Case Report

Haematological Malignancies in Systemic Sclerosis Patients: Case Reports and Review of the World Literature

Table 1

Haematological diseases in course of systemic sclerosis.

First author/yearNumber casesStudy type (country)Age/sexDis. durationSkin subsetSerologyVisceral inv.Ass. SjogrenHistory notesClinical pictureHematological malignancyOutcomes

Agard/20001CR (France)62 F14LACANoneNoMGUSSpleno/lymphoadenop., ascitesSmall B cell NHLImproved with CHOP

Airo’/20111CS (360 Italian pts)ndndndACAndndndndNHLnd

Alacacioglu/20051CR (Turkey)57 M3ndndndndndBilateral upper/lower eyelid herniasOrbital marginal zone NHLImproved with chemo/radiotherapy

Angeli/19911CR (France)42 F4LACAndNondSplenomegalyCLLnd

Arai/20091CR (Japan)31 F1ndndndndndNoneThymic large B-NHL Remission with CHOP

Arnaud/20061CR (France)76 F11LndEndH. pylori +ndGastric MALT lymphomand

Bachleitner-Hofmann/20021CR (Austria)73 F14LACAL, EndMGUSndMMMarked and sustained improvement with therapy for MM and SSc

Baldini/19941CR (Italy)59 F1ndANAndndndndLymphocytic Ly of intermediate diff.Improved

Bellis/20141CR (France)37 M1LANAndndndRight axillary lymphoadenopathyCD30+ anaplastic Ly Lymphoma and SSc remission with BMT

Ben Ghorbel/20051CR (Tunisy)70 F6LScl70LNondGeneralized lymphoadenopatiesFollicular B NHLImproved with CHOP

Bielefeld/19965CS (21 French pts)39 F, 56 F, 69 F, 12 M, 71 M0, 6, 6, 9, 2ndndndndndndCML, AML, immunocytoma, Burkitt’s Ly, Waldenstrom d.nd

Bistue/19901CR (Argentina)36 FndDndLNondDyspnea, splenomegaly, and feverMyelofibrosisnd

Cavallero/19941CR (Italy)79 MndDANAndndCarpenterPurpura of legsHairy cell leukemiaDied for pneumonia after 3 months

Charlanne/20041CR (France)72 F<1LACANoYesOverlap RA-SSNeutropenia and lymphocytosisLarge granular lymphocyte leukemiaSustained (>1 year) improvement with MTX 7.5/week for leukemia and autoimmunity

Chatterjee/20055RS (538 US pts)2 NHL are Fnd2 NHL : 1 L, 1 DndndndndndNHL (2); MM (2); leukemia (1)nd

Čolović/20111CR (Serbia)55 F20LndndndndIntense facial pruritus, paraproteinemiaMMRemission for SSc and MM

Comer/19921CR (UK)31 F1LANAE, L, HNondNeck/mediastinum lymphadenopathyIIb-staged HLHL remission (MOPP), SSc evolution by 1 year

Constans/19931CR (France)65 F0LACACRESTNondHairy cell leukemiand

Derk/20031CR (USA)66 M2DScl70ENondExpanding mass at the tongue baseLarge B-NHLRemission with CHOP

Doyle/19855CS (USA)10; 22; 31 54; 70 F4; 9; 9; 40; 57LndCRESTndndndHL; MM (2); “malignant Ly”; CLLVariable outcomes

Duggal/20021CR (India)42 MndndndndndndndHLnd

Duncan/19797CS (2,141 USA pts)50–79 F2, 0, 1, 3, 0, 61, 1ndndndndndndCLL (3), MM, lymphosarcoma (2), CMMLDied by 1 year (2), alive > 5 years (4)

Dupond/19891CR (France)73 FndLACACREST, LYesndSplenomegalyCMMLnd
Ferroir/19911CR (France)42 M2ndANAndNondndMixed follicular LyDiagnosis at autopsy

Frigui1CR (France)56 F10LScl70L, KNondSkin lesionCutaneous B-cell Ly (supraorbital)Regression after radiotherapy but relapse

Gisser/19791CR (USA)29 F4ndndL, HndPrevious chlorambucil treat.AnemiaCMLDied for bronchopneumonia

Hall/19781CR (USA)22 F14ndndE calcinosisNoGeneralized lipodystrophyDiffuse lymphoadenopathiesNodular sclerosing HLnd

Hasegawa/19991CR (Japan)43 M<1DANoAndNondNeck/armpits lymphoadenopathiesDiffuse large T cell NHLLymphoma and SSc remission (CHOP 4 cycles)

Haviv/19971CR (Israel)72 F1, 5LANAL, KNondFever, wasting, and arthralgiasDiffuse small cell NHLDeath for sepsis

Hill/20032RS (441 Australian pts)FndndndndndndndNot better specifiednd

Hoshida/20047CS (Japan)57 (56–65), 2/5 M/F2.2 (0–12)ndndnd2/7ndndHL (2); diffuse large B cell Ly (5)All died by 1 year

Kaşifoğlu/20061CR (Turkey)50 F7LScl70LSSA+ndWeakness, weight lossCMLImproved with HU

Kaşifoğlu/20163CS (340 Turkish pts)ndndndndndndndndMM, CML, follicular NHLnd

Katz/19791CR (USA)5711ndANAndndPemphigus v.ndDiffuse histiocytic Ly nd

Kyndt/19971CS (123 French pts)76 F8ndScl70LYesndndCMMLnd

Kojima/20062CS (Japan)ndndndndndndndndB cell follicular Lynd

Kuo/20126RS (2,053 Taiwanese pts)1 M, 5 FndndndndndndndLy (3), myeloprolif. dis. (2), CML (2)nd

Lee/20011CR (Korea)56 F15LACACRESTNoPorphyria c.t.Splenomegaly Myelofibrosis nd

Marto/20141CR (Portugal)76 F0LACALNoMultiple polyps of the colonMultiple adenop., diarrhea, and rectorrhagiaIIIb-staged mantle cell NHL of the colonLy remission with R-CHOP

Miyamoto/20001CR (Japan)55 F17ndndndNondFever, fatigue, pancytopenia, and splenomegalyMyelofibrosisTreated with pulse steroids and transfusions

Olesen/201018RS (2,040 Danish pts)M/F 9/92/18 : <1ndndndndndndNHL (10); leukemia (7)nd

Owlia/20141CR (Iran)58 M15LndENosmoker (30 p-y)Lumbar pain (extensive bony infiltration)MMDeath 2 years after VAD/bortezomib

Ozturk/20061CR (Turkey)54 F5LndCRESTNondSweet syndrome MyelofibrosisImproved with steroids and hydroxyurea

Parma/19961CR (Italy)683ndndndndndPrimitive muscle and bone involv.Large multilobated B-cell NHLImproved

Prochorec-Sobieszek/20041CR (Poland)22 F<1LPmSclndNondParotid swellingParotid MALTomand

Rodrigues/19891CR (Brazil)ndndndndndndConcom. thyroid adenoca.ndIleal B-cell Ly Rapid deterioration until death

Rosenthal/19933RS (233 Swedish pts)nd<1 (1)ndndndndndndNHL (2), not better specified hematological cancer (1)nd

Rothfield/19921CS (148 USA pts)ndndndScl70ndndndndLymphocytic Lynd

Roumm/19853CS (262 USA pts)33 F, 50 F, 71 F3.5, 6.5, 5.5ndndndndndndCML, AML, and histiocytic Lynd
Ryczek/20131CR (Poland)ndndndndndndndndCMLnd

Schnack/19541CR (Austria)53 F8DndndndndndMMnd

Senel/20061CR (Turkey)65 F0DScl70L, KNondWeakness, sweating, and weight lossCMLnd

Shvidel/20021CS (Israel)71 FndndndndndndndT large granular lymphocytic leukemiand

Siau/20115CS (68 UK pts)nd0 (case of PC)LndndndndndMM (2), diffuse large B-NHL, thyroid NHL, solitary IgM PCnd

Sidi/19902CS (Israel)47 M, 77 M20; 11LndCRESTNondGeneralized lymphoadenopathyB-CLLAlive up to 2 years; death for bronchopneumonia and paralytic ileus

Sugai/19871CR (Japan)67 F11DANAE, LYesndParotid swelling and generalized lymphadenopathyIIIb-staged NHLDeath after 3 COPP cycles for complicating interstitial pneumonitis

Suzuki/19941CR (Japan)68 M3DANAndNondGait disturbance, anemia, and hemorrhagic strokeBrain diffuse large B-NHLDeath for pneumonitis during BACOPP chemotherapy

Szekanecz/20083CS (218 Hungarian pts)53; 67; 69 F2; 1.9; 0.7DScl70;L-H-E; none; L-H-K-Endndnd(2) b-CLL; (1) chronic small lymphocytic B NHLSurviving > 5 years

Talbott/19792CS (USA)64 M; 73 M<1; 10L; DndNone; L-HProbablePt number 1 coal minerBackache; generalized weaknessMMRapid deterioration and death

Vettori/20101CR (Italy)45 FSine sclerod.Progressive weight lossGastric B-cell Ly

Watanabe/19941CR (Japan)44 FndndndndndndLeukocytosis, thrombocytosisCMLCML remission and SSc improvement with therapy

William/20111CR (USA)61 M30LACAE, LNondThrombocytopenia, cervical adenopathySmall lymphocytic B-NHLRemission with FCR

Wooten/19981CR (USA)nd3LCRESTndPorphyria c.t.ndCMLnd

Yamamoto/20051CR (Japan)72 M5DScl70LndndMultiple lymphoadenopathyAngioimmunobl. T cell Ly with EBV-assoc. B cell lymphoprol. dis.Died 6 months after CHOP therapy because of sepsis, initially improved

Present study2CR (Italy)37 M; 72 F2; 28D; LSSA/SSB ACAE, L; CREST + LYes; nond; previous breast cancerWeakness, sweating, and weight loss; asymptomaticDiffuse large B-NHL; marginal B-NHLDied few months after during R-CHOP therapy; lung lobe resection and remission

Total 130 pts

The table included all the case reports and the cohort studies that reported cases of haematological malignancies in the course of SSc [467]. Pts = patients; type of study: CR = case report; CS = case series/cohort studies; RS = registry studies; skin subset: D = diffuse, L = limited; serology: ACA = anticentromere, Scl70 = anti-topoisomerase I, ANA = specific antinuclear autoantibodies; organ involvements: K = kidney, L = lung, H = heart, E = esophagus; MGUS = monoclonal gammopathy of undetermined significance; CREST = former acronym for limited SSc form including calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia; CLL = chronic lymphocytic leukemia; CML = chronic myelogenous leukemia; AML = acute myelogenous leukemia; MM = multiple myeloma; PC = plasmacytoma; NHL = non-Hodgkin lymphoma; CMML = chronic myelomonocytic leukemia; Ly = lymphoma; HL = Hodgkin lymphoma; MTX = methotrexate; (R-)CHOP = chemotherapic regimen for NHL; FCR = chemotherapic regimen with fludarabile, cyclophosphamide, and rituximab; BMT = bone marrow transplantation; (BA)COPP = bleomycin, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone; MOPP = mustine, vincristine, procarbazine, and prednisone; HU = hydroxyurea; VAD = vincristine, doxorubicin, and dexamethasone.