Abstract
Objective
To examine the risk of hematologic malignancies in older adults with ankylosing spondylitis
(AS).
Patients and Methods
We used US Medicare data from January 1, 1999, to December 31, 2010, to identify a
population-based cohort of beneficiaries with AS. We also included beneficiaries with
inflammatory bowel disease (IBD) as disease controls and beneficiaries without AS
or IBD as unaffected controls. We excluded those treated with tumor necrosis factor
inhibitors in this period. We followed up each group for new diagnosis claims for
hematologic malignancies until September 30, 2015.
Results
We included 12,451 beneficiaries with AS, 234,905 with IBD, and 10,975,340 unaffected
controls, with a mean follow-up of 9.9, 9.3, and 8.0 years, respectively. We identified
297 hematologic malignancies in the AS group, 4538 malignancies in the IBD group,
and 128,239 malignancies in unaffected controls. The standardized incidence ratio
in AS vs unaffected controls was 1.39 (95% CI, 1.05 to 1.61) for non-Hodgkin lymphoma,
1.50 (95% CI, 1.17 to 1.92) for chronic lymphocytic leukemia, and 1.52 (95% CI, 1.12
to 2.06) for multiple myeloma. Risks of acute myeloid leukemia and chronic myeloid
leukemia were not elevated in AS, and there were too few cases of Hodgkin lymphoma
to compute risks. Risks were comparable to those of beneficiaries with IBD. We also
performed a systematic literature review of the risk of hematologic malignancy in
AS, focusing on age associations, which have not been previously examined. We identified
21 studies in the systematic literature review, which included mainly young or middle-aged
patients. Results suggested that AS was largely not associated with an increased risk
of hematologic malignancies. Two cohort studies reported an increased risk of multiple
myeloma in AS.
Conclusion
The risks of non-Hodgkin lymphoma, chronic lymphocytic leukemia, and multiple myeloma
are increased among elderly patients with AS.
Abbreviations and Acronyms:
ALL (acute lymphocytic leukemia), AML (acute myeloid leukemia), AS (ankylosing spondylitis), CLL (chronic lymphocytic leukemia), CML (chronic myeloid leukemia), CMS (Centers for Medicare and Medicaid Services), IBD (inflammatory bowel disease), ICD-9-CM (International Classification of Diseases), Ninth Revision (Clinical Modification), NSAID (nonsteroidal anti-inflammatory drug), SIR (standardized incidence ratio), TNFi (tumor necrosis factor inhibitor)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 02, 2022
Footnotes
Grant Support: This work was supported in part by grant ZIA-AR-041153 from the Intramural Research Program at the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health.
Identification
Copyright
Published by Elsevier Inc on behalf of Mayo Foundation for Medical Education and Research
