Autoimmune disease is a risk factor for the development of non-Hodgkin's lymphoma.

OBJECTIVE: To investigate the relationship of prior autoimmune disease to the development of non-Hodgkin's lymphoma (NHL). METHODS: Patients with NHL (n = 278) seen from 1993 to 2002 were compared with a group of patients with other hematological disorders (controls, n = 317) seen at the same time. All patients were questioned about prior autoimmune disease. Comparisons between NHL patients and controls were based on analysis of a 2 2 table of counts using Fisher's exact test. Analysis of the effect of autoimmune disease on NHL status, controlling for other risk factors, was performed using logistic regression. RESULTS: Thirty-six (13%) NHL patients had a prior autoimmune disease compared to 5% of controls (p = 0.001). Sixty-nine percent of NHL patients with a prior autoimmune disease were female compared to 43% without a prior autoimmune disease, and this was similar in control patients, 69% and 48%, respectively. Twenty percent of all women with NHL had a history of autoimmune disease compared to 7% of women in the control group (p = 0.001). Nineteen of the NHL patients with autoimmune disease (56%) received immunosuppressive treatment compared to 5 (38%) in the controls. CONCLUSION: Autoimmune disease may account in part for the increase in NHL, especially in women.

Primary splenic lymphoma: report of 10 cases using the REAL classification.

Primary splenic lymphoma (PSL) is rare with a reported incidence of less than 1%. Diffuse large cell pathology has been reported in 22-33% of the cases and is felt to have a poor outcome. We report our experience in patients with PSL seen at Mount Sinai Medical Center during the years 1994-1999. Our objective was to evaluate staging (using the Ahmann and Kehoe criteria), prognosis using the International Prognostic Index (IPI), and pathology using the Revised European-American Lymphoma Classification (REAL) classification. Ten patients were identified. Eight of the 10 patients had diffuse large cell lymphoma (DLCL). Using the IPI, four patients were categorized as low risk, three as low/intermediate risk, and three as high risk. The only two deaths occurred in the high-risk group. Lymph node involvement beyond the splenic hilum seen by imaging studies represents an advanced non-Hodgkin's lymphoma and should be included no longer in the staging of PSL. Nine of the 10 underwent a splenectomy. Eight of the nine patients received chemotherapy following splenectomy. Seven of the nine patients remained in remission from 1 to 19 years. Splenectomy followed by combination chemotherapy, results in excellent long-term survival in PSL.

Non-Hodgkin's lymphoma in patients 70 years of age or older: factors associated with survival.

The incidence of non-Hodgkin's lymphoma (NHL) has increased dramatically especially in persons over 60 years of age. We reviewed our experience in patients with NHL who were 70 years of age or older and seen between 1992 and 1998 in an effort to find any unique risk factors in this age group. There were 64 patients. Twenty-five had indolent disease and 38 had aggressive disease. The majority of patients with indolent lymphoma presented with nodal disease and were more likely to have bone marrow involvement. In contrast, 71% of patients with aggressive lymphoma presented with extra-nodal disease. Five of seven (71%) patients with indolent and 22 of 29 (76%) with aggressive NHL who received an Adriamycin containing regimen as first line therapy achieved a complete response. The International Prognostic Index (IPI) was a strong predictor of both survival (P<001) and response (P=007) for the group as a whole. The IPI accurately predicted the survival of patients with aggressive NHL (P=026). This was not the case with indolent lymphomas. This study suggests that elderly patients with NHL are more likely to have aggressive disease, a diffuse pathology and an extra-nodal presentation.