes per 100,000 patient-years. More than 90% of the patients developing NHLs had type II cryoglobulins. The NHLs were classified as nonaggressive in 31 cases (53%), aggressive in 20 (34%), and mucosa-associated lymphoid tissue lymphomas in 6 (10%); 2 cases were unclassifiable. The median time from the diagnosis of CS to the clinical onset of NHL was 6.26 years (range, 0.81-24 years). The clinical course and response to chemotherapy in the patients with CS who had NHL were similar to those usually described in patients with NHL without CS; the course of the CS only marginally benefited from chemotherapy.
  
  
  CONCLUSIONS
  The overall risk of NHL in patients with CS is about 35 times higher than in the general population (12 times higher if nonaggressive lymphomas are excluded). The presence of CS did not significantly affect the treatment of newly diagnosed lymphomas.
authors.affiliation: Unità Operativa di Medicina Generale, Saronno Hospital, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Monti
authors.forename: Pietro
authors.initials: P
authors.lastname: Pioltelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Saccardo
authors.forename: Mauro
authors.initials: M
authors.lastname: Campanini
authors.forename: Marco
authors.initials: M
authors.lastname: Candela
authors.forename: Giobatta
authors.initials: G
authors.lastname: Cavallero
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Vita
authors.forename: Clodoveo
authors.initials: C
authors.lastname: Ferri
authors.forename: Cesare
authors.initials: C
authors.lastname: Mazzaro
authors.forename: Sergio
authors.initials: S
authors.lastname: Migliaresi
authors.forename: Elena
authors.initials: E
authors.lastname: Ossi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pietrogrande
authors.forename: Armando
authors.initials: A
authors.lastname: Gabrielli
authors.forename: Massimo
authors.initials: M
authors.lastname: Galli
authors.forename: Fulvio
authors.initials: F
authors.lastname: Invernizzi
mesh_terms: D000368:Aged; D003449:Cryoglobulinemia / Q000150:complications*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors