Malignancy in Systemic Lupus Erythematosus (SLE) Patients

Abstract

Background: Malignancies are among the leading causes of death in Systemic Lupus Erythematosus (SLE)<br />patients with studies reporting a higher prevalence of malignancy in SLE patients compared to the general population.<br />We wanted to determine the frequency of cancer in a cohort of SLE patients and identify its associated risk factors.<br />Methods: Cross-sectional study involving SLE patients attending the nephrology outpatient clinic, Universiti<br />Kebangsaan Malaysia Medical Centre between January and June 2014. Results: We recruited 228 patients (207 female,<br />21 male), aged 40.48 ± 12.86 years with mean SLE duration of 11.65 ± 6.46 years. Majority (87%) had lupus nephritis<br />and were in remission with a median SLEDAI score 2 (0, 14). Majority (89%) were on corticosteroid with either a<br />steroid sparing agent like mycophenolate mofetil (15.4%), azathioprine (36.8%) or ciclosporin (15.4%). One hundred<br />and sixty (70.2%) patients were either receiving or had received intravenous cyclophosphamide with median dose<br />of 5,173.6 ± 3,242.4 mg. Seven female patients were diagnosed with cancer during the course of their SLE with 56<br />(34-78) years being median age at malignancy and SLE duration of 4 (0-12) years. Majority (5/7) had lupus nephritis<br />and all patients a median dose of prednisolone 10 (2.5, 10) mg with 10 (4-24) years of steroids. Two patients had a<br />family history of cancer with majority developing cancer after the diagnosis of SLE. Two patients received intravenous<br />cyclophosphamide prior to the development of cancer for their SLE compared to overall cohort of 160. Three patients<br />had colorectal cancer, 2 had cervical cancer, 1 had breast cancer, and one patient had germ cell tumour and one thyroid<br />cancer. All patients had their cancer successful treated with no signs of recurrence. Conclusion: We found a lower<br />occurrence of cancer in our SLE patients as compared with the reported literature.