title: Patients with systemic lupus erythematosus and haematological malignancy at a tertiary care centre: timing, histopathology and therapy.
abstract: OBJECTIVE
  Patients with systemic lupus erythematosus (SLE) are at higher risk of haematological malignancies (HMs) than the general population. Most reports have focused on HM diagnosed after SLE, and have excluded concurrent and preceding diagnoses. Information on response to therapy is also limited.
  
  
  METHODS
  We identified 13 296 cases of HM and 10 539 potential patients with SLE at our centre; 45 patients were confirmed to have HM and SLE. Our retrospective case series was based on these 45 patients.
  
  
  RESULTS
  Of the 45 patients, 64% were diagnosed with HM ≥1 year after diagnosis with SLE, and 36% with HM before or concurrent with SLE. Of the 29 patients with HM after SLE, 13 had diffuse large B cell lymphoma (DLBCL), 6 indolent lymphoma, 4 leukaemia, 3 Hodgkin's disease, and 1 each Burkitt's lymphoma, T cell lymphoma and multiple myeloma. Eleven patients with DLBCL were treated with cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone (CHOP) or rituximab-CHOP; hydroxydaunorubicin, oncovin and prednisone; only four achieved durable remission. Of the 16 patients diagnosed with HM before or concurrent with SLE, 9 were diagnosed with HM more than 2 years before SLE and tended to be in remission prior to SLE diagnosis. Seven patients were diagnosed with HM and SLE concurrently; in terms of their HM, six achieved remission or stable disease.
  
  
  CONCLUSIONS
  In summary, DLBCL was the most common type of lymphoma in patients diagnosed with HM after SLE; these patients presented with advanced-stage disease and had poor outcomes. In contrast, patients diagnosed with HM before or concurrent with SLE had early stage disease and typically achieved remission.
authors.affiliation: Department of Internal Medicine, Division of Rheumatology , University of Michigan , Ann Arbor, Michigan , USA.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Knight
authors.affiliation: Stanford Cancer Center, Stanford School of Medicine , Stanford, California , USA.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Blayney
authors.affiliation: Department of Internal Medicine, Division of Rheumatology , University of Michigan , Ann Arbor, Michigan , USA ; Department of Environmental Health Sciences , University of Michigan , Ann Arbor, Michigan , USA ; Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor, Michigan , USA.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Somers
keywords: Diffuse large B-cell lymphoma; Hematologic neoplasms; Systemic Lupus Erythematosus