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Incidence and Characteristics of Non-Hodgkin Lymphomas in a Multicenter Case File of Patients With Hepatitis C Virus–Related Symptomatic Mixed Cryoglobulinemias
Giuseppe Monti, MD;
Pietro Pioltelli, MD;
Francesco Saccardo, MD;
Mauro Campanini, MD;
Marco Candela, MD;
Giobatta Cavallero, MD;
Salvatore De Vita, MD;
Clodoveo Ferri, MD;
Cesare Mazzaro, MD;
Sergio Migliaresi, MD;
Elena Ossi, MD;
Maurizio Pietrogrande, MD;
Armando Gabrielli, MD;
Massimo Galli, MD;
Fulvio Invernizzi, MD
Arch Intern Med. 2005;165:101-105.
Background Some patients with cryoglobulinemic syndrome (CS) develop frank non-Hodgkin lymphoma (NHL), but the incidence and timing of this event are still poorly defined.
Methods A retrospective multicenter study was performed of hepatitis C virus–positive patients with CS observed in 11 Italian centers belonging to the Italian Group for the Study of Cryoglobulinemia.
Results The inclusion criteria were satisfied by 1255 patients. During a cumulative follow-up of 8928 patient-years, 59 cases of NHL were diagnosed, for an estimated rate of 660.8 new cases per 100 000 patient-years with 224.1 new cases of aggressive NHL subtypes per 100 000 patient-years. More than 90% of the patients developing NHLs had type II cryoglobulins. The NHLs were classified as nonaggressive in 31 cases (53%), aggressive in 20 (34%), and mucosa-associated lymphoid tissue lymphomas in 6 (10%); 2 cases were unclassifiable. The median time from the diagnosis of CS to the clinical onset of NHL was 6.26 years (range, 0.81-24 years). The clinical course and response to chemotherapy in the patients with CS who had NHL were similar to those usually described in patients with NHL without CS; the course of the CS only marginally benefited from chemotherapy.
Conclusions The overall risk of NHL in patients with CS is about 35 times higher than in the general population (12 times higher if nonaggressive lymphomas are excluded). The presence of CS did not significantly affect the treatment of newly diagnosed lymphomas.
Author Affiliations: Unità Operativa di Medicina Generale, Saronno Hospital (Drs Monti and Saccardo); Istituto di Medicina Interna II e Ematologia, S Gerardo Hospital, Monza (Dr Pioltelli); Unità Operativa di Medicina Generale, Novara Hospital (Dr Campanini); Istituto di Clinica Medica, University of Ancona (Drs Candela and Gabrielli); Unità Operativa Medicina Generale, S Croce Hospital, Cuneo (Dr Cavallero); Istituto di Reumatologia, University of Udine (Dr De Vita); Istituto di Patologia Medica e Reumatologia, University of Pisa (Dr Ferri); Unità Operativa di Medicina Generale, Pordenone Hospital (Dr Mazzaro); Istituto di Clinica Medica e Reumatologia, University of Naples (Dr Migliaresi); Istituto di Medicina Interna, University of Padua (Dr Ossi); Istituto di Medicina Interna, S Paolo Hospital, University of Milan (Drs Pietrogrande and Invernizzi); and Istituto di Malattie Infettive e Tropicali, L Sacco Hospital, University of Milan (Dr Galli), Italy.
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