Original article—alimentary tract
Patients With Celiac Disease and B-Cell Lymphoma Have a Better Prognosis Than Those With T-Cell Lymphoma

https://doi.org/10.1016/j.cgh.2010.09.007Get rights and content

Background & Aims

Celiac disease (CD) is associated with an increased risk of lymphoma. However, relatively few studies have assessed the outcome of patients diagnosed with both CD and lymphoma. We evaluated the temporal association between lymphoma and CD, along with clinical presentation, response to therapy, and prognosis.

Methods

Patients diagnosed with both CD and lymphoma were identified retrospectively in a tertiary referral center. Clinical characteristics and survival were analyzed.

Results

Sixty-three patients (36 men) were identified who had been diagnosed with lymphoma and CD. Thirty-six (57%) were diagnosed with CD before they were diagnosed with lymphoma. The most common histologic entity was diffuse, large, B-cell lymphoma, which affected 18 (29%) patients. Complete information for staging was available in 59 patients; 24 (38%) had stage IV disease. Only chemotherapy or only radiation therapy was used for 43 (68%) and 11 (17%) patients, respectively. The 5- and 10-year cumulative survival rates for the entire cohort were 58% and 39%, respectively. Survival of patients with T-cell lymphoma was shorter than for all other lymphomas (119.4 vs 22.8 mo; P = .02).

Conclusions

CD is associated with B- and T-cell lymphomas. Patients with B-cell lymphomas had a better prognosis than those with T-cell lymphoma. Therapy is unsatisfactory for enteropathy-type T-cell lymphoma.

Section snippets

Patients

Patients carrying the diagnosis of both CD and lymphoma were identified through the Mayo Clinic patient registry and the Mayo Clinic Lymphoma Database. Patients diagnosed with lymphoma in the period from 1970 to 2005 who also had a diagnosis of CD were included. Details of presenting history, physical examination, staging investigations, treatment, and clinical outcome were extracted from patient records. We collected information necessary to perform accurate lymphoma staging and to apply the

Patients and Clinical Presentation

Sixty-three patients carrying both a diagnosis of lymphoma and CD were identified. Thirty-six (57%) were men, and 27 (43%) were women. The median age at the time of diagnosis of lymphoma was 62 years (range, 11–91 y). The lymphoma diagnosis was confirmed from 1975 to 1985 in 16 (25%), from 1986 to 1996 in 22 (35%), and from 1997 to 2005 in 25 (40%) patients. Thirty-six (57%) patients had CD diagnosed before being diagnosed with lymphoma. Four (6%) patients were diagnosed with CD and lymphoma

Discussion

We describe a single-center experience of 63 patients with lymphoma and CD. We included all patients who were seen at the Mayo Clinic carrying a diagnosis of both lymphoma and CD regardless of the temporal relationship between these 2 disorders. A slight majority of patients had a pre-existing diagnosis of CD at the time of the lymphoma diagnosis, though all of the cases of ETL either had an established diagnosis of CD before the diagnosis of lymphoma or coincident with the diagnosis of

Acknowledgments

Current addresses of T.R.H.: Department of Internal Medicine, Division of Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa Hospitals and Clinics and Iowa City VA Medical Center, Iowa City, Iowa.

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    Conflicts of interest The authors disclose no conflicts.

    Funding This article was supported by the National Institutes of Health under the Ruth L. Kirschstein National Research Service Award/Training Grant in Gastrointestinal Allergy and Immunology (T32 AI-07047 to A.R.-T.) and National Institutes of Health grant DK-57892 (to J.A.M.).

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