[Neoplasia in patients with systemic lupus erythematosus: analysis of two cases of hematological malignancies]. / Nowotwór u chorych na toczen rumieniowaty ukladowy--analiza dwóch wybranych przypadków chorych na choroby rozrostowe ukladu bialokrwinkowego.

ABSTRACT

INTRODUCTION: Patients with systemic lupus erythematosus (SLE) demonstrate a significantly greater risk of malignant disease (MD) in comparison to the healthy population. Hematological malignancies, especially lymphomas, predominate among MD patients. It is believed that immune disturbances in SLE, lymphotropic virus superinfections, and long-term immunosuppressive therapy may induce the process of MD. CASE REPORTS Case 1. A female with a 34-year history of SLE was treated with low doses of glucocorticoids and chloroquine. In July 2011, severe pancytopenia complicated by septic shock was observed and the patient died. Histopathologic examination of bone marrow revealed the presence of a B-cell lymphoma. Case 2. A female with a 26-year history of SLE presented with anti-dsDNA and anti-SSA antibodies. Exacerbations of SLE were treated with high doses of glucocorticoids, cyclophosphamide, and azathioprine. In December 2011, pancytopenia was observed and bone marrow histology was in favor of acute monoblastic leukemia. CONCLUSIONS: Data from the literature and our own observations confirm the necessity of oncologic follow-up in SLE. The risk of MD in SLE increases with duration of the disease and depends on the serologic profile of SLE and medication used. Hematological exacerbations in SLE, particularly protracted and therapy-resistant anemia and leukopenia, should be differentiated from a hematological malignancy.