title: Myeloid leukaemia in systemic lupus erythematosus--a nested case-control study based on Swedish registers.
abstract: OBJECTIVE
  To assess the risk factors for leukaemic transformation and myeloid leukaemia in patients with SLE.
  
  
  METHODS
  A national SLE cohort identified through SLE discharge diagnoses in the Swedish hospital discharge register during 1964 to 1995 (n = 6438) was linked to the national cancer register. A nested case-control study in SLE patients who developed acute or chronic myeloid leukaemia was performed with SLE patients without malignancy as controls. Medical records from cases and controls were reviewed and bone marrow specimens were re-evaluated. A Medline search of previously published cases of SLE and myeloid leukaemia was performed.
  
  
  RESULTS
  After confirmation of SLE diagnosis according to the ACR criteria, eight patients with SLE and myeloid leukaemia and 18 SLE controls were included in the study. Preceding leucopenia was significantly associated with leukaemia development, whereas other SLE manifestations were not. Two cases had a preceding bone marrow confirming myelodysplastic syndrome (MDS). Only two cases were significantly treated with cyclophosphamide or AZA. A Medline search resulted in only 15 previously published cases of coincident SLE and myeloid leukaemia. Preceding MDS was reported in five of these, whereas only eight had been treated with cytotoxic drugs.
  
  
  CONCLUSIONS
  Low-dose chemotherapy was not a major cause of myeloid malignancy in our population-based cohort of SLE patients nor in the reported cases from literature. Leucopenia was a risk factor for myeloid leukaemia development and an MDS was frequently seen. Therefore bone marrow investigation should be considered in SLE patients with long-standing leucopenia and anaemia.
authors.affiliation: Department of Rheumatology, Malar Hospital, SE 631 88 Eskilstuna, Sweden. bjorn.lofstrom@dll.se
authors.forename: Björn
authors.initials: B
authors.lastname: Löfström
authors.forename: Carin
authors.initials: C
authors.lastname: Backlin
authors.forename: Christer
authors.initials: C
authors.lastname: Sundström
authors.forename: Eva
authors.initials: E
authors.lastname: Hellström-Lindberg
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Lundberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001856:Bone Marrow Examination / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D007951:Leukemia, Myeloid / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D007970:Leukopenia / Q000150:complications / Q000453:epidemiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents