Predictable biomarkers of developing lymphoma in patients with Sjögren syndrome: a nationwide population-based cohort study

// Yu-Hsiang Chiu 1 , Chi-Hsiang Chung 2 , Kuen-Tze Lin 3 , Chin-Sheng Lin 4 , Jia-Hong Chen 5 , Hsiang-Cheng Chen 1 , Ren-Yeong Huang 6 , Chi-Tsung Wu 7 , Feng-Cheng Liu 1 and Wu-Chien Chien 2,8 1 Department of Internal Medicine, Division of Rheumatology/Immunology/Allergies, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 2 School of Public Health, National Defense Medical Center, Taipei, Taiwan 3 Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 4 Department of Internal Medicine, Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 5 Department of Internal Medicine, Division of Hematology/Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 6 Department of Periodontology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 7 Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan 8 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Correspondence to: Wu-Chien Chien, email: // Feng-Cheng Liu, email: // Keywords : Sjogren syndrome, non-Hodgkin’s lymphoma, diffuse large B-cell lymphoma, immunosuppressive agents, lip biopsy Received : August 04, 2016 Accepted : January 23, 2017 Published : February 04, 2017 Abstract Sjogren syndrome (SS) is commonly known to be correlated with lymphoma. This study included 16,396 individuals in the SS cohort and 65,584 individuals in the non-SS cohort, all of whom were enrolled in the Taiwan National Health Insurance database between 2000 and 2010. We evaluated the risk factors of non-Hodgkin’s lymphoma (NHL) in the primary SS cohort by applying a Cox multivariable proportional-hazards model. We increased the correlation of patients with SS and NHL, with an adjusted HR of 4.314 (95% CI 2.784 – 6.685). Of the 16,396 SS patients, 66 individuals had salivary gland slices without NHL development, while the other 16,330 individuals that did not have salivary gland slices revealed 30 individuals that developed NHL. Of the 16,396 SS patients, 128 individuals underwent immunomodulator agent therapy (including hydroxychloroquine, azathioprine, cyclosporine, methotrexate, and rituximab) without NHL development. None of the 30 individuals that developed NHL from SS received immunomodulator agents. We found that patients with SS were at an increased risk of developing NHL, with the most common NHL subgroup being diffused large B-cell lymphoma. SS patients who were candidates for salivary gland slices or immunomodulator agents were associated with a lower risk of developing lymphoma over time. We recommend that patients at a higher risk upon diagnosis of SS receive close follow-up and aggressive treatment.