Case Report

SLE and Non-Hodgkin’s Lymphoma: A Case Series and Review of the Literature

Table 1

Studies on the role of cyclophosphamide and azathioprine on SLE-related lymphomagenesis.

Ref.Study designPt follow-upNumber of patients with lymphoma/hematological malignanciesDrugs studiedCommentsOutcomes

[4]Prospective observational68592 patient months3Azathioprine & cyclophosphamide3/914 patients had lymphoma. 1 was on AZT, 1 on CYP, and 1 on both.
348/911 were on AZT, 188/911 on CYP
No association

[5]Retrospective202011Azathioprine & CYP1 on CYP,
0 on AZT
No association

[6]Retrospective2191Azathioprine & CYP0 on immunosuppressivesNo association

[7]Retrospective 784  
  246 cancer cases and 538 controls without cancer
46Azathioprine & CYPCyclophosphamide: 17.5% of 538 cancer free patients, 7.4% of 246 cancer patients; azathioprine: 34.9% of 538 cancer free patients, 25.0% of 246 cancer patientsNo association Cyclophosphamide 2.09 (0.69–6.30)
Azathioprine 1.19 (0.48–2.92)

[8]Retrospective8648Azathioprine & CYP11 of 28 cancer patients on CYP, 12 of 28 cancer patients on AZPNo association

[9]Retrospective503675Azathioprine, CYP, MMF, and prednisone75 lymphoma cases, only 15 had prior exposure to CYP, 19 to AZA,
9 to methotrexate, and 6 to MMF
No association Cyclophosphamide ever used 2.80 (0.87 to 8.98) Azathioprine (AZA) ever used fully adjusted 0.84 (0.32 to 2.25)

[10] Retrospective643816Azathioprine, CYPCyclophosphamide: 2/16 in patients with NHL, 3/26 in patients without NHL
Azathioprine: 5/16 in patients with NHL, 9/26 in patients without NHL
No association
CYP (RR 0.3–3.3)
AZP RR 0.9 [0.4–2.1]

[11]Prospective5976 patient years1CYP1/49 on CYP developed NHLNo association

[12]Prospective17376 patient years3AZT, CYPNone on CYP or AZTNo association