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Myeloid leukaemia in systemic lupus erythematosus—a nested case–control study based on Swedish registers
Rheumatology, 07/20/09

Löfström B et al. - In a study to assess the risk factors for leukaemic transformation and myeloid leukaemia in pts with systemic lupus erythematosus (SLE), it appears that low-dose chemotherapy was not a major cause of myeloid malignancy in this cohort of SLE pts nor in the reported cases from literature. Leucopenia was a risk factor for myeloid leukaemia development and a myelodysplastic syndrome (MDS) was frequently seen. Thus, bone marrow investigation should be considered in SLE pts with long-standing leucopenia and anaemia.

• A national SLE cohort identified through SLE discharge diagnoses in the Swedish hospital discharge register during 1964 to 1995 (n=6438) was linked to national cancer register.
• A nested case–control study in SLE pts who developed acute or chronic myeloid leukaemia was performed with SLE pts without malignancy as controls.
• Medical records from cases and controls were reviewed and bone marrow specimens were re-evaluated.
• A Medline search of previously published cases of SLE and myeloid leukaemia was performed.

• After confirmation of SLE diagnosis according to the ACR criteria, 8 pts with SLE and myeloid leukaemia and 18 SLE controls were included.
• Preceding leucopenia was significantly associated with leukaemia development, whereas other SLE manifestations were not.
• 2 cases had a preceding bone marrow confirming MDS.
• Only 2 cases were significantly treated with cyclophosphamide or AZA.
• A Medline search resulted in only 15 previously published cases of coincident SLE and myeloid leukaemia.
• Preceding MDS was reported in 5 of these, whereas only 8 had been treated with cytotoxic drugs.

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