title: Lymphoma development in patients with autoimmune and inflammatory disorders--what are the driving forces?
abstract: For decades, it has been known that patients with certain autoimmune and inflammatory disorders, such as rheumatoid arthritis (RA) and primary Sjögren's syndrome (pSS), have an increased risk of developing malignant lymphoma. Although the clinico-biological reasons for this association remain largely unknown, our knowledge has improved and new insights have been obtained. First, the direct link between autoimmunity and lymphomagenesis has been strengthened by large epidemiological studies showing a consistent risk increase of lymphoma associated with certain autoimmune/inflammatory conditions in independent cohorts from different countries. Second, a number of local and systemic disease-related risk factors in these diseases have been repeatedly linked to lymphoma development, with the prime examples being disease severity and the degree of inflammatory activity. Considering the key role of B- and T-cell activation in the pathogenesis of both autoimmunity and lymphoma, it is perhaps not surprising that longstanding chronic inflammation and/or antigen stimulation have emerged as major predisposing factors of lymphoma in patients with active autoimmune disease. Finally, increasing evidence suggests that lymphomas associated with autoimmunity constitute a different spectrum of entities compared to lymphomas arising in patients without any known autoimmune or inflammatory conditions, pointing to a different pathobiology. In this review, we summarize the recent literature that supports a direct or indirect link between immune-mediated disease and lymphoma and describe the characteristics of lymphomas developing in the different diseases. We also discuss molecular, genetic and microenvironmental factors that may come into play in the pathobiology of these disorders.
authors: Unit of Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: Eva.Baecklund@telia.com.
authors: Eva
authors: E
authors: Baecklund
authors: Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
authors: Karin E
authors: KE
authors: Smedby
authors: Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
authors: Lesley-Ann
authors: LA
authors: Sutton
authors: Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden; Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
authors: Johan
authors: J
authors: Askling
authors: Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
authors: Richard
authors: R
authors: Rosenquist
mesh_terms: D001327:Autoimmune Diseases / Q000150:complications / Q000276:immunology / Q000473:pathology*; D018122:B7-1 Antigen / Q000276:immunology; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000473:pathology*; D008223:Lymphoma / Q000209:etiology / Q000276:immunology / Q000473:pathology*; D012307:Risk Factors; D012859:Sjogren's Syndrome / Q000150:complications / Q000276:immunology / Q000473:pathology; D059016:Tumor Microenvironment / Q000235:genetics / Q000276:immunology*; D018127:Tumor Necrosis Factor Receptor Superfamily, Member 7 / Q000276:immunology
chemical_list: D018122:B7-1 Antigen; D018127:Tumor Necrosis Factor Receptor Superfamily, Member 7
keywords: Antigen stimulation; Autoimmune disease; Chronic inflammation; Genetic events; Lymphoma; Risk factors