Abstract
BackgroundSystemic lupus erythematosus (SLE) is a chronic and complex multi-system autoimmune disorder. Higher risks of hematological malignancies (HM) were observed in SLE patients, which was associated with higher mortality. The mechanism and risk factors of HM oncogenesis in SLE patients are still under investigation. The aim of this study was to explore clinical characteristics, risk factors, and prognosis of SLE patients with or without HM in the Chinese population.MethodsA retrospective, case-controlled study was conducted in 72 SLE patients between January 2013 and December 2020. Clinical and laboratory data were collected and compared between the two groups of patients with HM and those without HM. Logistic regression analysis was performed to determine risk factors of HM oncogenesis. The survival rate was estimated by Kaplan-Meier methods and Cox proportional hazards regression analysis.ResultsAmong 72 SLE patients in this study, fifteen complicated with HM and 57 without HM were identified. The incidence rate of HM was approximately 0.24% with elevated standardized incidence ratios of lymphoma and leukemia (27.559 and 12.708, respectively). Patients with HM were older when diagnosed with SLE, with a higher frequency of infection and splenomegaly, lower levels of hemoglobin and high-density lipoprotein compared with those without HM. Fewer patients with HM expressed positive anti-dsDNA antibody (26.7% vs 66.7%, P = 0.005) or received hydroxychloroquine treatment (40.0% vs 86.0%, P = 0.001). Older age at SLE diagnosis (OR=1.122, 95% CI: 1.037–1.214) was regarded as an independent risk factor of HM oncogenesis. Female (RR= 0.219, 95% CI: 0.070–0.681) and hydroxychloroquine (RR= 0.281, 95% CI: 0.094–0.845) were protective factors of mortality in SLE patients.ConclusionsSLE patients with an older age are at an increased risk of HM carcinogenesis. The prognosis of male patients with SLE tends to be poorer whether complicated with HM. The association of antinuclear antibody spectrum, medication, and HM oncogenesis in SLE needs further investigation.
Highlights
Systemic lupus erythematosus (SLE) is a chronic and complex multi-system autoimmune disorder
All the infections in Group A were pneumonia, and no significant predominance was shown in pathogens, including Klebsiella pneumonia (2, 22.2%), Cytomegalovirus (1, 11.1%), Pneumocystis jirovecii (1, 11.1%), and unidentified microorganisms (5, 55.6%)
Common SLE symptoms such as rash, arthritis, and oral ulceration were similar between the two groups, but more patients in Group A had splenomegaly than those in Group B (46.7% vs. 15.8%, P = 0.027)
Summary
Systemic lupus erythematosus (SLE) is a chronic and complex multi-system autoimmune disorder. The aim of this study was to explore clinical characteristics, risk factors, and prognosis of SLE patients with or without HM in the Chinese population. Several studies have reported elevated cancer risks in SLE [5,6,7,8,9,10,11,12,13,14], especially hematological malignancies [11,12,13,14,15,16,17,18,19,20,21], which had an influence on the prognosis of patients [4, 11, 22]. We conducted a retrospective study to investigate the clinical characteristics, laboratory parameters, risk factors and prognosis of Chinese SLE patients with HM
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