Characterizing Autoimmune Disease-associated Diffuse Large B-cell Lymphoma in a SEER-Medicare Cohort

We used the Surveillance, Epidemiology, and End Results (SEER) eMedicare-linked database to characterize the patterns of presentation, treatment, and survival in older diffuse large B-cell lymphoma (DLBCL) patients with concomitant autoimmune disease. DLBCL patients with autoimmune disease were more likely to be female but otherwise did not differ significantly from other DLBCL patients in demographic data, treatment, or clinical outcomes. Background: Severe immune dysregulation such as seen in autoimmune (AI) disease is known to act as a significant risk factor for diffuse large B-cell lymphoma (DLBCL). However, little is known about the demographics or clinical outcomes of DLBCL that arises in the setting of AI disease. Patients and Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database for patients with a diagnosis from 1999 to 2009 linked to their Medicare claims data through 2011 to characterize the presentation, treatment, and survival patterns in DLBCL patients, including those with rheumatoid arthritis, systemic lupus erythematosus (SLE), Sjgren syndrome, and other B-cellemediated AI diseases. We examined the baseline clinical characteristics for patients with B-celle mediated AI disease, plotted the overall survival and lymphoma-related survival (LRS) for these groups, and compared the median survival times. Results: Patients with DLBCL and AI disease were more commonly female. However, patients with DLBCL and rheumatoid arthritis, SLE, Sjgren syndrome, or other B-cell AI diseases did not differ from other DLBCL patients in any other baseline presenting features and received similar first-line treatment. A trend toward decreased LRS was seen in patients with SLE and DLBCL compared with all other groups, but this difference was not statistically significant in this cohort. Conclusion: In the present retrospective claims-based cohort of older patients with DLBCL, concomitant AI disease was uncommon and was more likely to occur in female DLBCL patients, which likely reflects the greater incidence of AI disease in women. The possibility of lower LRS for SLE patients should be explored in future studies.