title: Subsequent leukaemia in autoimmune disease patients.
abstract: Previous studies have shown that patients diagnosed with some autoimmune (AI) diseases are at an increased risk of leukaemia but limited data are available on survival. We systematically analysed the risks (standardized incidence ratio, SIR) and survival (hazard ratio, HR) in nine types of leukaemia among 402 462 patients hospitalized for any of 33 AI diseases and compared to persons not hospitalized for AI diseases. Risk for all leukaemia was increased after 13 AI diseases and survival was decreased after six AI diseases. SIRs were increased after all AI diseases for seven types of leukaemia, including SIR 1·69 (95% confidence interval (CI): 1·29-2·19) for acute lymphoblastic leukaemia (ALL), 1·85 (95% CI: 1·65-2·07) for acute myeloid leukaemia, 1·68 (95% CI: 1·37-2·04) for chronic myeloid leukaemia, 2·20 (95% CI: 1·69-2·81) for 'other myeloid leukaemia', 2·45 (95% 1·99-2·98) for 'other and unspecified leukaemia', 1·81 (95% CI: 1·11-2·81) for monocytic leukaemia, and 1·36 (95% CI: 1·08-1·69) for myelofibrosis. The HRs were increased for four types of leukaemia, most for myelofibrosis (1·74, 95% CI: 1·33-2·29) and ALL (1·42, 95% CI: 1·03-1·95). Some AI diseases, including rheumatoid arthritis, were associated with increased SIRs and HRs in many types of leukaemia. The present data showed increases in risk and decreases in survival for many types of leukaemia after various AI diseases. Leukaemia is a rare complication in AI disease but findings about this comorbidity at the time of leukaemia diagnosis may help to optimize the treatment and improve survival.
authors.affiliation: Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany.|Centre for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: Kari
authors.initials: K
authors.lastname: Hemminki
authors.affiliation: Centre for Primary Health Care Research, Lund University, Malmö, Sweden.|College of Lab Medicine, Hebei North University, Zhangjiakou, China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Liu
authors.affiliation: Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany.|Centre for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: Asta
authors.initials: A
authors.lastname: Försti
authors.affiliation: Centre for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: Jianguang
authors.initials: J
authors.lastname: Ji
authors.affiliation: Centre for Primary Health Care Research, Lund University, Malmö, Sweden.|Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
authors.affiliation: Centre for Primary Health Care Research, Lund University, Malmö, Sweden.|Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
mesh_terms: D001327:Autoimmune Diseases / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000453:epidemiology / Q000209:etiology*; D007951:Leukemia, Myeloid / Q000453:epidemiology / Q000209:etiology; D011087:Polycythemia Vera / Q000453:epidemiology / Q000209:etiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology / Q000209:etiology; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology
references.citation: Anderson, L.A., Pfeiffer, R.M., Landgren, O., Gadalla, S., Berndt, S.I. & Engels, E.A. (2009) Risks of myeloid malignancies in patients with autoimmune conditions. British Journal of Cancer, 100, 822-828.
references.citation: Bjorkholm, M., Ohm, L., Eloranta, S., Derolf, A., Hultcrantz, M., Sjoberg, J., Andersson, T., Hoglund, M., Richter, J., Landgren, O., Kristinsson, S.Y. & Dickman, P.W. (2011) Success story of targeted therapy in chronic myeloid leukaemia: a population-based study of patients diagnosed in Sweden from 1973 to 2008. Journal of Clinical Oncology, 29, 2514-2520.
references.citation: Cines, D.B., Liebman, H. & Stasi, R. (2009) Pathobiology of secondary immune thrombocytopenia. Seminars in Hematology, 46, S2-S14.
references.citation: Extermann, M. (2007) Interaction between comorbidity and cancer. Cancer Control, 14, 13-22.
references.citation: Forabosco, P., Bouzigon, E., Ng, M.Y., Hermanowski, J., Fisher, S.A., Criswell, L.A. & Lewis, C.M. (2009) Meta-analysis of genome-wide linkage studies across autoimmune diseases. European Journal of Human Genetics, 17, 236-243.
references.citation: Goldin, L.R. & Landgren, O. (2009) Autoimmunity and lymphomagenesis. International Journal of Cancer, 124, 1497-1502.
references.citation: Hauswirth, A.W., Skrabs, C., Schutzinger, C., Gaiger, A., Lechner, K. & Jager, U. (2007) Autoimmune haemolytic anaemias, Evans' syndromes, and pure red cell aplasia in non-Hodgkin lymphomas. Leukaemia & Lymphoma, 48, 1139-1149.
references.citation: Hemminki, K., Li, X., Sundquist, K. & Sundquist, J. (2007) Familial risks for asthma among twins and other siblings based on hospitalizations in Sweden. Clinical and Experimental Allergy, 37, 1320-1325.
references.citation: Hemminki, K., Li, X., Sundquist, K. & Sundquist, J. (2008) Familial risks for chronic obstructive pulmonary disease among siblings based on hospitalizations in Sweden. Journal of Epidemiology and Community Health, 62, 398-401.
references.citation: Hemminki, K., Houlston, R., Sundquist, J., Sundquist, K. & Shu, X. (2012a) Co-morbidity between early-onset leukaemia and type 1 diabetes-suggestive of a shared viral etiology? PLoS ONE, 7, e39523.
references.citation: Hemminki, K., Liu, X., Ji, J., Sundquist, J. & Sundquist, K. (2012b) Autoimmune disease and subsequent digestive tract cancer by histology. Annals of Oncology, 23, 927-933.
references.citation: Hemminki, K., Liu, X., Forsti, A., Ji, J., Sundquist, J. & Sundquist, K. (2012c) Effect of autoimmune diseases on incidence and survival in subsequent multiple myeloma. Journal of hematology & oncology, 5, 59.
references.citation: Hodgson, K., Ferrer, G., Pereira, A., Moreno, C. & Montserrat, E. (2011) Autoimmune cytopenia in chronic lymphocytic leukaemia: diagnosis and treatment. British Journal of Haematology, 154, 14-22.
references.citation: Ji, J., Liu, X., Sundquist, K. & Sundquist, J. (2011) Survival of cancer in patients with rheumatoid arthritis: a follow-up study in Sweden of patients hospitalized with rheumatoid arthritis 1 year before diagnosis of cancer. Rheumatology (Oxford), 50, 1513-1518.
references.citation: Juliusson, G., Lazarevic, V., Horstedt, A.S., Hagberg, O., Hoglund, M. & Swedish Acute Leukaemia Registry, G. (2012) Acute myeloid leukaemia in the real world: why population-based registries are needed. Blood, 119, 3890-3899.
references.citation: Kristinsson, S.Y., Bjorkholm, M., Hultcrantz, M., Derolf, A.R., Landgren, O. & Goldin, L.R. (2011) Chronic immune stimulation might act as a trigger for the development of acute myeloid leukaemia or myelodysplastic syndromes. Journal of Clinical Oncology, 29, 2897-2903.
references.citation: Landgren, O., Engels, E.A., Caporaso, N.E., Gridley, G., Mellemkjaer, L., Hemminki, K., Linet, M.S. & Goldin, L.R. (2006) Patterns of autoimmunity and subsequent chronic lymphocytic leukaemia in Nordic countries. Blood, 108, 292-296.
references.citation: Landgren, A.M., Landgren, O., Gridley, G., Dores, G.M., Linet, M.S. & Morton, L.M. (2011) Autoimmune disease and subsequent risk of developing alimentary tract cancers among 4.5 million US male veterans. Cancer, 117, 1163-1171.
references.citation: Ludvigsson, J.F., Andersson, E., Ekbom, A., Feychting, M., Kim, J.L., Reuterwall, C., Heurgren, M. & Olausson, P.O. (2011) External review and validation of the Swedish national inpatient register. BMC Public Health, 11, 450.
references.citation: Ramadan, S.M., Fouad, T.M., Summa, V., Hasan, S. & Lo-Coco, F. (2012) Acute myeloid leukaemia developing in patients with autoimmune diseases. Haematologica, 97, 805-817.
references.citation: Riihimaki, M., Thomsen, H., Brandt, A., Sundquist, J. & Hemminki, K. (2011) What do prostate cancer patients die of? Oncologist, 16, 175-181.
references.citation: Riihimaki, M., Thomsen, H., Brandt, A., Sundquist, J. & Hemminki, K. (2012) Death causes in breast cancer patients. Annals of Oncology, 23, 604-610.
references.citation: Shu, X., Ji, J., Li, X., Sundquist, J., Sundquist, K. & Hemminki, K. (2010) Cancer risk among patients hospitalized for type 1 diabetes mellitus: a population-based cohort study in Sweden. Diabetic Medicine, 27, 791-797.
references.citation: Shu, X., Ji, J., Sundquist, J., Sundquist, K. & Hemminki, K. (2011a) Survival in cancer patients hospitalized for inflammatory bowel disease in Sweden. Inflammatory Bowel Diseases, 17, 816-822.
references.citation: Shu, X., Ji, J., Sundquist, J., Sundquist, K. & Hemminki, K. (2011b) Survival in cancer patients hospitalized for psoriasis: a population-based cohort study in Sweden. British Journal of Dermatology, 165, 129-136.
references.citation: Zhernakova, A., van Diemen, C.C. & Wijmenga, C. (2009) Detecting shared pathogenesis from the shared genetics of immune-related diseases. Nature Reviews Genetics, 10, 43-55.