Effect of autoimmune diseases on incidence and survival in subsequent multiple myeloma

Background: Patients with many types of autoimmune diseases (AIDs) are at an increased risk of cancer,which may depend on underlying dysregulation of the immune system or treatment. Wesystematically analyzed myeloma risk and survival in patients diagnosed with 33 differentAIDs. Methods: Data on patients with AIDs were retrieved from the Swedish Hospital Discharge Register andwere linked to myeloma diagnoses from the Cancer Registry. Standardized incidence ratios(SIR) and hazard ratios (HRs) were calculated for subsequent myeloma between 1964 and2008. Results: Among patients with the 33 AIDs analyzed, 457 cases of myeloma were diagnosed. Theoverall SIR for myeloma was 1.12 and the overall HR was 0.92 and non-significant. SIRs formyeloma were significantly increased after ankylosing spondylitis (2.02) and systemicsclerosis (2.63). Only the HR for myeloma after rheumatic fever (5.27) was significantlyincreased. The SIR for myeloma before age 60 years was 1.45; the SIR for myeloma wasonly increased in the period 1964-1990 (1.31) and not later (1.04). Only the SIR for myelomaafter ankylosing spondylitis was increased in the period 1991-2008 (2.09); the HRs formyeloma were increased after polymyositis/dermatomyositis (6.44) and rheumatic fever(4.43) but there were only three cases of myeloma after these AIDs. Conclusions: The present data showed an increase in myeloma SIR after two AIDs, ankylosing spondylitisand systemic sclerosis, and in HR after rheumatic fever. The overall myeloma risk after anyAID was no longer increased in the latter follow-up period of 1991 through 2008.

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